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New Approaches for Prevention of Intravascular Catheter-Related Infections

from Infections in Medicine ®

Hend Hanna, MD, MPH, Issam Raad, MD, The University of Texas M. D. Anderson Cancer Center, Houston; Rabih Darouiche, MD, Baylor College of Medicine, Houston

Abstract and Introduction

Abstract An estimated 300,000 cases of catheter-related bloodstream infection (CRBSI) will occur in the United States this year. Newer interventions to control CRBSI include anticoagulant/antimicrobial lock, use of ionic silver at the insertion site, employment of an aseptic hub model, and antimicrobial impregnation of catheters. Patients most likely to benefit from these strategies are those at the highest risk for bloodstream infections and those in whom such infections would result in the greatest morbidity and mortality.

Introduction The progress of modern medicine has been advanced, in part, by the wide use of invasive medical devices, including intravascular catheters. However, intravascular catheters are often associated with serious infectious complications, such as catheter-related bloodstream infection (CRBSI).[1] In fact, CRBSI is considered to be the most common type of nosocomial bloodstream infection, a finding that has been attributed to the wide use of intravascular catheters in hospitalized patients.[2,3]

It is estimated that 7 million central venous catheters (CVCs) will be inserted annually in the United States. Even with the best available aseptic techniques being used during insertion and maintenance of the catheter, 1 of every 20 CVCs inserted will be associated with at least 1 episode of bloodstream infection.[4]

Therefore, it is estimated that more than 300,000 episodes of CVC-related bloodstream infections will occur annually in the United States over the next few years.[5] Pittet and colleagues[6] recently estimated the attributable mortality rate of such infections in critically ill patients to be 25%. Each episode of CRBSI will cost $28,690 per survivor and result in an additional average stay of 6.5 days in the ICU.

The high morbidity, mortality, and cost attributed to CRBSI are the driving forces underlying the search for new preventive approaches associated with novel technologic innovations. However, new preventive approaches that are shown to be clinically efficacious must be based on our advanced understanding of the pathogenesis of catheter-related infections in human subjects. Therefore, before describing these preventive approaches, it is appropriate to highlight the mechanisms through which catheters become colonized and ultimately cause bloodstream infections.

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