title: Managing intravascular catheter-related infections in heart transplant patients: how far can we apply IDSA guidelines for immunocompromised patients?
abstract: OBJECTIVE
  This study discusses the applicability to heart transplant patients of recently issued guidelines on the diagnosis, management and prevention of catheter-related bloodstream infections (CR-BSIs). It also updates newly available information of possible interest to the care of heart transplant patients.
  
  
  RESULTS
  Catheters remain the leading cause of early bloodstream infections in heart transplant patients. The cause of CR-BSI is mainly attributable to Gram-positive microorganisms. Very frequently, the origin of a bloodstream infection in a heart transplant patient with multiple catheters is not clear, and a precise diagnosis is required. Management without catheter removal may be undertaken when indicated. Empiric therapy should cover Gram-positive, multidrug resistant and Gram-negative bacteria along with Candida. Prolonged antibiotic treatment exceeding 14 days is recommended and should be continued up to 4-6 weeks in the case of Staphylococcus aureus. Prevention measures include education and training, maximal sterile barrier precautions during catheter insertion, a 2% chlorhexidine preparation for skin antisepsis, avoiding routine replacement of catheters and using antimicrobial/antiseptic impregnated short-term central vein catheters (CVCs) and chlorhexidine sponge dressings.
  
  
  CONCLUSIONS
  Until confirmatory data are obtained, present guidelines for diagnosing, managing and preventing CR-BSI can be applied to heart transplant patients. We would nevertheless highlight that the additional precautions should be taken of broader empiric antimicrobial therapy followed by longer duration treatment in these patients.
authors.affiliation: Department of Clinical Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Marañón, Universidad Complutense, Madrid, Spain. ebouza@microb.net
authors.forename: Emilio
authors.initials: E
authors.lastname: Bouza
authors.forename: Almudena
authors.initials: A
authors.lastname: Burillo
authors.forename: María
authors.initials: M
authors.lastname: Guembe
mesh_terms: D016470:Bacteremia / Q000276:immunology / Q000628:therapy; D055499:Catheter-Related Infections / Q000276:immunology* / Q000382:microbiology / Q000628:therapy*; D016027:Heart Transplantation / Q000009:adverse effects*; D006801:Humans; D016867:Immunocompromised Host