Catheter-related bloodstream infections

Catheter-related bloodstream infections (CBIs) rank among the most frequent and potentially lethal nosocomial infections. Intravascular devices become contaminated on the outer surface during nonaseptic insertion or maintenan ce of the catheter exit site or endoluminally during hub manipulation. CBI is heralded by spiking fever, malaise and rigors and should be promptly dia gnosed to prevent endocarditis and septic metastasis. In about two-thirds o f the cases the offending organisms are coagulase-negative staphylococci; S taphylococcus aureus, gram-negative bacilli, and Candida sp. are responsibl e for one-third of these infections and carry a worse prognosis. Diagnosis of CBI relies on proper bacteriologic techniques, some of which can be perf ormed in situ avoiding withdrawal of the device. Prevention strategies shou ld aim at avoiding extra- and endoluminal contamination and should be based on three main pillars: maximal aseptic barriers at insertion, appropriate site maintenance, and junctional (hub) care and protection. Treatment inclu des catheter withdrawal and appropriate antibiotic coverage. For long term cuffed catheters, local treatment with intraluminal administration of antib iotics is effective and can save a significant number of catheters, particu larly those colonized by coagulase-negative staphylococci.