New Challenges in the Diagnosis, Management, and Prevention of Central Venous Catheter-Related Infections

Abstract

Catheters are the leading source of bloodstream infections in critically ill patients. Because the clinical signs of infection are nonspecific, such infections are overly suspected, which results in unnecessary removal of catheters. A conservative approach might be attempted in mild infections, whereas catheters should always be removed in cases of severe sepsis or septic shock. Nowadays, comprehensive unit-based improvement programs are effective to reduce catheter-related bloodstream infections (CR-BSIs). Rates of CR-BSI higher than 2 per 1000 catheter-days are no longer acceptable. A locally adapted checklist of preventive measures should include cutaneous antisepsis with alcoholic preparation, maximal barrier precaution, strict policy of catheter maintenance, and ablation of useless catheters. Antiseptic dressings and, to a lesser extent, antimicrobial-coated catheters, might be added to the prevention strategies if the level of infections remains high despite implementation of a prevention program. In the case of CR-BSI in intensive care units (ICUs), the catheter should be removed. In the case of persistence of fever or positive blood cultures after 3 days, inadequate antibiotic therapy, endocarditis, or thrombophlebitis should be ruled out.

New materials and devices for preventing catheter-related infections

“…However, this meta-analysis unmasked significant heterogeneity across study results, and the pooled CR-BSI rate in the control groups was unacceptably high in two studies (7.2% and 14%). When taking into account only the three studies with acceptable CR-BSI rates, chlorhexidine/silver/sulfadiazine-impregnated catheters failed to significantly decrease the CR-BSI rate (impregnated 8/614 vs. control 9/589 catheters; OR (random effect), 0.852; 95% CI, 0.2-3.6) [81]. …”

Full and Broad-Spectrum In Vivo Eradication of Catheter-Associated Biofilms Using Gentamicin-EDTA Antibiotic Lock Therapy

“…entral venous catheters are routinely used to administer medication or fluids to patients admitted to oncology, nephrology, and intensive care units (2,47,52). Although these devices greatly improve patient health, their use is often associated with medical complications due to colonization by pathogenic microorganisms (38).…”

In Vitro and In Vivo Effectiveness of an Innovative Silver-Copper Nanoparticle Coating of Catheters To Prevent Methicillin-Resistant Staphylococcus aureus Infection

“…This is in accordance with observations by Lloyd et al (48), who did not observe fibrin sheath formation on intravenous catheters within the first 15 to 30 min following insertion, and with those by Mehall et al (35), who showed that fibrin sheaths around implanted catheter favored bacterial attachment following bacteremia. Moreover, these results also support that although catheter colonization arising from a skin entry site at the time of insertion is the most frequent route of colonization, long-term implanted IVC infections result from breakthrough seeding from other sources via transient bacteremia (49). This explains why clinical studies on the prevention of IVC-associ- ated infections using catheters coated with Ag yielded disappointing results (19,50,51).…”