Catheter-related bloodstream infections

Veenstra DL, Saint S, Sullivan SD. Cost-effectiveness of antiseptic-impregnated central venous catheters for the prevention of catheter-related bloodstream infection. JAMA 1999 282(6) 554-60. 

Safdar N, Kluger DM, Maki DG. A review of risk factors for catheter-related bloodstream infection caused by percutaneoulsy inserted, non-cuffed central venous catheters Implications for preventive strategies. Medicine 2002 86 466-479. 

Berenholtz S, Pronovost P, lipsett P, Hobson D, Earsing K, Fadey J, et aL Eliminating catheter-related bloodstream infections in the intensive care unit Crit Care Med. 2004 32(10) 2014—20. 

The final consideration to be addressed in this chapter on the choice of a polymer fortrsein medical devices is cost. Biomedical polymers can range from inexpensive (PVC, polyethylene) to extremely expensive (e.g., polymers with peptide components). A disposable catheter intended for minutes or hotus use in the body will not jrrstily an expensive polymer. On the other hand, a device implanted with the intent of a lifetime of acceptable performance might rrse an expensive polymeric component if long-term performance benefit can be demonstrated. Also, a higher priced polymer might be justified based on reduced complications. For example, as catheter-related bloodstream infections can add over 56000 to a hospital stay, a more expensive antibacterial catheter should be justified. ... 

As the success of this and related programmes became apparent, a much wider intervention was launched led by the Michigan Health and Hospital Keystone Association for Patient Safety and Quality. 108 Michigan ICUs took part in an 18-month intervention programme aimed particularly at decreasing catheter related bloodstream infections, a common, costly and potentially lethal complication of ICU care. In the United States, 80 000 patients each year were affected, with up to 28 000 deaths in intensive care units from this cause. 

Maki, D. G., Stolz, S. M., Wheeler, S., and Mermel, L. A., Prevention of central venous catheter-related bloodstream infection by use of an antiseptic-impregnated catheter. A randomized, controlled trial, Ann. Intern. Med., 1997 127(4) 257-266. 

Si es-Sena, A., Strategies for prevention of catheter-related bloodstream infections, Support Care Cancer, 1999 7(6) 391-395. 

Central Venous Catheter-Related Bloodstream Infections... 

Infection risk Catheter-related bloodstream infections pose a significant problem for hospitalized patients. In a randomized comparison in 960 patients of 5-fiuoruracil or chlorhexidine-I-silver sulfadiazine as central venous catheter coatings, 5-fluorouracil was non-inferior to chlorhexidine-b silver sulfadiazine with respect to the incidence of catheter colonization (2.9% versus 5.3%) [ll ]. Local site infections occurred in 1.4% with 5-fluoruracil and 0.9% with chlorhexidine + silver sulfadiazine. There were no episodes of catheter-related bloodstream infections with 5-fluoruracil but two episodes with chlorhexidine + silver sulfadiazine. The incidence of adverse events was low and comparable in the two groups. 

Comparative studies In 40 patients with cancers and probably or definite catheter-related bloodstream infections who were given daptomycin 6 mg/kg/day, compared with 40 historical-matched control patients treated with vancomycin, there was no difference in adverse events or withdrawals [I34M] However, nausea, vomiting, dizziness, a raised CK activity and rashes were more frequent with daptomycin and pruritus and erythema with vancomycin. 

Dimick JB, Pelz RK, Consunji R, Swoboda SM, Hendrix CW, Lipsett PA. Increased resource use associated with catheter-related bloodstream infection in the surgical intensive care unit. Arch Surg 2001 136 229-34. 

Blot SI, Depuydt P, Annemans L, Benoit D, Hoste E, De Waele JJ, et al. Clinical and economic outcomes in critically ill patients with nosocomial catheter-related bloodstream infections. Clin Infect Dis 2005 41 1591-8. 

Abdelkefi A, Achonr W, Ben Othman T, Ladeb S, Toijman L, Lakhal A, et al. Use of heparin-coated central venous lines to prevent catheter-related bloodstream infection. J Support Oncol 2007 5 273-8. 

Bong JJ, Kite P, Wilco MH, et al. Prevention of catheter related bloodstream infection by silver iontophoretic central venous catheters a randomised controlled trial. J Clin Pathol October 2003 56(10) 731-5. 

Ranucci M, Isgro G, Giomarelli PP, et al. Impact of oligon central venous catheters on catheter colonization and catheter-related bloodstream infection. Crit Care Med January 2003 31(l) 52-9. 

Parenteral nutrition was a susceptibility factor for central venous catheter-related bloodstream infections in 109 patients who received chemotherapy after surgery for colorectal cancer for a total of 5558 catheter-days in a retrospective database evaluation (OR = 13 95% Cl = 2.5, 62). 

Pronovost P, Needham D, Berenholtz S, Si-nopoli D. Chu H, Cosgrove S, et al An intervention to decrease catheter-related bloodstream infections in the ICU. N Engl J Med... 

Catheter-related bloodstream infections are reduced by interdialytic locking with taurolidine, a nontoxic antimicrobial agent Although the use of a formulation of 1.35% taurolidine in 4% citrate, compared to 5,000 U/ml heparin, was associated with a greater need for thrombolysis to maintain catheter patency [32], the addition of 500 U/ml heparin to taurolidine-citrate solution avoided the need for thrombolysis without increasing bacteremia, with catheter patency comparable to heparin 5,000 U/ml [33]. A taurolidine-citrate (4%)-urokinase (25,000 U) lock solution is now available. 

Delcour C, Bruninx G IncompatibiUty of contrast medium and trisodium citrate. Car-diovasc Intervent Radiol 2013 36 237-238. Camins BC, Richmond AM, Dyer KL, et al Crossover intervention trial evaluating the efficacy of a chlorhexidine-impregnated sponge in reducing catheter-related bloodstream infections among patients undergoing hemodialysis. Infect Control Hosp Epidemiol 2010 31 1118-1123. 

Maragakis LL, et al Increased catheter-related bloodstream infection rates after the introduction of a new mechanical valve intravenous access port. Infect Control Hosp Epidemiol 2006 27 67-70. 

According to the CDC, almost 1.7 million hospital-acquired infections (HAIs) occur yearly, contributing to approximately 99,000 deaths. Such infections were long accepted by clinicians as an inevitable hazard. Recent efforts demonstrate that simple measures can prevent the majority of common infections. Hospitals and providers must work to reduce the burden of these infections. Four specific infections account for more than 80 percent of all hospital-related infections. They are surgical site infections, catheter-associated urinary tract infections, central venous catheter-related bloodstream infections, and ventilator-associated pneumonia. Preventing the transmission of antibiotic-resistant bacteria such as methicillin-resistant Staphylococcus aureus (MRSA) remains an important infection control priority. Effective measures exist to prevent the most common healthcare-related infections. 

Elimination of 43 observed catheter-related bloodstream infections, saving eight lives. 

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