Management and Prevention of Central Venous Catheter-Related Infections in the ICU

Abstract

Central venous catheter-related bloodstream infections (CR-BSI) are a frequent event in the intensive care unit (ICU) setting. In contrast to other nosocomial infections, most risk factors for CR-BSI are linked to the device and can be prevented efficiently. Rates of CR-BSI higher than 1 per 1,000 catheter days are no longer acceptable. A continuous quality improvement program is effective to reduce them. Key elements of prevention of CR-BSI are hand hygiene, avoidance of insertion of unnecessary catheters, full sterile barrier precautions at insertion, preferential use of subclavian venous insertion site, cutaneous antisepsis with 2% chlorhexidine alcoholic preparation, use of chlorhexidine-impregnated dressings, immediate replacement of moistened or detached catheter dressings, and removal of catheters as soon as possible. Audit and feedback of the process of care, infection rates, and periodic re-education of health care providers are other instrumental tools in the prevention of CR-BSI. Catheter removal is the main therapeutic intervention, especially recommended in the case of sepsis or shock. While awaiting culture results, an empiric antimicrobial treatment of CR-BSI should target gram-positive microorganism (i.e., Staphylococcus aureus) and gram-negative coverage should be based on clinical variables, patients' risk factors, and previous colonization status. While a short course of antimicrobials (7 days) is sufficient for noncomplicated CR-BSI, a longer course of 14 days should be preferred for uncomplicated S. aureus and Candida CR-BSI. In case of persisting fever or positive blood culture after 3 days despite adequate antimicrobial therapy and catheter removal, catheter-related complications (e.g., endocarditis, thrombophlebitis, septic metastasis) should be ruled out.

Short-Course Versus Long-Course Systemic Antibiotic Treatment for Uncomplicated Intravascular Catheter-Related Bloodstream Infections due to Gram-Negative Bacteria, Enterococci or Coagulase-Negative Staphylococci: A Systematic Review

“…Current guidelines and expert statements recommended treatment durations of 7–14 days for Gram-negative CRBSI, 5–7 days for CoNS and 5–14 days for enterococcal CRBSI [ 13 , 14 , 16 , 19 , 20 , 32 ] (Table 3 ). As the treatment duration depends on several factors (e.g.…”

“…at least 14 days). Of note, Staphylococcus lugdunensis was not included among CoNS since it can cause an aggressive clinical course, and as a consequence, longer treatment durations are recommended [ 15 , 16 , 19 , 20 ]. We excluded studies investigating lock therapies with systemic antimicrobials because lock therapy may require more prolonged systemic antibiotic courses, and our target population was uncomplicated intravascular catheter infection.…”

Early prophylaxis of central venous catheter-related thrombosis using 1% chlorhexidine gluconate and chlorhexidine-gel-impregnated dressings: a retrospective cohort study

“…We speculated that the results were affected by differences among the prophylactic anticoagulants used and their doses. The efficacy of antithrombotic prophylaxis for CRT is controversial 5 – 8 , 29 , and no clear benefit has been determined for critically ill patients who received anticoagulant prophylaxis for CRT. Hence, individualised risk and benefit evaluations are required.…”

Factors Related to ICU-Acquired Infections Incidence in Iran: Analysis of National Nosocomial Infections Registry Data

“…Device-related infections are a leading cause of HAIs, particularly in ICUs. Also, catheter-related infections are the most frequent cause of hospital-acquired bacteremia and mechanical complications and are mostly accessible to prevention if establishing standard disinfection and sterilization mechanisms and rigorous policies are implemented [12,13]. Furthermore, mechanical ventilation is a commonly used mode of support in the ICU [11,14].…”