Best Practice & Research Clinical Anaesthesiology
Volume 22, Issue 3 , Pages 407-421 , September 2008

Central venous catheter-associated infections

  • Walter Zingg, MD (Doctor)

      Affiliations

    • Tel.: +41 22 372 3364; Fax: +41 22 372 3987.
  • Bernhard Walder, MD (Associate Professor)

      Affiliations

    • Corresponding Author InformationCorresponding author. Tel.: +41 22 372 3063; Fax: +41 22 372 7511.

References 

  1. Goldmann DA, Maki DG. Infection control in total parenteral nutrition. JAMA : The Journal of the American Medical Association. 1973;223:1360–1364
  2. Maki DG, Goldman DA, Rhame FS. Infection control in intravenous therapy. Annals of Internal Medicine. 1973;79:867–887
  3. Maki DG, Kluger DM, Crnich CJ. The risk of bloodstream infection in adults with different intravascular devices: a systematic review of 200 published prospective studies. Mayo Clinic Proceedings. 2006;81:1159–1171
  4. Lorente L, Villegas J, Martin MM, et al. Catheter-related infection in critically ill patients. Intensive Care Medicine. 2004;30:1681–1684
  5. Jean G, Charra B, Chazot C, et al. Risk factor analysis for long-term tunneled dialysis catheter-related bacteremias. Nephron. 2002;91:399–405
  6. Kuizon D, Gordon SM, Dolmatch BL. Single-lumen subcutaneous ports inserted by interventional radiologists in patients undergoing chemotherapy: incidence of infection and outcome of attempted catheter salvage. Annals of Internal Medicine. 2001;161:406–410
  7. Mermel LA. Prevention of intravascular catheter-related infections. Annals of Internal Medicine. 2000;132:391–402
  8. Coello R, Charlett A, Ward V, et al. Device-related sourcesw of bacteraemia in English hospitals-opportunities for the prevention of hospital-acquierd bacteraemia. The Journal of Hospital Infection. 2003;53:46–57
  9. National Nosocomial Infections Surveillance (NNIS) System Report, data summary from January 1992 through June 2004, issued October 2004. American Journal of Infection Control. 2004;32:470–485
  10. Aubaniac R. Subclavian intravenous injection; advantages and technic, Presse Med. 1952;60:1456
  11. Mostert JW, Kenny GM, Murphy GP. Safe placement of central venous catheter into internal jugular veins. Archives of Surgery (Chicago, Ill. : 1960). 1970;101:431–432
  12. Peters JL, Mehtar S, Vallis CJ, Kenning BR. Central venous catheter design and maintenance complications. British Journal of Anaesthesia. 1979;51:805–806
  13. Pottecher T, Forrler M, Picardat P, et al. Thrombogenicity of central venous catheters: prospective study of polyethylene, silicone and polyurethane catheters with phlebography or post-mortem examination. European Journal of Anaesthesiology. 1984;1:361–365
  14. Hecker JF, Scandrett LA. Roughness and thrombogenicity of the outer surface of intravascular catheters. Journal of Biomedical Materials Research. 1985;19:381–395
  15. Garner JS, Jarvis WR, Emori TG, et al. CDC definitions for nosocomial infections, 1988. American Journal of Infection Control. 1988;16:128–140
  16. O'Grady NP, Alexander M, Dellinger EP, et al. Guidelines for the prevention of intravascular catheter-related infections. Centers for Disease Control and Prevention. MMWR Recommendations and Reports. 2002;51:1–29
  17. Seo SK, Venkataraman L, DeGirolami PC, Samore MH. Molecular typing of coagulase-negative staphylococci from blood cultures does not correlate with clinical criteria for true bacteremia. The American Journal of Medicine. 2000;109:697–704
  18. Casey AL, Worthington T, Lambert PA, Elliott TS. Evaluation of routine microbiological techniques for establishing the diagnosis of catheter-related bloodstream infection caused by coagulase-negative staphylococci. Journal of Medical Microbiology. 2007;56:172–176
  19. Edwards JR, Peterson KD, Andrus ML, et al. National Healthcare Safety Network (NHSN) Report, data summary for 2006, issued June 2007. American Journal of Infection Control. 2007;35:290–301
  20. Vonberg RP, Behnke M, Geffers C, et al. Device-associated infection rates for non-intensive care unit patients. Infection Control and Hospital Epidemiology. 2006;27:357–361
