Intravascular catheters required for the care of many hospitalized patients can give rise to bloodstream infection, a complication of care that has occurred most frequently in intensive care unit (ICU) settings. Elucidation of the pathogenesis of catheter-related bloodstream infections (CRBSIs) has guided development of effective diagnostic, management, and prevention strategies. When CRBSIs occur in the ICU, physicians must be prepared to recognize and treat them. Prevention of these infections requires careful attention to optimal catheter selection, insertion and maintenance, and to removal of catheters when they are no longer needed. This review provides a succinct summary of the epidemiology, pathogenesis, and microbiology of CRBSIs and a review of current guidance for the diagnosis, management, and prevention of these infections.
SettePDorizzRMAzziniAM. Vascular access: an historical perspective from Sir William Harvey to the 1956 Nobel Prize to Andre F. Cournand, Werner Forssman and Dickinson W. Richards. J Vasc Acess. 2012;13(2):137–144.
2.
MermelLAAllonMBouzaEClinical practice guidelines for the diagnosis and management of intravascular catheter-related infection: 2009 update by the Infectious Disease Society of America. Clin Infectious Dis. 2009;49(1):1–45.
HoranTCAndrusMDudeckMA. CDC/NHSN surveillance definitions of health care-associated infections and criteria for specific types of infections in the acute care setting. Am J Infect Control. 2008;36(5):309–332.
7.
MakiDGKlugerDMCrnichCJ. The risk of bloodstream infection in adults with different intravascular devices: a systematic review of 200 published prospective studies. Mayo Clin Proc. 2006;81(9):1159–1171.
8.
O’GradyNPAlexanderRNBurnsLAGuidelines for the prevention of intravascular catheter-related infections, 2011. Am J Infect Control. 2011;39(4 suppl 1):S1–S34.
9.
BeekmannSEHendersonDK. Infections caused by percutaneous intravascular devices. In: MandellGLBennettJEDolinR, eds. Principles and Practice of Infectious Disease. Vol 1. 6th ed. Philadelphia, PA: Elsevier; 2005:3347–3361.
10.
MakiDGRingerM. Evaluation of dressing regimens for prevention of infection with peripheral intravenous catheters: gauze, a transparent polyurethrane dressing and an iodophor-transparent dressing. JAMA. 1987;258(17):2396–2403.
11.
LiñaresJSitges-SerraAGarauJPérezJLMartínR. Pathogenesis of catheter sepsis: a prospective study with quantitative and semiquantitaive cultures of catheter hub and segments. J Clin Microbiol. 1985;21(3):357–360.
12.
MermelLA. What is the predominant source of intravascular catheter infections?Clin Infect Dis. 2011;52(2):211–212.
13.
FitzgeraldSFO’GormanJMorris-DownesMMA 12-year review of Staphylococcus aureus bloodstream infections in hemodialysis patients: more work to be done. J Hosp Infect. 2011;79(3):218–221.
14.
PearsonML.Guideline for prevention of intravascular device-related infections. Hospital infection control practices avisory committee. Infect Control Hosp Epidemiol. 1996;17(7):438–473.
15.
RaadIHachemRHannaHSources and outcomes of bloodstream nfections in cancer patients: the role of central venous catheters. Eur J Clin Microbiol Infect Dis. 2007;26(8):549–556.
16.
LorenteLJimenezASantanaMMicroorganisms responsible for intravascular catheter-related bloodstream infection according to the catheter site. Crit Care Med. 2007;35(10):2424–2427.
17.
MarraAROpillaMEdmondMBEKirbyDF. Epidemiology of bloodstream infection in patients receiving long-term parenteral nutrition. J Clin Gastroenterol. 2007;41(1):19–28.
18.
Beck-SagueCJarvisWR.Secular trends in the epidemiology of nosocomial fungal infections in the United States, 1980-1990. National nosocomial infections surveillance system. J Infectious Dis. 1993;167(5):1247–1251
19.
