Patient selection: neonate in the neonatal ICU with a central vascular line
Parameter:
(1) organism(s) isolated on blood culture
(2) number of times blood cultures positive
(3) whether or not catheter removed within 24 hours of organism identification
The catheter should be promptly removed after the first blood culture that is positive for:
(1) Staphylococcus aureus
(2) non-enteric Gram-negative bacteria
(3) enteric Gram-negative bacteria
The chances of end-organ damage and death increases with:
(1) the number of blood cultures positive for the bacteria
(2) delay in removing the catheter once a micro-organism has been identified
Isolation of a coagulase-negative Staphylococcus (CNS) may prompt an initial attempt to sterilize the catheter medically.
(1) After the first blood culture is positive an attempt can be made to leave the catheter in place and to treat with antibiotics. A favorable outcome can occur if subsequent blood cultures are all negative.
(2) The catheter must be pulled if three or more blood cultures are positive for CNS.
