Recurrent and Relapsing Catheter-Related Bloodstream Infections in Patients Requiring Long-term Vascular Access.

Patients requiring long-term vascular access are at risk of experiencing recurrent or relapsing infections. Decisions to remove and replace these devices when infected depend on their clinical status, the pathogen involved, options for alternative access sites, the risk of mechanical complications or loss of access with attempted catheter replacement, and interruptions of care plans. This State-of-the-Art Review focuses on a team approach to the management of such complex patients. Management involves empiric and then directed systemic antimicrobial therapy, antimicrobial lock therapy, decisions regarding the use of antibiotic-impregnated catheters, and intentional preservation of central venous access for future device insertion. Meticulous documentation, a team approach to care including shared decision-making with the patient and family, optimization of available prophylactic medications and devices, and individualized adherence to evidence-based best practices and professional standards fill important gaps in care delivery and will improve the prevention and management of these infections in this vulnerable patient population.