Catheter Related Blood Stream Infections

Catheter-related bloodstream infection (CRBSI) is defined as the presence of bacteraemia originating from an intravenous catheter. It is the most prevalent cause of nosocomial bacteraemia and one of the most common, expensive and lethal side effects of central venous catheterization.

Intravascular catheters are a necessary part of modern procedures in order to administer fluids, blood products, medication, nutritional solutions and for hemodynamic monitoring of critical patients. The most frequent cause of infection is the catheter hub, while it can also originate from the infusate, the catheter exit site or hematogenous dissemination from another source. Organisms from the catheter hub develop an adhesive biofilm that spreads down the catheter's inner surface. These organisms enter the bloodstream when the fluid is flowing through catheter. Gram-negative bacilli, various gram-positive bacteria, Candida species, and coagulase-negative Staphylococci are among the microorganisms which are frequently isolated in CRBSI.

In order to lower the associated morbidity and mortality, early identification and treatment are essential. Central venous catheters need to be examined every day and national recommendations for CRBSI prevention should be adhered to. It is customary to follow the protocol of removing an infected central venous catheter and administer antibiotics for two to three days prior to inserting a new catheter.

Infection control measures include the use of maximal barrier, safety measures during catheter insertion, efficient cutaneous anti-sepsis and preventive measures based on preventing microorganisms from the skin or catheter hub from adhering to the catheter. The most significant preventive measures for catheter-related infections were the implementation of continuous quality improvement programs, health care worker education, trainings and adherence to standardized protocols for intravascular catheter insertion and maintenance. New hub models, antibiotic lock solutions, antibiotics impregnated catheters and dressings are among the few technologies being used to prevent infections directed at CVCs, which have been demonstrated to lower the risk of CRBSI.

CRBSI is one of the main causes of morbidity and mortality. It is crucial that clinical microbiologists conduct routine ICU rounds and have bedside conversations with intensivists about infection control and prevention strategies. Timely management of CRBSI can save many lives when urgent microbiological results are communicated promptly.

References

1. Leonard A. Mermel, Michael Allon, Emilio Bouza, Donald E. Craven, Patricia Flynn, Naomi P. O'Grady et al. Clinical Practice Guidelines for the Diagnosis and Management of Intravascular Catheter-Related Infection: Update by the Infectious Diseases Society of America, Clinical Infectious Diseases 2009;49(1):1–45.

2. Cantón-Bulnes ML, Garnacho-Montero J. Practical approach to the management of catheter-related bloodstream infection. Rev Esp Quimioter. 2019;32 Suppl 2(Suppl 2):38-41. 

3. Centers for Disease Control and Prevention (CDC). Vital signs: central line-associated blood stream infections--United States, 2001, 2008, and 2009. MMWR Morb Mortal Wkly Rep. 2011;60(8):243-248.