Article

Intravascular catheter infections

Guy's and St Thomas' Hospital, London SE1 7EH, UK.
The Journal of hospital infection (Impact Factor: 2.78). 09/2009; 73(4):323-30. DOI: 10.1016/j.jhin.2009.05.008
Source: PubMed

ABSTRACT Formerly an under-appreciated iatrogenic infection, catheter-related bloodstream infections (CRBSIs) are now the focus of considerable preventive strategies. Although robust clinical definitions remain elusive due to the difficulty in identifying the focus of infection in hospitalised patients, surveillance definitions are proving useful to monitor and compare institutional rates of CRBSI and to target infection control resources. New catheter-sparing diagnostic techniques have been developed, that are probably most applicable to assessment of infection in stable ambulatory patients with single long-term tunnelled catheters rather than acutely unwell hospitalised patients. There is an impressive body of evidence that can be used to support implementation, surveillance and audit of basic infection control practices that should help institutions reduce CRBSI rates. The introduction of preventive antimicrobial strategies at the catheter site has been recommended by international guidelines, yet there remains justifiable concern about long-term selection of resistant organisms. This has not been adequately addressed in current studies. Economic analyses require data on the clinical effect of CRBSIs to adequately assess the benefit; such data are scarce, owing to the difficulty in assessing the contribution from comorbidities, with consequential conflicting results. Overall, institutions can justifiably first assess the benefit of a sustained programme of re-enforcing basic infection control practice on CRBSI before assessing whether the introduction of additional preventive antimicrobial strategies are likely to have any benefit.

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    • "Intravascular catheters (IVCs) occupy a very important place in the day-to-day provision of healthcare in hospitals. Nearly 300 million IVCs are used yearly in USA [1]. Along with their undoubted advantages, however, the application of IVCs is also associated with life-threatening infections [2]. "
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    ABSTRACT: Intravascular catheters (IVCs) are the most frequently used medical devices in hospitals. However, they are associated with life-threatening IVC-related bloodstream infection (IVC-BSI), which is one of the main hospital-acquired infections, and continue to be associated with morbidity, mortality and additional medical cost. Most published studies focus on measuring the rate of IVC-BSIs and addressing their importance, but only a few studies have mentioned the possible routes for microbes entering the bloodstream, which would help in developing effective prevention methods, and large trial studies are lacking. Some studies on IVC-BSIs have reported the most frequently isolated microbes, but caution needs to be made since many fastidious microbes are not isolated under current laboratory conditions. Although it is known that microbes colonise IVC surfaces and develop biofilms, leading to IVC-BSI, the relationships of microbial biofilms with patients' symptoms or outcomes remain unclear. Here we discuss the knowledge gained from microbial research in other (non-IVC) medical and non-medical applications that may be helpful in understanding the IVC context. In addition, published theory and data regarding microbial colonisation and biofilm development specifically in IVCs are reviewed. More research is needed to explore mechanisms of IVC-BSI and to provide superior prevention strategies.
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    ABSTRACT: Intravascular catheter related infection (CRI) is one of the most serious nosocomial infections. Diagnostic criteria include a positive culture from the catheter tip along with blood, yet in many patients with signs of infection, current culture techniques fail to identify pathogens on catheter segments. We hypothesised that a molecular examination of the bacterial community on short term arterial catheters (ACs) would improve our understanding of the variety of organisms that are present in this niche environment and would help develop new methods for the diagnosis of CRI. The whole bacterial community presenting on all ACs was evaluated by molecular methods, i.e., a strategy of whole community DNA extraction, PCR amplification followed by cloning and 16S rDNA sequence analysis. Ten ACs were removed from patients suspected of CRI and 430 clones from 5 "colonised" and 5 "uncolonised" (semi-quantitative method) AC libraries were selected for sequencing and subsequent analysis. A total of 79 operational taxonomic units (OTUs) were identified at the level of 97% similarity belonging to six bacterial divisions. An average of 20 OTUs were present in each AC, irrespective of colonisation status. Conventional culture failed to reveal the majority of these bacteria. There was no significant difference in the bacterial diversity between the 'uncolonised' and 'colonised' ACs. This suggests that vascular devices cultured conventionally and reported as non infective may at times potentially be a significant source of sepsis in critically ill patients. Alternative methods may be required for the accurate diagnosis of CRI in critically ill patients.
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