Review offers guidance for managing recurrent catheter-related bloodstream infections

Patients who depend on long-term intravenous catheters for chemotherapy, hemodialysis, intravenous nutrition and other essential therapies face an ongoing risk of catheter-related bloodstream infections, a potentially life-threatening complication that can be difficult to manage when the device remains necessary for care.

A new State-of-the-Art Review published in Clinical Infectious Diseases provides clinicians with practical guidance for preventing, diagnosing and treating recurrent and relapsing infections while preserving vascular access whenever possible.

The review, Recurrent and Relapsing Catheter-Related Bloodstream Infections in Patients Requiring Long-term Vascular Access, was led by Leonard A. Mermel, DO, of the Division of Infectious Diseases at The Warren Alpert Medical School of Brown University and Brown University Health, together with colleagues from institutions in the United States and Europe. Published online Oct. 9, 2026, the article synthesizes current evidence and expert clinical experience to address complex clinical decisions involving patients who require long-term vascular access.

Many patients with cancer, kidney failure, intestinal disorders and other serious conditions rely on central venous catheters for ongoing treatment. When bloodstream infections occur, clinicians must balance treatment of the infection against the risks associated with removing and replacing devices that may be difficult to reinsert or required for continued therapy. The review emphasizes that care should be individualized based on the patient's clinical condition, the infecting organism and the availability of alternative access sites.

"Patients who require long-term vascular access often present some of the most challenging infection-management decisions in medicine," Mermel said. "The catheter can be both the source of infection and the means by which critical treatment is delivered. Our review provides a framework to help clinical teams make individualized decisions that prioritize patient safety while maintaining continuity of care whenever possible."

The review highlights several key recommendations, including prompt diagnosis using blood cultures drawn from both the catheter and a peripheral vein, multidisciplinary care involving infectious disease specialists, vascular-access teams, pharmacists and interventional radiologists, and consideration of antimicrobial lock therapy in appropriate patients. The authors also discuss circumstances in which catheter removal is necessary and situations in which preserving vascular access may be a reasonable option.

In addition, the review examines preventive strategies, including the use of antibiotic-impregnated catheters in high-risk patients and approaches to reducing future infection risk while maintaining access to essential therapies.

The authors also identify priorities for future research, including infection-resistant catheters, improved antimicrobial lock solutions and emerging technologies that could help detect, monitor and prevent catheter-related infections.