  21. Marschall J, Leone C, Jones M, et al. Catheter-associated bloodstream infections in general medical patients outside the intensive care unit: a surveillance study. Infection Control and Hospital Epidemiology. 2007;28:905–909
  22. Rosenthal VD, Maki DG, Salomao R, et al. Device-associated nosocomial infections in 55 intensive care units of 8 developing countries. Annals of Internal Medicine. 2006;145:582–591
  23. Mehta A, Rosenthal VD. Device-associated nosocomial infection rates in intensive care units of seven Indian cities. Findings of the International Nosocomial Infection Control Consortium (INICC). The Journal of Hospital Infection. 2007;67:168–174
  24. Lobo RD, Levin AS, Gomes LM, et al. Impact of an educational program and policy changes on decreasing catheter-associated bloodstream infections in a medical intensive care unit in Brazil. American Journal of Infection Control. 2005;33:83–87
  25. Ramirez Barba EJ, Rosenthal VD, Higuera F, et al. Device-associated nosocomial infection rates in intensive care units in four Mexican public hospitals. American Journal of Infection Control. 2006;34:244–247
  26. Rosenthal VD, Guzman S, Crnich C. Device-associated nosocomial infection rates in intensive care units of Argentina. Infection Control and Hospital Epidemiology. 2004;25:251–255
  27. Moreno CA, Rosenthal VD, Olarte N, et al. Device-associated infection rate and mortality in intensive care units of 9 Colombian hospitals: findings of the International Nosocomial Infection Control Consortium. Infection Control and Hospital Epidemiology. 2006;27:349–356
  28. Richet H, Hubert B, Nitemberg G, et al. Prospective multicenter study of vascular-catheter-related complications and risk factors for positive central-catheter cultures in intensive care unit patients. Journal of Clinical Microbiology. 1990;28:2520–2525
  29. Moro ML, Vigano EF, Cozzi Lepri A. Risk factors for central venous catheter-related infections in surgical and intensive care units. The Central Venous Catheter-Related Infections Study Group. Infection Control and Hospital Epidemiology. 1994;15:253–264
  30. Adler A, Yaniv I, Steinberg R, et al. Infectious complications of implantable ports and Hickman catheters in paediatric haematology-oncology patients. The Journal of Hospital Infection. 2006;62:358–365
  31. Rijnders BJ, Van Wijngaerden E, Vandecasteele SJ, et al. Treatment of long-term intravascular catheter-related bacteraemia with antibiotic lock: randomized, placebo-controlled trial. The Journal of Antimicrobial Chemotherapy. 2005;55:90–94
  32. Goetz AM, Wagener MM, Miller JM, Muder RR. Risk of infection due to central venous catheters: effect of site of placement and catheter type. Infection Control and Hospital Epidemiology. 1998;19:842–845
  33. Merrer J, De Jonghe B, Golliot F, et al. Complications of femoral and subclavian venous catheterization in critically ill patients: a randomized controlled trial. JAMA : The Journal of the American Medical Association. 2001;286:700–707
  34. Ruesch S, Walder B, Tramer MR. Complications of central venous catheters: internal jugular versus subclavian access–a systematic review. Critical Care Medicine. 2002;30:454–460
  35. Cobb DK, High KP, Sawyer RG, et al. A controlled trial of scheduled replacement of central venous and pulmonary-artery catheters. The New England Journal of Medicine. 1992;327:1062–1068
  36. Yilmaz G, Koksal I, Aydin K, et al. Risk factors of catheter-related bloodstream infections in parenteral nutrition catheterization. JPEN. Journal of Parenteral and Enteral Nutrition. 2007;31:284–287
  37. Opilla MT, Kirby DF, Edmond MB. Use of ethanol lock therapy to reduce the incidence of catheter-related bloodstream infections in home parenteral nutrition patients. JPEN. Journal of Parenteral and Enteral Nutrition. 2007;31:302–305
  38. Melly MA, Meng HC, Schaffner W. Microbiol growth in lipid emulsions used in parenteral nutrition. Archives of Surgery (Chicago, Ill. : 1960). 1975;110:1479–1481
  39. Zurcher M, Tramer MR, Walder B. Colonization and bloodstream infection with single- versus multi-lumen central venous catheters: a quantitative systematic review. Anesthesia and Analgesia. 2004;99:177–182
