Catheter-Related Bloodstream Infections (CRBSIs)

Catheter-related bloodstream infections (CRBSIs) are common causes of hospital-associated illness. Although their rates have been declining over the past decades, they still contribute to significant morbidity and mortality and excess costs. CRBSIs usually present as fever without an apparent source but may be accompanied by suppurative complications at the insertion site of the catheter or evidence of hematogenous spread to other tissues and organs. Quantitative and semiquantitative blood cultures are usually performed to determine whether a catheter is infected, but if these methods are not available, and there is motivation to retain a catheter that might be infected, blood cultures of the same volume can be collected from a peripheral vein and from the catheter and then monitored for differential time to positivity. Coagulase-negative Staphlyococci, such as Staphylococcus epidermidis, are the most common microbiologic cause of CRBSI, although a vast array of different bacterial and fungal species have also been reported. Some etiologic agents can be particularly virulent, leading to signs of sepsis. Complications of CRBSIs include skin and soft tissue infection at the catheter insertion site. The bacteremia (or fungemia) associated with the contaminated intravascular device can lead to hematogenous seeding and infection of distal sites such as the cardiac valves, lungs, muscles, bones, and joints. The ideal treatment for any contaminated, implanted medical device, including intravascular catheters, is to remove them while administering appropriate antibiotics or antifungal medications. Bacterial and fungal contamination (infection) of medical hardware is notoriously difficult to eradicate using anti-infective medications alone. In many cases however, it may be impossible or impractical to remove an infected catheter.