Infections related to intravascular devices used for infusion therapy

Catheter-related bloodstream nfections are associated with recognized morbidity and mortality, especially in critically ill patients. Skin insertion site, the catheter hub, hematogenous seeding of the catheter tip from a distant site of infection, and infusate contamination are the sources of catheter colonization and infections. Coagulase-negative staphylococci, Staphylococcus aureus, aerobic gram-negative bacilli, and Candida spp most commonly cause catheter-related bloodstream infection. Catheter-sparing diagnostic methods, such as differential quantitative blood cultures and time to positivity have emerged as reliable diagnostic techniques. Management of catheter-related infection varies according to the type of catheter involved. In most cases of nontunneled catheter-related bacteremia and fungemia, the catheter should be removed. For management of bacteremia and fungemia from a tunneled catheter or implantable device, such as a port, the decision to remove the catheter or device should be based on the severity of the patient's illness, documentation that the vascular-access device is infected, assessment of the specific pathogen involved, and presence of complications, such as endocarditis, septic thrombosis, tunnel infection, or metastatic seeding. When a catheter-related infection is documented and a specific pathogen is identified, systemic antimicrobial therapy should be narrowed and consideration given for antibiotic lock therapy, if the catheter or implantable device is not removed. Novel preventive strategies include cutaneous antisepsis, maximum sterile barrier, use of antimicrobial catheters, and antimicrobial catheter lock solution.