Clinician survey for the management of central venous catheter-related bloodstream infection: catheter retention versus replacement

Background: When bloodstream infection (BSI) occurs in patients with a central venous catheter (CVC), the catheter may be the original source (catheter-related, CR) or may become a source for persistent infection. BSI should prompt an evaluation of CVC necessity, but there are challenges associated with CVC replacement. Methods: An online multinational survey was sent to professional societies of specialties involved in treating patients who have BSI and a CVC. Clinicians were asked to choose retention versus replacement for scenarios involving different CVC types, infection sources, and pathogens. Additional questions explored central venous catheter-related bloodstream infection (CRBSI) diagnosis, management, and willingness to enrol patients in a randomized controlled trial (RCT). Results: 220 physicians responded. For peripherally inserted central catheter-related BSI, most favoured CVC replacement, although there was variability across pathogens ( Candida spp 100%, Staphlococcus aureus 99%; Pseudomonas aeruginosa 94%; Enterococcus spp 75%; Enterobacterales 66%; coagulase-negative staphylococci 58%). For tunnelled CVC-related BSI, replacement recommendations also varied ( Candida 99%; S. aureus 95%; P. aeruginosa 87%; Enterococcus spp 58%; Enterobacterales 44%; coagulase-negative staphylococci 33%). For catheter-unrelated BSI, there was a lower tendency to replace the CVC. For each combination of pathogen and CVC type, a majority (>50%) of participants reported willingness to enrol patients into an RCT comparing CVC replacement versus retention; the only exceptions below 50% were S. aureus (44%) or Candida spp (44%) CRBSIs from short-term non-tunnelled CVCs. Conclusion: There is heterogeneity in CVC management practices and stated equipoise for an RCT comparing management approaches for a range of CVC types, BSI sources, and pathogens.