  40. Timsit JF, Farkas JC, Boyer JM, et al. Central vein catheter-related thrombosis in intensive care patients: incidence, risks factors, and relationship with catheter-related sepsis. Chest. 1998;114:207–213
  41. Robert J, Fridkin SK, Blumberg HM, et al. The influence of the composition of the nursing staff on primary bloodstream infection rates in a surgical intensive care unit. Infection Control and Hospital Epidemiology. 2000;21:12–17
  42. Hugonnet S, Chevrolet JC, Pittet D. The effect of workload on infection risk in critically ill patients. Critical Care Medicine. 2007;35:76–81
  43. Maki DG, Ringer M, Alvarado CJ. Prospective randomised trial of povidone-iodine, alcohol, and chlorhexidine for prevention of infection associated with central venous and arterial catheters. Lancet. 1991;338:339–343
  44. Mimoz O, Pieroni L, Lawrence C, et al. Prospective, randomized trial of two antiseptic solutions for prevention of central venous or arterial catheter colonization and infection in intensive care unit patients. Critical Care Medicine. 1996;24:1818–1823
  45. Karakitsos D, Labropoulos N, De Groot E, et al. Real-time ultrasound-guided catheterisation of the internal jugular vein: a prospective comparison with the landmark technique in critical care patients. Critical Care (London, England). 2006;10:R162
  46. Gastmeier P, Menzel K, Sohr D, Ruden H. Usefulness of severity-of-illness scores based on admission data only in nosocomial infection surveillance systems. Infection Control and Hospital Epidemiology. 2007;28:453–458
  47. Richards MJ, Edwards JR, Culver DH, Gaynes RP. Nosocomial infections in pediatric intensive care units in the United States. National Nosocomial Infections Surveillance System. Pediatrics. 1999;103:e39
  48. Elward AM, Fraser VJ. Risk factors for nosocomial primary bloodstream infection in pediatric intensive care unit patients: a 2-year prospective cohort study. Infection Control and Hospital Epidemiology. 2006;27:553–560
  49. Aly H, Herson V, Duncan A, et al. Is bloodstream infection preventable among premature infants? A tale of two cities. Pediatrics. 2005;115:1513–1518
  50. Geffers C, Baerwolff S, Schwab F, Gastmeier P. Incidence of healthcare-associated infections in high-risk neonates: results from the German surveillance system for very-low-birthweight infants. The Journal of Hospital Infection. 2008;68:214–221
  51. Safdar N, Maki DG. Inflammation at the insertion site is not predictive of catheter-related bloodstream infection with short-term, noncuffed central venous catheters. Critical Care Medicine. 2002;30:2632–2635
  52. Safdar N, Fine JP, Maki DG. Meta-analysis: methods for diagnosing intravascular device-related bloodstream infection. Annals of Internal Medicine. 2005;142:451–466
  53. Maki DG, Weise CE, Sarafin HW. A semiquantitative culture method for identifying intravenous-catheter-related infection. The New England Journal of Medicine. 1977;296:1305–1309
  54. Cleri DJ, Corrado ML, Seligman SJ. Quantitative culture of intravenous catheters and other intravascular inserts. The Journal of Infectious Diseases. 1980 Jun;141(6):781–786
  55. Brun Buisson C, Rauss A, Legrand P. Semiquantitative culture of catheter tips. Journal of Clinical Microbiology. 1987;25:1343–1344
  56. Sherertz RJ, Raad II, Belani A, et al. Three-year experience with sonicated vascular catheter cultures in a clinical microbiology laboratory. Journal of Clinical Microbiology. 1990;28:76–82
  57. Raad II, Sabbagh MF, Rand KH, Sherertz RJ. Quantitative tip culture methods and the diagnosis of central venous catheter-related infections. Diagnostic Microbiology and Infectious Disease. 1992;15:13–20
  58. Brun-Buisson C, Abrouk F, Legrand P, et al. Diagnosis of central venous catheter-related sepsis. Critical level of quantitative tip cultures. Archives of Internal Medicine. 1987;147:873–877
  59. Gowardman JR, Montgomery C, Thirlwell S, et al. Central venous catheter-related bloodstream infections: an analysis of incidence and risk factors in a cohort of 400 patients. Intensive Care Medicine. 1998;24:1034–1039
  60. Ekkelenkamp MB, van der Bruggen T, van de Vijver DA, et al. Bacteremic complications of intravascular catheters colonized with Staphylococcus aureus. Clinical Infectious Diseases. 2008;46:114–118
