CRBSIs (catheter-related bloodstream infection) continue to be associated with considerable morbidity and mortality and cause high treatment costs.
Optimal avoidance of infection and infection control are an absolute necessity when dealing with central vascular access devices (CVAD). Nevertheless, the incidence of CRBSI in Europe is 1.5–2 per 1000 catheter days despite the most varied preventive measures and the mortality of CRBSI is still between 5 and 25%. The risk of a catheter infection or CRBSI increases steadily depending on the duration of catheterisation. Just 24 hours after insertion of a CVAD, the vascular device becomes coated with a biofilm. This consists of polysaccharides, fibrin, fibronectin or laminin and is formed by both micro-organisms and endogenous substances1,2.
Bacteria can reach the bloodstream via the outer surface of the catheter or through the lumen of the CVAD or through the lumen of the CVAD; they lodge in the biofilm and are protected there against immune mechanisms (phagocytosis, antibodies) and also partially against antibiotics. Gram-positive bacteria are responsible for about 50 – 70% of CRBSIs. In a European CRBSI prevalence study, gram-positive bacteria were detected in 71%, gram-negative bacteria in 22% and fungi in 7%. The 5 most common micro-organisms were coagulase-negative staphylococci, Staphylococcus aureus, Candida spp., Enterococcus spp. and Pseudomonas spp(3).
- Mermel LA. (2000). Prevention of intravascular catheter-related infections. Ann Intern. Med132:391-402.
- Munoz P., Bouza E., San Juan R. Et al. (2004). Co-Operative Group of the European StudyGroup on Nosocomial. Inf ections (ESGNI): Clinical epidemiological characteristics and outcome of patients with catheter-related bloodstream infections in. Europe (ESGNI-006 Study). Clin.Microbiol. Infect.10: 843–5.
- Bouza E.,et al. (2004). A European perspective on intravascular catheter-related infections:report on the microbiology workload, aetiology and antimicrobial susceptibility. (ESGNI-005 Study). Clin. Microbiol. Infect.10: 838–42.