Episódio 109: Infecção de Corrente Sanguínea Associada ao Cateter

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Fred, Kaue e Luísa conversam um pouco sobre Infecção de Corrente Sanguínea Associada ao Cateter - Como diagnosticar? Como fazer antibioticoterapia? Quando investigar complicações? Como manejar Cateter de Longa Permanência?

Referências: 

EcoTT vs EcoTE - Em pacientes com os seguintes achados talvez EcoTT seja suficiente: 

1. Bacteremia nosocomial 
2. Culturas de controle negativas dentro de 4 dias do início do tratamento. 
3. Ausência de dispositivo intracardíaco
4. Sem hemodiálise 
5. Sem sinais clínicos de endocardite ou infecção secundária
6. Holland, Thomas L., Christopher Arnold, and Vance G. Fowler. "Clinical management of Staphylococcus aureus bacteremia: a review." Jama 312.13 (2014): 1330-1341.

Diretrizes: 

1. Manian FA. IDSA guidelines for the diagnosis and management of intravascular catheter-related bloodstream infection. Clin Infect Dis. 2009 Dec 1;49(11):1770-1; author reply 1771-2. doi: 10.1086/648113. PMID: 19891568. 
2. Chaves F. Diagnosis and treatment of catheter-related bloodstream infection: Clinical guidelines of the Spanish Society of Infectious Diseases and Clinical Microbiology and (SEIMC) and the Spanish Society of Spanish Society of Intensive and Critical Care Medicine and Coronary Units (SEMICYUC). Med Intensiva (Engl Ed). 2018 Jan-Feb;42(1):5-36. 

Cultura de Sangue do Cateter: 

1. Orihuela-Martín J, Rodríguez-Núñez O, Morata L, et al. Performance of differential time to positivity as a routine diagnostic test for catheter-related bloodstream infections: a single-centre experience. Clin Microbiol Infect 2020; 26:383.e1. 
2. Bouzidi H, Emirian A, Marty A, et al. Differential time to positivity of central and peripheral blood cultures is inaccurate for the diagnosis of Staphylococcus aureus long-term catheter-related sepsis. J Hosp Infect 2018; 99:192. 
3. Freeman JT, Elinder-Camburn A, McClymont C, et al. Central line-associated bloodstream infections in adult hematology patients with febrile neutropenia: an evaluation of surveillance definitions using differential time to blood culture positivity. Infect Control Hosp Epidemiol 2013; 34:89. 

Diagnóstico pela Ponta do Cateter: 

1. Peterson LR, Smith BA. Nonutility of catheter tip cultures for the diagnosis of central line-associated bloodstream infection. Clin Infect Dis 2015; 60:492. 

Ecocardiograma em Enterococco:

1. Berge, Andreas, et al. "The DENOVA score efficiently identifies patients with monomicrobial Enterococcus faecalis bacteremia where echocardiography is not necessary." Infection 47.1 (2019): 45-50.

Cateter Arterial e Cateter Periférico: 

1. Mermel LA. Short-term Peripheral Venous Catheter-Related Bloodstream Infections: A Systematic Review. Clin Infect Dis. 2017 Oct 30;65(10):1757-1762. 
2. Chopra V, O'Horo JC, Rogers MA, Maki DG, Safdar N. The risk of bloodstream infection associated with peripherally inserted central catheters compared with central venous catheters in adults: a systematic review and meta-analysis. Infect Control Hosp Epidemiol. 2013 Sep;34(9):908-18. doi: 10.1086/671737. 
3. O'Horo JC, Maki DG, Krupp AE, Safdar N. Arterial catheters as a source of bloodstream infection: a systematic review and meta-analysis. Crit Care Med. 2014 Jun;42(6):1334-9. Sítios e Risco Infeccioso: Parienti JJ, du Cheyron D, Timsit JF, et al.