Clinical Research Catheter Infections: Diagnosis, Etiology, Treatment, and Prevention

ABSTRACT Infection remains the leading complication that is associated with intravascular access devices. Despite continuous research efforts and advances in tech-nology, the rate of central venous catheter infections has remained relatively constant over the past decade. ’ This article focuses on four pertinent aspects of central venous access infection: microbial etiology and pathogenesis, diagnosis, prevention, and treatment. An update of the scientific literature in this area will aid clinicians in their patient care practices and serve to identify unanswered questions. The Scope of the Problem It has been estimated that over 200,000 nosoco-mial bloodstream infections occur yearly in the United States. ’ The majority of these infections are associated with the use of an intravascular device a 90 % of which can be attributed to central lines. Catheter-related bloodstream infections (CR-BSI) rank as the third most common nosocomial infection in the intensive care unit (ICU) according to the National Nosocomial Infection Surveillance (NNIS) System? From 1986 to 1998, this program reported that the pooled mean ICU, central line-associated bloodstream infection rate ranged from 4.5 (medicall surgical ICU) to 14.7 (burn ICU) bloodstream infec-tions per 1000 central line days (Table lL3 The attributed cost of a single bloodstream infection ranges from a low of $2800 to a high of $28,000.4*5 Although these costs place a significant burden on the health care system, the statistics do not fully define the impact of a CR-BSI on the individual patient. Additional costs to the patient include th