Background: Catheter-related sepsis is a clinical syndrome characterized by the presence of a
catheter-associated infection along with a systemic inflammatory response. The continual increase
in the use of central venous catheters (CVCs) has been associated with a substantial
risk of infectious complications that prolong the hospital stay and increase costs.
Methods: The literature on CVCs was reviewed to determine the incidence of catheterrelated
sepsis, its diagnosis, and the role of biofilms in pathogenesis.
Results: The European Sepsis Group recently reported that 28% of CVC infections in intensive
care unit patients were associated with sepsis, 24% with severe sepsis, and 30% with
septic shock. Clinical diagnosis remains difficult. After CVC insertion, the intravascular portion
of the device is covered rapidly by a thrombin layer, rich in host-derived proteins, that
forms a conditioning film and promotes surface adherence of microbial colonizers. These microorganisms
then enter their sessile mode of growth, secreting an exopolysaccharide slime
within which organism density is regulated by quorum-sensing molecules. Microorganisms
are dispersed in clumps that can become septic emboli. Antiadhesive, antiseptic, and antibiotic
coatings of catheters have demonstrated only modest clinical efficacy.
Conclusion: Our group is involved in the design and in vitro assessment of new polymeric
matrices for controlled release of antimicrobial molecules, and in comparative clinical studies
of conventional versus antibiotic-coated or -impregnated catheters.