  61. Coutlee F, Lemieux C, Paradis JF. Value of direct catheter staining in the diagnosis of intravascular-catheter-related infection. Journal of Clinical Microbiology. 1988;26:1088–1090
  62. Zufferey J, Rime B, Francioli P, Bille J. Simple method for rapid diagnosis of catheter-associated infection by direct acridine orange staining of catheter tips. Journal of Clinical Microbiology. 1988;26:175–177
  63. Capdevila JA, Planes AM, Palomar M, et al. Value of differential quantitative blood cultures in the diagnosis of catheter-related sepsis. European Journal of Clinical Microbiology & Infectious Diseases. 1992;11:403–407
  64. Siegman-Igra Y, Anglim AM, Shapiro DE, et al. Diagnosis of vascular catheter-related bloodstream infection: a meta-analysis. Journal of Clinical Microbiology. 1997;35:928–936
  65. Blot F, Nitenberg G, Chachaty E, et al. Diagnosis of catheter-related bacteraemia: a prospective comparison of the time to positivity of hub-blood versus peripheral-blood cultures. Lancet. 1999;354:1071–1077
  66. Raad I, Hanna HA, Alakech B, et al. Differential time to positivity: a useful method for diagnosing catheter-related bloodstream infections. Annals of Internal Medicine. 2004;140:18–25
  67. Guerti K, Ieven M, Mahieu L. Diagnosis of catheter-related bloodstream infection in neonates: a study on the value of differential time to positivity of paired blood cultures. Pediatric Critical Care Medicine. 2007;8:470–475
  68. Shah SS, Downes KJ, Elliott MR, et al. How long does it take to “rule out” bacteremia in children with central venous catheters?. Pediatrics. 2008;121:135–141
  69. Rushforth JA, Hoy CM, Kite P, Puntis JW. Rapid diagnosis of central venous catheter sepsis. Lancet. 1993;342:402–403
  70. Kite P, Dobbins BM, Wilcox MH, McMahon MJ. Rapid diagnosis of central-venous-catheter-related bloodstream infection without catheter removal. Lancet. 1999;354:1504–1507
  71. Millar MR, Johnson G, Wilks M, et al. Molecular diagnosis of vascular access device-associated infection in children being treated for cancer or leukaemia. Clinical Microbiology and Infection. 2008;14:213–220
  72. Blot SI, Depuydt P, Annemans L, et al. Clinical and economic outcomes in critically ill patients with nosocomial catheter-related bloodstream infections. Clinical Infectious Diseases. 2005;41:1591–1598
  73. Pittet D, Tarara D, Wenzel RP. Nosocomial bloodstream infection in critically ill patients. Excess length of stay, extra costs, and attributable mortality. JAMA : The Journal of the American Medical Association. 1994;271:1598–1601
  74. Halton K, Graves N. Economic evaluation and catheter-related bloodstream infections. Emerging Infectious Diseases. 2007;13:815–823
  75. Das I, Philpott C, George RH. Central venous catheter-related septicaemia in paediatric cancer patients. The Journal of Hospital Infection. 1997;36:67–76
  76. Pronovost P, Needham D, Berenholtz S, et al. An intervention to decrease catheter-related bloodstream infections in the ICU. The New England Journal of Medicine. 2006;355:2725–2732
  77. Lindblad B, Wolff T. Infectious complications of percutaneously inserted central venous catheters. Acta Anaesthesiologica Scandinavica. 1985;29:587–589
  78. Raad II, Hohn DC, Gilbreath BJ, et al. Prevention of central venous catheter-related infections by using maximal sterile barrier precautions during insertion. Infection Control and Hospital Epidemiology. 1994;15:231–238
  79. Berenholtz SM, Pronovost PJ, Lipsett PA, et al. Eliminating catheter-related bloodstream infections in the intensive care unit. Critical Care Medicine. 2004;32:2014–2020
  80. Tsuchida T, Makimoto K, Toki M, et al. The effectiveness of a nurse-initiated intervention to reduce catheter-associated bloodstream infections in an urban acute hospital: an intervention study with before and after comparison. International Journal of Nursing Studies. 2007;44:1324–1333
  81. Eggimann P, Harbarth S, Constantin MN, et al. Impact of a prevention strategy targeted at vascular-access care on incidence of infections acquired in intensive care. Lancet. 2000;355:1864–1868
