Catheter-related bloodstream infections (CRBSIs): Fever in a patient who has a central venous catheter in place
Catheter-related bloodstream infections (CRBSIs) are common causes of hospital-associated illness. Although their rates have been declining over the past decades, they still contribute to significant morbidity and mortality and excess costs. CRBSIs usually present as fever without an apparent source but may be accompanied by suppurative complications at the insertion site of the catheter or evidence of hematogenous spread to other tissues and organs. Quantitative and semiquantitative blood cultures are usually performed to determine whether a catheter is infected, but if these methods are not available, and there is motivation to retain a catheter that might be infected, blood cultures of the same volume can be collected from a peripheral vein and from the catheter and then monitored for differential time to positivity. Coagulase-negative Staphlyococci, such as Staphylococcus epidermidis, are the most common microbiologic cause of CRBSI, although a vast array of different bacterial and fungal species have also been reported. Some etiologic agents can be particularly virulent, leading to signs of sepsis. Complications of CRBSIs include skin and soft tissue infection at the catheter insertion site. The bacteremia (or fungemia) associated with the contaminated intravascular device can lead to hematogenous seeding and infection of distal sites such as the cardiac valves, lungs, muscles, bones, and joints. The ideal treatment for any contaminated, implanted medical device, including intravascular catheters, is to remove them while administering appropriate antibiotics or antifungal medications. Bacterial and fungal contamination (infection) of medical hardware is notoriously difficult to eradicate using anti-infective medications alone. In many cases however, it may be impossible or impractical to remove an infected catheter.
The length of anti-infective therapy is dictated by the causative organism, the patient’s clinical response once antimicrobials are started, the presence of local or distant complications, and whether the infected catheter is retained or not. Decisions to retain infected catheters while attempting to eradicate the infection with antibiotics should always be made thoughtfully, considering the risks of complications that may arise during that effort and the likelihood that the effort will be successful. Salvaging the catheter is possible in many circumstances, although certain bacteria, such as Staphylococcus aureus and Pseudomonas species, and all fungi are virtually impossible to clear. The rate of metastatic infection complications caused by these, and other virulent pathogens, correlates directly with the length of time elapsed before the catheter is removed. Other feared complications include sepsis, tunnel-tract infections, pocket site infections, and suppurative thrombophlebitis. The presence of any one of these complications should prompt immediate efforts to remove the infected device. Many hospitals have been successful in decreasing their rates or even eliminating central line-associated bloodstream infections (CLABSIs) by using combinations of preventive strategies referred to as “bundle” approaches.
Introduction to Clinical Infectious Diseases
Central venous catheters; Bloodstream infections; CLABSI; Central line-associated infection; CRBSI; Catheter-related bloodstream infection; Line infection
Inagaki K., El Feghaly R.E. (2019) Catheter-Related Bloodstream Infections (CRBSIs). In: Domachowske J. (eds) Introduction to Clinical Infectious Diseases. Springer, Cham. https://doi.org/10.1007/978-3-319-91080-2_29