GuembeMRodriguez-CreixemsMSanchez-CarrilloCPerez-ParaAMartin-RabadanPBouzaE. How many lumens should be cultured in the conservative diagnosis of catheter-related bloodstream infections?Clin Infectious Dis. 2010;50(12):1575–1579.
20.
MarraARCalRGRDuraoMSImpact of a program to prevent central-line associated bloodstream infection in the zero tolerance era. Am J Infect Control. 2010;38(6):434–439.
21.
LoboRDLevinASOliveiraMSEvaluation of interventions to reduce catheter-associated bloodstream infection: continuous tailored education versus one basic lecture. Am J Infect Control. 2010;38(6):440–448.
22.
SannohSClonesBMunozJMontecalvoMParvezB. A multi-modal approach to central venous catheter hub care can decrease catheter-related bloodstream infection. Am J Infect Control. 2010;38(6):424–429.
23.
PeredoRSabatierCVillagraAReduction in catheter-related bloodstream infections in critically ill patients through a multiple system intervention. Eur J Clin Microbiol Infect Dis. 2010;29(9):1173–1177.
24.
GuerinKWagnerJRainsKBessesenM. Reduction in central line-associated bloodstream infections by implementation of a postinsertion care bundle. Am J Infect Control. 2010;38(6):430–433.
25.
EggimannPHarbarthSConstantinMNTouveneauSChevroletJCPittetD. Impact of prevention strategy targeted at vascular access care on incidence of infections acquired in intensive care. Lancet. 2000;355(9218);1864–1868.
26.
BerenholtzSMPronovostPJLipsettPAEliminating catheter related bloodstream infections in the intensive care unit. Crit Care Med. 2004;32(10):2014–2020.
27.
CostelloJMMorrowDFGrahamDAPotter-BynoeGSandoraTJLaussenPC. Systematic intervention to reduce central line associated bloodstream infection rates in a pediatric cardiac intensive care unit. Pediatrics. 2008;121(5):915–923.
28.
FrankelHLCredeWBTopalJERoumanisSADevlinMWFoleyAB. Use of corporate Six Sigma performance improvement strategies to reduce catheter related bloodstream infections in a surgical ICU. J Am Coll Surg. 2005;201(3):349–358.
29.
GalpernDGuerreroATuAFahoumBWiseL. Effectiveness of a central line bundle campaign on line associated infections in the intensive care unit. Surgery. 2008;144(4):492–495.
30.
McKeeCBerkowitzICosgroveSEReduction of catheter associated bloodstream infections in pediatric patients: experimentation and reality. Pediatr Crit Care Med. 2008;9(1):40–46.
31.
KimJSHoltomPVigenC. Reduction of catheter-related bloodstream infections through the use of a central venous line bundle: epidemiologic and economic consequences. Am J Infect Control. 2011;39(8):640–646.
32.
FuruyaEYDickAPerencevichENPogorzelskaMGoldmannDStonePW. Central line bundle implementation in US intensive care units and impact on bloodstream infections. PLoS One. 2011;6(1):e15452.
PronovostPNeedhamDBerenholtzSAn intervention to decrease catheter-related bloodstream infections in the ICU. N Engl J Med. 2006;355(26):2725–2732.
35.
SrinivasanACraigMCardoD.The power of policy change, federal collaboration, and state coordination in healthcare associated infection prevention. Clin Infect Dis. 2012;55(3):426–431.
36.
WenzelRPStreedSA. Surveillance and use of computers in hospital infection control. J Hosp Infect. 1989;13(3):217–229.
37.
SextonDJChenLFAndersonDJ. Current definitions of central line-assocated bloodstream infection: is the emperor wearing clothes?Infect Control Hosp Epidemiol. 2010;31(12):1286–1289.
38.
DudeckMAHoranTCPetersonKDNational healthcare safety network, data summary for 2010, device-associated module. Am J Infect Control. 2011;39(10):798–816.
39.
GaynesRRichardsCEdwardsJFeeding back surveillance data to prevent hospital-acquired infection. Emerg Infectious Dis. 2001;7(2):295–298.
