CVC-related infections

The poor protection of silver in preventing CVC-related infections may be due either to the low susceptibility of staphylococcal species to silver ions ° or to deactivation of silver by interaction with the host blood proteins. ... 

Antibiotic-lock therapy (ALT) is used in addition to systemic treatment for CVC-related infections. After filling both catheter lumens with a mix of antibiotic and anticoagulant at the end of dialysis (catheter locking), antibiotic concentrations inside the catheter reach very high levels, much higher than the con-... 

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). 

It is now widely accepted that nuCTobial biofihns play a key role in all types of health-care-associated infections and especially in those related to medical devices. Particularly, biofilm formation on the device surfaces contributes to the severity of these infections. Indeed the development of biofilm is responsible for the chronic nature of related infections, and for the inherent resistance to antibiotic therapy. Raad et al. were among the first investigators who isolated biofilm-producing microorganisms from the intraluminal surface of CVCs, which r ained in situ for more than 30 days. 

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]. 

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. 

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-... 

Central Venous Catheters Central venous catheters (CVCs) are widely used in hospital practice indeed it has been estimated that, in the United States alone, about 5 million of these units are inserted annually [52]. The widespread use of CVCs is associated with potential infective complications, with the annual incidence of catheter-related bloodstream infection estimated at around 80000 cases in the US [53, 54]. 

---