Newer Approaches to Preventing Vascular Catheter-Related Sepsis

  • Rabih O. Darouiche
Part of the Perspectives on Critical Care Infectious Diseases book series (CCID, volume 5)

Abstract

Despite our enhanced understanding of the pathogenesis and risk factors predisposing to infection of vascular catheters, bloodstream infection remains the most common serious complication of such intravascular devices. Most nosocomial cases of bloodstream infection are associated with the use of intravascular devices, which account for at least 200,000 such cases each year in the U.S. (1,2). The contribution of vascular catheters to sepsis is particularly prominent in the intensive care unit (ICU) setting where, for instance, patients with indwelling intravascular devices have substantially higher rates of bloodstream infection than those without such devices (3). Although ICU patients may require the insertion of different types of intravascular catheters, including peripheral arterial catheters, pulmonary artery catheters, peripheral venous catheters, and central venous catheters, the latter account for most cases of catheter-related bloodstream infection. The mortality attributable to catheter-related bloodstream infection in ICU patients approaches 25%, and patients who survive such an infection are hospitalized for a mean of 6.5 days longer than those who do not develop such an infection (4). The management of catheter-related bloodstream infections can be very expensive as it reportedly costs an additional mean of $29,000 to treat one such episode in ICU patients (4).

Keywords

Catheter Heparin Pseudomonas Vancomycin Polyurethane 

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. 1.
    Darouiche RO, Raad II, Heard SO, et al. A comparison of two antimicrobial-impregnated central venous catheters. N Eng J Med. 1999;340:1–8.CrossRefGoogle Scholar
  2. 2.
    Raad I,Darouiche R, Dupuis J, et al. Central venous catheters coated with minocycline and rifampin for the prevention of catheter-related colonization and bloodstream infections: a randomized, double-blind trial. Ann Intern Med. 1997;127:267–274.PubMedGoogle Scholar
  3. 3.
    Jarvis WR, Edwards JR, Culver DH, et al. Nosocomial infection rates in adult and pediatric intensive care units in the United States. Am J Med.1991;91(Suppl.):185S–191S.Google Scholar
  4. 4.
    Pittet D, Tarara D, Wenzel RE Nosocomial bloodstream infection in critically ill patients: Excess length of stay, extra costs, and attributable mortality. JAMA. 1994;271:1598–1601.PubMedCrossRefGoogle Scholar
  5. 5.
    Raad II, Bodey GP. Infectious complications of indwelling vascular catheters. Clin Infect Dis. 1992;15: 197–210.PubMedCrossRefGoogle Scholar
  6. 6.
    Costerton JW, Stewart PS, Greenberg EP. Bacterial biofilms• a common cause of persistent infecdons. Science. 1999;284:1318–1322.PubMedCrossRefGoogle Scholar
  7. 7.
    Jensen ET, Kharazmi A, Lam K, Costerton JW, Hoiby N. Human polymorphonuclear leukocyte response to Pseudomonas aeruginosa grown in biofilms Infect. Immun. 1990;58:2383–2385.PubMedGoogle Scholar
  8. 8.
    Hoyle BD, Alcantara J, Costerton JW. Pseudomonas aeruginosa biofilm as a diffusion barrier to piperacillin. Antimicrob Agents Chemother. 1992;36:2054–2056.PubMedCrossRefGoogle Scholar
  9. 9.
    Kumon H, Tomochika K, Matunaga T, Ogawa M, Ohmori H. A sandwich cup method for the penetration assay of antimicrobial agents through Pseudomonas exopolysaccharides. Microbiol Immunol. 1994;38:615–619.PubMedGoogle Scholar
  10. 10.
