title: New challenges in the diagnosis, management, and prevention of central venous catheter-related infections.
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.
authors.affiliation: University Hospital Albert Michalon, Medical ICU, Grenoble, France. jftimsit@chu-grenoble.fr
authors.forename: Jean-François
authors.initials: JF
authors.lastname: Timsit
authors.forename: Yohann
authors.initials: Y
authors.lastname: Dubois
authors.forename: Clémence
authors.initials: C
authors.lastname: Minet
authors.forename: Agnès
authors.initials: A
authors.lastname: Bonadona
authors.forename: Maxime
authors.initials: M
authors.lastname: Lugosi
authors.forename: Claire
authors.initials: C
authors.lastname: Ara-Somohano
authors.forename: Rebecca
authors.initials: R
authors.lastname: Hamidfar-Roy
authors.forename: Carole
authors.initials: C
authors.lastname: Schwebel
mesh_terms: D000890:Anti-Infective Agents / Q000627:therapeutic use*; D055499:Catheter-Related Infections / Q000175:diagnosis / Q000188:drug therapy* / Q000517:prevention & control; D002405:Catheterization, Central Venous / Q000009:adverse effects*; D016638:Critical Illness; D020878:Device Removal / Q000379:methods; D006801:Humans; D007362:Intensive Care Units; D018805:Sepsis / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology; D012720:Severity of Illness Index; D012772:Shock, Septic / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology
chemical_list: D000890:Anti-Infective Agents