  82. Falagas ME, Fragoulis K, Bliziotis IA, Chatzinikolaou I. Rifampicin-impregnated central venous catheters: a meta-analysis of randomized controlled trials. The Journal of Antimicrobial Chemotherapy. 2007;59:359–369
  83. Abdelkefi A, Ben Othman T, Kammoun L, et al. Prevention of central venous line-related thrombosis by continuous infusion of low-dose unfractionated heparin, in patients with haemato-oncological disease. A randomized controlled trial. Thrombosis and Haemostasis. 2004;92:654–661
  84. Abdelkefi A, Achour W, Ben Othman T, et al. Use of heparin-coated central venous lines to prevent catheter-related bloodstream infection. The Journal of Supportive Oncology. 2007;5:273–278
  85. van Rooden CJ, Schippers EF, Guiot HF, et al. Prevention of coagulase-negative staphylococcal central venous catheter-related infection using urokinase rinses: a randomized double-blind controlled trial in patients with hematologic malignancies. The Journal of Supportive Oncology. 2008;26:428–433
  86. Dillon PW, Jones GR, Bagnall-Reeb HA, et al. Prophylactic urokinase in the management of long-term venous access devices in children: a Children's Oncology Group study. The Journal of Supportive Oncology. 2004;22:2718–2723
  87. Kalmanti M, Germanakis J, Stiakaki E, et al. Prophylaxis with urokinase in pediatric oncology patients with central venous catheters. Pediatric Hematology and Oncology. 2002;19:173–179
  88. Eggimann P, Hugonnet S, Sax H, et al. Long-term reduction of vascular access-associated bloodstream infection. Annals of Internal Medicine. 2005;142:875–876
  89. Valiquette L, Cossette B, Garant MP, et al. Impact of a reduction in the use of high-risk antibiotics on the course of an epidemic of Clostridium difficile-associated disease caused by the hypervirulent NAP1/027 strain. Clinical Infectious Diseases. 2007;45:S112–S121
  90. McKibben L, Horan T, Tokars JI, et al. Guidance on public reporting of healthcare-associated infections: recommendations of the Healthcare Infection Control Practices Advisory Committee. American Journal of Infection Control. 2005;33:217–226
  91. Trick WE, Zagorski BM, Tokars JI, et al. Computer algorithms to detect bloodstream infections. Emerging Infectious Diseases. 2004;10:1612–1620
  92. Cook D, Randolph A, Kernerman P, et al. Central venous catheter replacement strategies: a systematic review of the literature. Critical Care Medicine. 1997;25:1417–1424
  93. Chen HS, Wang FD, Lin M, et al. Risk factors for central venous catheter-related infections in general surgery. Journal of Microbiology, Immunology, and Infection. 2006;39:231–236
  94. Soufir L, Timsit JF, Mahe C, et al. Attributable morbidity and mortality of catheter-related septicemia in critically ill patients: a matched, risk-adjusted, cohort study. Infection Control and Hospital Epidemiology. 1999;20:396–401
  95. Digiovine B, Chenoweth C, Watts C, Higgins M. The attributable mortality and costs of primary nosocomial bloodstream infections in the intensive care unit. American journal of Respiratory and Critical Care Medicine. 1999;160:976–981
  96. Rello J, Ochagavia A, Sabanes E, et al. Evaluation of outcome of intravenous catheter-related infections in critically ill patients. American Journal of Respiratory and Critical Care Medicine. 2000;162:1027–1030
  97. Pelletier SJ, Crabtree TD, Gleason TG, et al. Bacteremia associated with central venous catheter infection is not an independent predictor of outcomes. Journal of the American College of Surgeons. 2000;190:671–680
  98. Renaud B, Brun-Buisson C. Outcomes of primary and catheter-related bacteremia. A cohort and case-control study in critically ill patients. American Journal of Respiratory and Critical Care Medicine. 2001;163:1584–1590
  99. Rosenthal VD, Guzman S, Migone O, et al. The attributable cost, length of hospital stay, and mortality of central line-associated bloodstream infection in intensive care departments in Argentina: A prospective, matched analysis. American Journal of Infection Control. 2003;31:475–480

 Disclosures: This review was funded with departmental and institutional support.

PII: S1521-6896(08)00051-7

doi: 10.1016/j.bpa.2008.05.007

Best Practice & Research Clinical Anaesthesiology
Volume 22, Issue 3 , Pages 407-421 , September 2008