Central venous catheter infections related

Hospitals and providers must work to reduce the burden of these infections. Four specific infections account for more than 80% of all hospital-related infections. Their list includes surgical site infections (SSls), catheter-associated urinary tract infection (CAUTIs), central venous catheter (CVC)-related bloodstream infections (CRBSls), and ventilator-associated pneumonia (VAP). Preventing the transmission of antibiotic-resistant bacteria such as MRSA has become increasingly important. Effective measures exist to prevent the most common healthcare-associated infections (H Als). 

Central venous catheter (CVC)-related problems, risks and safety hazardsare partly caused by different characteristics of the CVC-based access and their performance features. This chapter covers those issues in a chronological order, from factors related to the choice of the CVC, insertion site and insertion procedure itself, over those associated with CVC use and their monitoring up to safety hazards of interventional procedures. Not discussed are CVC infections as they are covered in a separate chapter in this book. 

Amphotericin B is the mainstay of treatment of patients with severe endemic fungal infections. The conventional deoxycholate formulation of the drug can be associated with substantial infusion-related adverse effects (e.g., chills, fever, nausea, rigors, and in rare cases hypotension, flushing, respiratory difficulty, and arrhythmias). Pre-medication with low doses of hydrocortisone, acetaminophen, nonsteroidal anti-inflammatory agents, and meperidine is common to reduce acute infusion-related reactions. Venous irritation associated with the drug can also lead to thrombophlebitis, hence central venous catheters are the preferred route of administration in patients receiving more than a week of therapy. 

Patients receiving central PN are at increased risk of developing infectious complications caused by bacterial and fungal pathogens.1,50 Infections maybe related to placement of a central venous catheter, contamination of a central venous catheter or... 

Systemic catheter-related infections and local infections at catheter exit sites have been studied in relation to 479 central venous catheters in a prospective study in 311 patients in a general hospital in Australia (22). Local infections developed in association with 54 catheters (11%) and systemic infections with 32 (6.7%). Local... 

HIV-positive subjects are expected to be at even greater risk of line-related infection. A prospective study of 212 subjects with HIV infection with 327 central venous catheters has provided evidence of this enhanced risk (36). Over the period 1994-97, 33% were suspected as being infected, although only 61 episodes were diagnosed as catheter-related sepsis. Three variables affected the rate of sepsis parenteral nutrition, low numbers of circulating CD+ cells, and a high Apache score. 

Henrickson KJ, Axtell RA, Hoover SM, Kuhn SM, Pritchett J, Kehl SC, Klein JP. Prevention of central venous catheter-related infections and thrombotic events in immunocompromised children by the use of vancomy-cin/ciprofloxacin/heparin flush solution A randomized, multicenter, double-bhnd trial. J Qin Oncol 2000 18(6) 1269-78. 

Colomb V, Fabeiro M, Dabbas M, Goulet O, Merckx J, Ricour C. Central venous catheter-related infections in children on long-term home parenteral nutrition incidence and risk factors. Clin Nutr 2000 19(5) 355-9. 

Sheng WH, Ko WJ, Wang JT, Chang SC, Hsueh PR, Luh KT. Evaluation of antiseptic-impregnated central venous catheters for prevention of catheter-related infection in intensive care unit patients. Diagn Microbiol Infect... 

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. 

Use of antibiotic impregnated central venous catheters to prevent catheter related infections. 

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. 

Raad, 1.1., Darouiche, R. O., Dupuis, J., Abi-Said, D., Gabrielli, A., Hachem, R., Wall, M., Harris, R., Jones, J., Buzaid, A., et al., Central venous catheters coated with minocycline and rifampin for the pevention of catheter-related colonization and bloodstream infections. A randomized, double-blind trial. The Texas Medical Center Catheter Study Group, Ann. Intern. Med., 1997 127(4) 267-274. 

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. 