    Stewart PS. Biofilm accumulation model that predicts antibiotic resistance of Pseudomonas aeruginosa biofilms. Antimicrob Agents Chemother. 1994;38:1052–1058.CrossRefGoogle Scholar
  11. 11.
    Darouiche RO, Dhir A, Miller AJ, Landon GC, Raad II, Musher DM. Vancomycin penetration into biofilm covering infected prostheses and effect on bacteria. J Infect Dis. 1994;170:720–723.PubMedCrossRefGoogle Scholar
  12. 12.
    Maki DG, Cobb L, Garman JK, Shapiro JM, Ringer M, Helgerson RB. An attachable silver-impregnated cuff for prevention of infection with central venous catheters: a prospective randomized multicenter trial. Am J Med. 1988;85:307–314.PubMedCrossRefGoogle Scholar
  13. 13.
    Bjornson HS, Colley R, Bower RH, Duty VP, Schwartz-Fulton JT, Fisher JE. Association between microorganism growth at the catheter insertion site and colonization of the catheter in patients receiving total parenteral nutrition. Surgery. 1982;192:720–726.Google Scholar
  14. 14.
    Frank MJ, Schaffner W Contaminated aqueous benzalkonium chloride. An unnecessary hospital infection hazard. JAMA. 1976;236:2418–2419.PubMedCrossRefGoogle Scholar
  15. 15.
    Conly JM, Grieves K, Peters B. A prospective, randomized study comparing transparent and dry gauze dressings for central venous catheters. J Infect Dis. 1989;159:310–318.PubMedCrossRefGoogle Scholar
  16. 16.
    Maki DG, Ringer M, Alvarado CJ. Prospective randomized trial of povidone-iodine, alcohol, and chlorhexidine for prevention of infection associated with central venous and arterial catheters. Lancet. 1991;338:339–343.PubMedCrossRefGoogle Scholar
  17. 17.
    Sitges-Serra A, Hernandez R, Maestro S, Pi-Suner T, Garces JM, Segura M. Prevention of catheter sepsis: the hub. Nutrition. 1997;13(suppl.):30S–35S.Google Scholar
  18. 18.
    Raad I, Costerton JW, Sabharwal U, Sacilowski M, Anaissie E, Bodey GP. Ultrastructural analysis of indwelling vascular catheters: a quantitative relationship between luminal colonization and duration of placement. J Infect Dis. 1993;168:400–407.PubMedCrossRefGoogle Scholar
  19. 19.
    Maki DG, Stolz SM, Wheeler S, Mermel LA. Prevention of central venous catheter-related bloodstream infection by use of an antiseptic-impregnated catheter: a randomized, controlled study. Ann Intern Med. 1997;127:257–266.PubMedGoogle Scholar
  20. 20.
    Kamal GD, Pfaller MA, Rempe LE, Jebson PJR. Reduced intravascular catheter infection by antibiotic bonding. JAMA. 1991;265:2364–2368.PubMedCrossRefGoogle Scholar
  21. 21.
    Thornton J, Todd NJ, Webster NR. Central venous line sepsis in the intensive care unit: a study comparing antibiotic coated catheters with plain catheters. Anesthesia. 1996;51:1018–1020.CrossRefGoogle Scholar
  22. 22.
    Maki DG, Band JD. A comparative study of polyantibiotic and iodophor ointments in prevention of vascular catheter-related infection. Am J Med. 1981;70:739–744.PubMedCrossRefGoogle Scholar
  23. 23.
    Bozetti F, Terno G, Bonfanti G, et al. Prevention and treatment of central venous catheter sepsis by exchange via a guidewire: a prospective controlled trial. Ann Surg. 1983;198:48–52.CrossRefGoogle Scholar
  24. 24.
    Gregory JA, Schiller WR. Subclavian catheter changes every third day in high risk patients. Am Surg. 1985;51:534–536.PubMedGoogle Scholar
  25. 25.
    Cobb DK, High KP, Sawyer RG, et al. A controlled trial of scheduled replacement of central venous and pulmonary-artery catheters. N Engl J Med. 1992;327:1062–1068.PubMedCrossRefGoogle Scholar
  26. 26.
