CRBSIs (catheter-related bloodstream infections) 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 (CVADs). Nevertheless, the incidence of CRBSI in Europe is 1.1 – 4.2 per 1000 catheter days despite the most varied preventive measures and the mortality of CRBSI is still between 5 and 25%.(1, 2, 3) The risk of CRBSI increases steadily depending on the duration of catheterisation. Already 24 hours after insertion of a CVAD, the vascular device can be coated with a biofilm. This typically consists of polysaccharides, fibrin, fibronectin or laminin and is formed by both microorganisms and endogenous substances.(4)
Microorganisms can reach the bloodstream via the outer surface of the CVAD or through the lumen; they lodge in the biofilm and are protected against immune mechanisms (phagocytosis, antibodies) and also partially against antibiotics. Gram-positive bacteria are responsible for about 50 – 70 % of CRBSI. 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 microorganisms were coagulase-negative staphylococci, Staphylococcus aureus, Candida spp., Enterococcus spp. and Pseudomonas spp. (5)
- Mermel, L. A. (2001). “New technologies to prevent intravascular catheter-related bloodstream
- infections.” Emerg Infect Dis 7(2): 197–9.
- Munoz, P., E. Bouza, et al. (2004). “Clinical-epidemiological characteristics and outcome
- of patients with catheter-related bloodstream infections in Europe (ESGNI-006 Study).” Clin Microbiol Infect 10(9): 843-5.
- Tacconelli, E., G. Smith, et al. (2009). “Epidemiology, medical outcomes and costs of catheter-
- related bloodstream infections in intensive care units of four European countries: literature- and registry-based estimates.” J Hosp Infect 72(2): 97–103.
- Donlan, R. M., Costerton J. W. (2002). “Biofilms: Survival mechanisms of clinically relevant
- microorganisms.” CMR.15.2.167–193.
- Bouza, E., R. San Juan, 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(9): 838–42.