Catheter-related sepsis in the intensive care unit: physiopathology, diagnosis, treatment and prevention

Purpose: To review the mechanisms, diagnosis, treatment and prophylaxis of catheter-related sepsis in intensive care unit patients. Data sources: A Medline((R)) research of the English- or French-language re ports published between 1966 and 2000 and a manual research of references o f relevant papers. Study selection: Experimental, clinical and basic research studies related to catheter-related sepsis. Data extraction: Data in selected articles were reviewed, and relevant clin ical information was extracted. Data synthesis: Infection remains the major complication related to cathete r insertion. No bacteriological exam or systematic catheter change is requi red in the absence of infection suspicion. In the intensive care unit, and without septic shock, the surveillance of skin cultures at the catheter ins ertion site or the time to positivity of hub-blood versus peripheral-blood culture determination may reduce the number of unnecessary removed catheter s. Catheter change over a guidewire is not recommended because of the risk of dissemination of infection. When the catheter is removed, a quantitative culture is warranted. The treatment of catheter-related sepsis is based on catheter removal. The use of antibiotics is limited to some organisms or w hen the infection is complicated. The persistence of fever and positive blo od cultures 72 h after catheter removal require to look for dissemination o f infection or septic thrombophlebitis, especially if S. aureus or Candida are incriminated. The treatment of infection without catheter removal is no t recommended in the intensive care unit because of a high risk of treatmen t failure. Compliance with catheter care guidelines and continuing quality improvement programs are the two major procedures in reducing catheter infe ction. Conclusions: Improved understanding of the pathophysiology of catheter-rela ted sepsis has led to improved prevention. Compliance with catheter care gu idelines and continuing quality improvement programs are majors procedures to reduce the risk of catheter infection. (C) 2001 Editions scientifiques e t medicales Elsevier SAS.