[Infections caused by intravascular catheters. Etiopathogenesis--diagnosis--therapy--prevention]

Despite improvements in infection control measures, catheter-related infections represent a challenging problem in modern medicine. The difficulties in correctly diagnosing catheter-related infections and the necessity to remove the device in case of suspected infection require preventive measures in the first place. Most authors stress the importance of strict aseptic catheter management. Nevertheless, there may still be a high incidence of catheter-related infections. Moreover, this problem is potentiated by the increasing use of intravascular devices. The current infection rates may be reduced by instituting novel preventive measures, e.g., decontamination of carriers using the anti-staphylococcal agent mupirocin. Another approach aims at inhibiting the adhesion of bacteria to intravascular catheters by modifying these catheters with antimicrobial agents. Newer studies show that impregnation of catheters with the antiseptic substances silver-sulphadiazine and chlorhexidine is effective in reducing bacterial colonisation of the catheters. A pilot study on intensive-care patients demonstrated a significant reduction in catheter-related infections and bacteraemia by impregnated catheters. This novel approach may reduce the incidence of catheter-related infections below the level which could be achieved by employing all current preventive measures.