Content area
Full Text
Figure 1. Proposed work-up for the management of suspected catheter-related infection in adult patients. *Reconsider the impact of catheter bloodstream infection. [double dagger]Empirical treatment strongly recommended except for a clincally stable patient, if all intravascular access can be removed. CRI: Catheter-related infection; CVC: Central venous catheter. Adapted with permission from [7,10-12,21,37].
(Figure omitted. See article PDF.)
Central venous catheters (CVCs) are used for a wide range of indications, extending far beyond fluid and transfusion therapy, including parenteral nutrition, hemodynamic monitoring, continuous chemotherapy, home antibiotic therapy and chronic outpatient hemodialysis. Side effects are complications related to the insertion, occlusion of the catheter, venous thrombosis and catheter-related infections (CRIs). Among them, bloodstream infections (BSIs) are considered to be the most severe complication of healthcare that can occur, with a significant increase in morbidity and mortality [1-5].
Infections associated with the use of intravascular devices represent 10-20% of all nosocomial infections and may complicate the stays of up to 10% of intensive care unit (ICU) patients. Almost all patients staying in an ICU require at least one intravascular device for fluid/drugs administration and approximately half of them are CVCs [6-8]. According to the data from the National Nosocomial Infections Surveillance system, it is extrapolated that nearly 50,000 ICU patients develop a CVC-related BSI every year in US ICUs (five episodes per 1000 catheter-days) [3]. Among these, up to 24,000 die, including 8000 (35%) as a direct consequence of the infection [9]. In a large systematic review of 200 prospective studies evaluating the risk of BSI in adults, Maki et al. conclude that all types of intravenous devices should be viewed at risk of related BSI [4]. Arterial catheters used for hemodynamic monitoring and peripherally inserted central catheters used in hospitalized patients posed risks lower than those associated with CVC. Most of these infections are, however, preventable through education-based multimodal interventions [5,10]. Nevertheless, despite all these efforts, CRIs remain a daily concern for most clinicians and will potentially increase with the growing number of patients requiring sophisticated care.
We will not review all strategies targeted at their prevention [5,9,10]. After a brief review of some important work regarding pathophysiological and diagnosis aspects, we will address some practical aspects of the treatment of CRIs and, more specifically, about currently...