    Powell C, Kudsk KA, Kulich Pamandelbaum JA, Fabri PJ. Effect of frequent guidewire exchanges on triple lumen catheter sepsis.JPEN Parenter Enteral Nutr. 1988;12:464–465.Google Scholar
  27. 27.
    Schwartz C, Henrickson KJ, Roghmann K, Powell K. Prevention of bacteremia attributed to luminal colonization of tunneled central venous catheters with vancomycin-susceptible organisms J Clin Oncol. 1990;8:591–597.Google Scholar
  28. 28.
    Rackoff WR, Weiman M, Jakobowski D, et al. A randomized, controlled trial of the efficacy of a heparin and vancomycin solution in preventing central venous catheter infections in children. J Pediatr. 1995;127:147–151.PubMedCrossRefGoogle Scholar
  29. 29.
    Flowers RH III, Schwenzer KJ, Kopel RF, Fisch MJ, Tucker SI, Farr BM. Efficacy of an attachable subcutaneous cuff for the prevention of intravascular catheter-related infection. A randomized, controlled trial. JAMA. 1989;261:878–883.PubMedCrossRefGoogle Scholar
  30. 30.
    Groeger JS, Lucas AB, Coit D, et al. A prospective, randomized evaluation of the effect of silver impregnated subcutaneous cuffs for preventing tunneled chronic venous access catheter infections in cancer patients. Ann Surg. 1993;218:206–210.PubMedCrossRefGoogle Scholar
  31. 31.
    Timsit JF, Sebille V, Farkas JC, et al. Effect of subcutaneous tunneling on internal jugular catheter-related sepsis in critically ill patients: A prospective randomized multicenter study. JAMA. 1996;276: 1416–1420.PubMedCrossRefGoogle Scholar
  32. 32.
    Timsit JF, Bruneel F, Cheval C, et al. Use of tunneled femoral catheters to prevent catheter-related infection: A randomized, controlled trial. Ann Intern Med. 1999;130:729–735.PubMedGoogle Scholar
  33. 33.
    Randolph AG, Cook DJ, Gonzales CA, Brun-Buisson C. Tunneling of short-term central venous catheters to prevent catheter-related infection: a meta-analysis of randomized, controlled trials. Crit Care Med. 1998;26:1452–1457.PubMedCrossRefGoogle Scholar
  34. 34.
    Andrivet P, Bacquer A, Ngoc CV, et al. Lack of clinical benefit from subcutaneous tunnel insertion of central venous catheters in immunocompromised patients. Clin Infect Dis. 1994;18:199–206.PubMedCrossRefGoogle Scholar
  35. 35.
    Von Meyenfeldt MMF, Stapert J, de Jong PCM, et al. TPN catheter sepsis: lack of effect of subcutaneous tunneling of PVC catheters on sepsis rate. JPEN J Parent Enter Nutr. 1980;4:514–517.CrossRefGoogle Scholar
  36. 36.
    Moran KT, McEntee G, Jones B, et al. To tunnel or not to tunnel catheters for parenteral nutrition. Ann R Coll Surg. 1987;69:235–236.Google Scholar
  37. 37.
    Nelson DB, Kien CL, Mohr B, et al. Dressing changes by specialized personnel reduce infection rates in patients receiving central venous parenteral nutrition.JPENJ Parenter Enteral Nutr. 1986;10: 220–222.CrossRefGoogle Scholar
  38. 38.
    Faubion WC, Wesley JR, Khalidi N, Silva J. Total parenteral nutrition catheter sepsis: impact of the team approach. JPEN J Parenter Enteral Nutr. 1986;10:642–645.PubMedCrossRefGoogle Scholar
  39. 39.
    Tomford JW, Hershey CO, McLaren CE, Porter DK, Cohen DI. Intravenous therapy team and peripheral venous catheter-associated complications. A prospective controlled study. Arch Intern Med. 1984;144:1191–1194.PubMedCrossRefGoogle Scholar
  40. 40.
    Raad II, Hohn DC, Gilbreath BJ, et al. Prevention of central venous catheter-related infections by using maximal sterile barrier precautions during insertion. Infect Control Hosp Epidemiol. 1994;15:231–238.PubMedCrossRefGoogle Scholar
