First Things First (assess and treat for the following)

• These infections are primarily due to central venous catheters (CVCs) but could also involve peripherally inserted venous or arterial access, or even drains (including urinary catheters). Can consider short- or long-term CVC.
• Risk of infection is related primarily to insertion factors and duration of use. Other factors include host defenses, multiple organ failure, or ongoing sepsis.
• CRBSIs significantly increase hospital morbidity and mortality. The diagnosis can be based on microbiological confirmation from the catheter or sepsis with clinical concern for the catheter as the source. A higher degree of suspicion is required for cultures of organisms usually classified as skin contaminants.
• CRBSIs can be either primary or secondary (originating from a focus of infection elsewhere).
• Management of CRBSI usually involves removal of the infected catheter (as well as other simultaneous catheters if possible), antibiotic therapy, and appropriate antibiotic coverage.
• Hemodynamic management is as for other causes of sepsis.