A single positive blood culture for Staph aureus or a Gram-negative rod is an indication for prompt removal of a central line. Attempts to "treat through" these infections result in an increased incidence of complicated bacteremia (meningitis, osteomyelitis, endocarditis, abscess) and death. (Benjamin, et al. Pediatrics 2001;107:1272-1276.)

Attempting to treat coagulase-negative staphylococcal (CONS) bacteremia by administering vancomycin through the central line may be successful in clearing the infection. If the line remains in situ, clearance of the infection should be documented by a negative blood culture. If serial (3) blood cultures remain positive for CONS, the line should be removed. (Benjamin, et al. Pediatrics 2001.)

A positive blood culture for any Candida species is also an indication for immediate removal of the line. (Hostetter, SPR 2000.)

Benjamin et al. Bacteremia, Central Catheters, and Neonates: When to Pull the Line. Pediatrics 2001;107:1272-1276.

Discussed at Clinical Division Meeting 7/16/01.