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Semin Respir Crit Care Med 2011; 32(2): 139-150
DOI: 10.1055/s-0031-1275526
© Thieme Medical Publishers

New Challenges in the Diagnosis, Management, and Prevention of Central Venous Catheter–Related Infections

Jean-François Timsit1 , 2 , Yohann Dubois1 , Clémence Minet1 , Agnès Bonadona1 , Maxime Lugosi1 , Claire Ara-Somohano1 , 2 , Rebecca Hamidfar-Roy1 , Carole Schwebel1
  • 1University Hospital Albert Michalon, Medical ICU, Grenoble, France
  • 2University Joseph Fourier, Albert Bonniot Institute, Grenoble, France
Further Information

Publication History

Publication Date:
19 April 2011 (online)

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ABSTRACT

Catheters are the leading source of bloodstream infections in critically ill patients. Because the clinical signs of infection are nonspecific, such infections are overly suspected, which results in unnecessary removal of catheters. A conservative approach might be attempted in mild infections, whereas catheters should always be removed in cases of severe sepsis or septic shock. Nowadays, comprehensive unit-based improvement programs are effective to reduce catheter-related bloodstream infections (CR-BSIs). Rates of CR-BSI higher than 2 per 1000 catheter-days are no longer acceptable. A locally adapted checklist of preventive measures should include cutaneous antisepsis with alcoholic preparation, maximal barrier precaution, strict policy of catheter maintenance, and ablation of useless catheters. Antiseptic dressings and, to a lesser extent, antimicrobial-coated catheters, might be added to the prevention strategies if the level of infections remains high despite implementation of a prevention program. In the case of CR-BSI in intensive care units (ICUs), the catheter should be removed. In the case of persistence of fever or positive blood cultures after 3 days, inadequate antibiotic therapy, endocarditis, or thrombophlebitis should be ruled out.

KEYWORDS

Catheter-related infection - prevention - diagnosis - therapy

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Jean-François TimsitM.D. Ph.D. 

University Hospital Albert Michalon, BP 217

38043 Grenoble CEDEX 9, France

Email: jftimsit@chu-grenoble.fr

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