Intravascular catheter infections

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.