Flynn PM, Shenep JL, Stokes DC, Barrett FF (1987) In situ management of confirmed central venous catheter-related bacteremia. Pediatr Infect Dis J 6 729-734 Foley MJ (1995) Radiologic placement of long-term central venous peripheral access system ports (PAS Port) results in 150 patients. J Vase Interv Radiol 6 255-262 FraneyT, DeMarco LC,Geiss AC, Ward RJ (1988) Catheter fracture and embolization in a totally implanted venous access catheter. JPEN J Parenter Enteral Nutr 12 528-530 Freytes CO, Reid P, Smith KL (1990) Long-term experience with a totally implanted catheter system in cancer patients. J Surg Oncol 45 99-102... 

Weightman NC, Simpson EM, Speller DC, Mott MG, Oakhill A (1988) Bacteraemia related to indwelling central venous catheters prevention, diagnosis and treatment. Eur J Clin Microbiol Infect Dis 7 125-129... 

Oncu S, Ozsut H, Yildirim A, et al. Central venous catheter related infections risk factors and the effect of glycopeptide antibiotics. Ann Clin Microbiol Antimicrob February... 

Bach A. Clinical studies on the use of antibiotic- and antiseptic-bonded catheters to prevent catheter-related infection. Zentralbl Bakteriol December 1995 283(2) 208-14. Greenfeld JI, Sampath L, Popilskis SJ, et al. Decreased bacterial adherence and biofilm formation on chlorhexidine and silver sulfadiazine-impregnated central venous catheters implanted in swine. Crit Care Med May 1995 23(5) 894-900. 

Gilbert RE, Harden M. Effectiveness of impregnated central venous catheters for catheter related blood sbeam infection a systematic review. Curr Opin Infect Dis June 2008 21(3) 235 5. 

Lai NM, Chaiyakunapruk N, Lai NA, et al. Catheter impregnation, coating or bonding for reducing central venous catheter-related infections in adults. Cochrane Database Syst Rev 2013 6 CD007878. 

Moretti EW, Ofstead CL, Kristy RM, et al. Impact of central venous catheter type and methods on catheter-related colonization and bacteraemia. J Hosp Infect October 2005 61(2) 139 5. 

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). 

Published guidelines on the management of catheter-related infections are in favor of the use of ALT for the treatment of catheter-related infections [24]. The in vitro stability of antibiotic-heparin combinations in CVCs was studied by Vercaigne et al. [25]. While ciprofloxacin produced immediate precipitation with heparin, cefazolin, vancomycin and ceftazidime at 10 mg/ml and gentamycin at 5 mg/ml were successfully incubated with heparin (5,000 U/ml) for 72 h in the central venous catheter lumen. Although free antibiotic in CVC solution was reduced, the final concentration was still sufficient for an effective antibiotic-heparin lock [25]. Good evidence is available to support ALT in the prevention of catheter-related bacteremia in patients on hemodialysis [26,27]. However, others have reported that the use of ALT may be limited due to antibiotic toxicity and the appearance of antibiotic-resistant microbial isolates [28, 29]. 

Hemodialysis (HD) catheter-associated bloodstream infections (BSls) are a type of CLABSI due to a central venous catheter (CVC) specifically designed for HD. In 2002, it was estimated that 50,000 CLABSIs occur in dialysis patients in the US annually. A more recent surveillance study found the rate of access-related BSIs to be 0.73 events per 100 patient-months [5]. Aside from catheters, patients in need of renal replacement therapy should eventually use arteriovenous fistula (AVF) or arteriovenous grafts (AVG) for HD, or alternatively, may receive peritoneal dialysis. All renal replacement therapies are associated with a risk of infection however, this risk varies with the method selected. Data from a CDC surveillance program display nicely how the type of access influences the BSI rate per 100 patient-months 0.5 (for AVFs), 0.9 (AVG), 4.2 (permanent CVCs), and an impressive 27.1 for temporary CVCs [6]. Another, more practi-... 

Lee SC, et al An outbreak of methicillin-re-sistant Staphylococcus aureus infections related to central venous catheters for hemodialysis. Infect Control Hosp Epidemiol 2004 25 678-684. 

---