  41. 41.
    Mermel LA, McCormick RD, Springman SR, Maki DG. The pathogenesis and epidemiology of catheter-related infection with pulmonary artery Swan-Ganz catheters: a prospective study utilizing molecular subtyping. Am J Med. 1991;91(suppl. 3B):197S–205S.PubMedCrossRefGoogle Scholar
  42. 42.
    Segura M, Alvarez-Lerma F, Tellado JM, et al. Advances in surgical technique: a clinical trial on the prevention of catheter-related sepsis using a new hub model. Ann Surg. 1996;223:363–369.PubMedCrossRefGoogle Scholar
  43. 43.
    Heard SO, Wagle M, Vijayakumar E, et al. The influence of triple-lumen central venous catheters coated with chlorhexidine/silversulfadiazine on the incidence of catheter-related bacteremia: a randomized, controlled clinical trial. Arch Intern Med. 1998;158;81–87.PubMedCrossRefGoogle Scholar
  44. 44.
    Ciresi D, Albrecht RM,Volkers PA, Scholten DJ. Failure of an antiseptic bonding to prevent central venous catheter-related infection and sepsis. Am Surg.1996;62:641–646.PubMedGoogle Scholar
  45. 45.
    Veenstra DL, Saint S, Saha S, Lumley T, Sullivan SD. Efficacy of antiseptic-impregnated central venous catheters in preventing catheter-related bloodstream infection. JAMA. 1999;281:261–267.PubMedCrossRefGoogle Scholar
  46. 46.
    Veenstra DL, Saint S, Sullivan SD. Cost-effectiveness of antiseptic-impregnated central venous catheters for the prevention of catheter-related bloodstream infection. JAMA. 1999;282:554–560.PubMedCrossRefGoogle Scholar
  47. 47.
    Logghe C, Van Ossel C, D’Hoore W, Ezzedine H, Wauters G, Haxhe JJ. Evaluation of chlorhexidine and silver-sulfadiazine impregnated central venous catheters for the prevention of bloodstream infection in leukemic patients: a randomized controlled trial. J Hosp Infect. 1997;37:145–156.PubMedCrossRefGoogle Scholar
  48. 48.
    Raad I, Darouiche R, Hachem R, Mansouri M, Bodey GP. The broad spectrum activity and efficacy of catheters coated with minocycline and rifampin. J Infect Dis. 1996;173:418–424.PubMedCrossRefGoogle Scholar
  49. 49.
    Widmer AF, Frei R, Rajacic Z, Zimmerli W. Correlation between in vivo and in vitro efficacy of antimicrobial agents against foreign body infections. J Infect Dis. 1990;162:96–102.PubMedCrossRefGoogle Scholar
  50. 50.
    Raad II, Darouiche RO, Hachem R, et al. Antimicrobial durability and rare ultrastructural colonization of indwelling central catheters coated with minocycline and rifampin. Crit Care Med. 1998;26:219–224.PubMedCrossRefGoogle Scholar
  51. 51.
    Garrett DO, Jochimsen E, Murfitt K, et al. The emergence of decreased susceptibility to vancomycin in Staphylococcus epidermidis. Infect Contr Hosp Epidemiol. 1999;20:167–170.CrossRefGoogle Scholar
  52. 52.
    Fridkin SK, Edwards JR, Pichette SC, at al. Determinants of vancomycin use in adult intensive care units in 41 United States Hospitals. Clin Infect Dis.1999;28:1119–1125.PubMedCrossRefGoogle Scholar
  53. 53.
    Sieradzki K, Roberts RB, Haber SW, Tomasz A. The development of vancomycin resistance in a patient with methicillin-resistant Staphylococcus aureus infection. N Engl J Med. 1999;340:517–523.PubMedCrossRefGoogle Scholar
  54. 54.
    Smith TL, Pearson ML, Wilcox KR, et al. Emergece of vancomycin resistance in Staphylococcus aureus. N Engl J Med 1999;340:493–501.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2001

Authors and Affiliations

  • Rabih O. Darouiche
    • 1
  1. 1.Baylor College of Medicine and Veterans Affairs Medical CenterHoustonUSA

Personalised recommendations