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Published on: July 13, 2019
Catheter-related infection: diagnosis, prevention and treatment
1Department of Anesthesiology, Umass Memorial Medical Center, 55 Lake Avenue North, Worcester, MA 01655, USA. stephen.heard@umassmed.edu
Insights
Preventing catheter-related bloodstream infections (CRBSI) is crucial for critically ill patients. Implementing preventive measures and newer catheter technologies can significantly reduce CRBSI incidence and improve patient outcomes.
Area of Science:
- Infectious Diseases
- Critical Care Medicine
- Medical Microbiology
Background:
- Catheter-related bloodstream infections (CRBSI) pose a significant threat to critically ill patients, increasing morbidity and healthcare costs.
- Understanding the incidence, epidemiology, microbiology, diagnosis, risk factors, and treatment of CRBSI is essential for effective patient management.
Purpose of the Study:
- To review and synthesize current knowledge on catheter-related bloodstream infections.
- To examine the latest findings on CRBSI prevention, diagnosis, and treatment strategies.
Main Methods:
- A comprehensive literature search was conducted using Medline and other review articles.
- Inclusion of important abstracts from the past year, provided the data had not yet been published in peer-reviewed journals.
Main Results:
- Coagulase-negative staphylococci, enterococci, and Staphylococcus aureus are the primary causative agents of CRBSI.
- Diagnosis often involves catheter removal and culture, but techniques like differential time to positivity offer in situ diagnosis.
- Key preventive strategies include staff education, subclavian insertion, chlorhexidine skin preparation and catheter care, and maximum barrier precautions.
Conclusions:
- Prevention remains the most effective strategy against CRBSI.
- Ongoing research focuses on newer antiseptic and antibiotic-impregnated catheters, antibiotic resistance, and the combined impact of multiple interventions.
Introduction:
Catheter infection continues to be a serious problem in critically ill patients. This review will examine the incidence, epidemiology, microbiology, diagnosis, risk factors for and treatment of catheter-related bloodstream infections.
Methods:
Relevant articles were culled from a Medline search and other review articles on catheter-related infection. Important abstracts presented within the past year were included in the review if the data had not been published in a peer-reviewed journal.
Results:
Catheter-related bloodstream infections (CRBSI) increase morbidity and the cost of care of patients. The predominant organisms associated with CRBSI are coagulase negative staphylococci, enterococci and Staphylococcus aureus. Diagnosis usually requires catheter removal and culture but newer techniques such as "differential time to positivity" may permit diagnosis of CRBSI in situ. Reducing risk factors for infection are important: education of house staff, use of the subclavian insertion site, skin preparation with chlorhexidine solutions, use of maximum barrier precautions during catheter insertion and catheter maintenance with chlorhexidine sponges. If infection rates are still high after institution of these measures, use of antiseptic or antibiotic-impregnated catheters should be considered. Treatment of CRBSI in critically ill patients mandates catheter removal and treatment with systemic antibiotics.
Conclusions:
The best treatment for CRBSI is prevention. Ongoing studies are evaluating the effectiveness of newer antiseptic catheters, the risk of developing antibiotic resistance when using antibiotic-impregnated catheters and the contribution of multiple interventions on the development of CRBSI.
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