Catheter-Related Bloodstream Infections
Document Type
Book Chapter
Publication Date
4-2025
Identifier
DOI: 10.1007/978-3-031-84089-0_42
Abstract
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 local or systemic complications. Quantitative and semiquantitative blood cultures can determine whether a catheter is infected, but these methods necessitate catheter removal and are not always available. When there is motivation to retain the catheter, 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 staphylococci, such as Staphylococcus epidermidis, have traditionally been the most common microbiologic cause of CRBSI, although recent data suggest an increase in Enterococci, Enterobacteriaceae, and Candida species. Some etiologic agents can be particularly virulent, leading to signs of sepsis. Complications of CRBSIs can be localized (e.g., skin and soft tissue infection at the catheter insertion site) or disseminated (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 it while administering appropriate antimicrobials. 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 or salvage 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 the effort will be successful. Salvaging the catheter is possible in many circumstances, although certain bacteria such as Pseudomonas species, and fungi, are virtually impossible to clear without removal of the infected catheter. 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.
Journal Title
Introduction to Clinical Infectious Diseases
First Page
463
Last Page
475
Keywords
Central venous catheters; Bloodstream infections; CLABSI: Central line-associated infection; CRBSI: Catheter-related bloodstream infection; Line infection
Recommended Citation
Lyon, E., El Feghaly, R.E. (2025). Catheter-Related Bloodstream Infections. In: Domachowske, J.B. (eds) Introduction to Clinical Infectious Diseases. Springer, Cham. https://doi.org/10.1007/978-3-031-84089-0_42
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