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Intravascular device-related infections in critically ill patients
D Pittet1, S Hulliger, R Auckenthaler
1Division of Infectious Diseases, University Hospital of Geneva, Switzerland.
Abstract:
Intravascular device-related infections (IVDRIs) are among the most common nosocomial infections in critically ill patients. Quantitative or semi-quantitative microbiology diagnosis is necessary for their management. Most causative organisms arise from the skin; staphylococci are responsible for two-thirds of the IVDRIs, with Staphylococcus aureus responsible for 5% to 15%. Complications may include septic shock, suppurative thrombophlebitis, and endocarditis. In critically ill patients, intravenous lines are responsible for at least 23% of nosocomial bloodstream infection, which has a mortality of 25% and is associated with a longer stay in intensive care and costs $28,960 per survivor. IVDRIs can be treated with intravenous antibiotics without removing the device, but removal of the catheter is recommended. Prevention is based on careful insertion practice and optimal catheter care. Systemic replacement of the intravenous lines every three to five days is common practice in the USA but not elsewhere in Europe. This issue should be studied, particularly in critically ill patients.
Insights
Intravascular device-related infections (IVDRIs) are common in critically ill patients, often caused by staphylococci. Prevention through careful insertion and catheter care is crucial, alongside appropriate diagnosis and treatment.
Area of Science:
- Infectious Diseases
- Critical Care Medicine
- Medical Microbiology
Background:
- Intravascular device-related infections (IVDRIs) are a significant cause of nosocomial infections in critically ill patients.
- Staphylococci, particularly Staphylococcus aureus, are the primary pathogens responsible for a majority of IVDRIs.
- These infections are associated with high mortality rates, prolonged intensive care unit stays, and increased healthcare costs.
Purpose of the Study:
- To highlight the prevalence and impact of IVDRIs in critically ill patients.
- To emphasize the diagnostic and management challenges posed by these infections.
- To discuss current prevention strategies and areas for further research.
Main Methods:
- Review of existing literature on IVDRIs in critically ill populations.
- Analysis of etiological agents, focusing on staphylococcal species.
- Examination of diagnostic approaches, treatment modalities, and preventive measures.
Main Results:
- IVDRIs account for at least 23% of nosocomial bloodstream infections in critically ill patients, with a 25% mortality rate.
- Staphylococci cause two-thirds of IVDRIs; Staphylococcus aureus accounts for 5-15%.
- Complications include septic shock, suppurative thrombophlebitis, and endocarditis.
Conclusions:
- Effective management of IVDRIs requires accurate microbiological diagnosis and appropriate treatment, often involving catheter removal.
- Prevention strategies, including meticulous insertion techniques and catheter care, are paramount.
- Further research is needed, especially concerning optimal prophylactic measures and device replacement protocols in critically ill patients.