From prevention to treatment: Comprehensive strategies for the management of Staphylococcus aureus induced catheter-related bloodstream infections

Staphylococcus aureus (SA) is a prominent pathogen that frequently causes catheter-related bloodstream infections (CRBSIs) in hemodialysis patients with tunneled central lines. The guidelines' key recommendation for managing SA-induced CRBSIs is to remove the infected catheter. In real life, however, this may be hindered by logistical or clinical problems (e.g. unavailability of surgical rooms, incarcerated catheters, catheter-associated thrombosis). Furthermore, an interventional approach may expose patients to complications, such as those related to the procedure itself or the development of central vein stenoses. Prospective observational studies seem to support the possibility of preserving the infected line in case of early pathogen identification and CRBSI management with empirical large-spectrum antibiotics, followed by targeted treatment once the antibiogram is available. Further options for the treatment and prevention of SA-induced infections are becoming available, leading to a rapidly evolving therapeutic scenario. This review aims to perform a multidisciplinary revision of the available evidence and current unsolved problems, focusing on future perspectives for the management and prevention of SA-induced CRBSIs in hemodialysis patients.