Diagnosis of intravascular catheter-related infections
- Jeffrey D Band, MD, FACP, FIDSA
Jeffrey D Band, MD, FACP, FIDSA
- Attending Physician, Section of Infectious Diseases and International Medicine
- Beaumont Hospital-Royal Oak, MI
- Professor of Medicine
- Oakland University William Beaumont School of Medicine
- Section Editors
- Anthony Harris, MD, MPH
Anthony Harris, MD, MPH
- Section Editor — Hospital Acquired Infections
- Professor of Medicine
- University of Maryland School of Medicine
- Sheldon L Kaplan, MD
Sheldon L Kaplan, MD
- Editor-in-Chief — Pediatrics
- Section Editor — Pediatric Infectious Diseases
- Professor and Vice Chairman for Clinical Affairs
- Baylor College of Medicine
Approximately 80,000 central venous catheter–related bloodstream infections occur in United States intensive care units each year [1,2]. In general, the diagnostic approach to catheter-related bloodstream infection (CRBSI) consists of clinical evaluation and microbiologic confirmation with separate blood cultures obtained from the catheter as well as a peripheral vein.
The clinical features and diagnosis of CRBSI will be reviewed here. Issues related to treatment of CRBSI are discussed in detail separately. (See "Treatment of intravascular catheter-related infections".)
For surveillance purposes, the Centers for Disease Control and Prevention (CDC) has introduced the term laboratory-confirmed bloodstream infection (LCBI) . LCBI must meet at least one of the following criteria:
●Patient has a recognized pathogen cultured from one or more blood cultures, and the pathogen is not related to an infection at another site.
●Patient has at least one of the following signs or symptoms: fever (>38.0°C), chills, or hypotension, and the pathogen is not related to an infection at another site or, if the organism is a common commensal, it must be present from two or more blood cultures drawn on separate occasions.
- Mermel LA, Allon M, Bouza E, et al. Clinical practice guidelines for the diagnosis and management of intravascular catheter-related infection: 2009 Update by the Infectious Diseases Society of America. Clin Infect Dis 2009; 49:1.
- Mermel LA. Prevention of intravascular catheter-related infections. Ann Intern Med 2000; 132:391.
- National Healthcare Safety Network. Bloodstream Infection Event (Central Line-Associated Bloodstream Infection and Non-Central Line-Associated Bloodstream Infection). http://www.cdc.gov/nhsn/PDFs/pscManual/4PSC_CLABScurrent.pdf (Accessed on November 16, 2015).
- Maki, DG, Mermel, LA. Infections due to infusion therapy. In: Hospital infections, Bennett JV, Brachman PS (Eds), Lippincott-Raven, Philadelphia, PA 1998. p.689-724.
- Safdar N, Maki DG. Inflammation at the insertion site is not predictive of catheter-related bloodstream infection with short-term, noncuffed central venous catheters. Crit Care Med 2002; 30:2632.
- Shukrallah B, Hanna H, Hachem R, et al. Correlation between early clinical response after catheter removal and diagnosis of catheter-related bloodstream infection. Diagn Microbiol Infect Dis 2007; 58:453.
- Kiehn TE, Armstrong D. Changes in the spectrum of organisms causing bacteremia and fungemia in immunocompromised patients due to venous access devices. Eur J Clin Microbiol Infect Dis 1990; 9:869.
- Pearson ML. Guideline for prevention of intravascular device-related infections. Hospital Infection Control Practices Advisory Committee. Infect Control Hosp Epidemiol 1996; 17:438.
- Mayhall CG. Diagnosis and management of infections of implantable devices used for prolonged venous access. Curr Clin Top Infect Dis 1992; 12:83.
- Gaur AH, Flynn PM, Heine DJ, et al. Diagnosis of catheter-related bloodstream infections among pediatric oncology patients lacking a peripheral culture, using differential time to detection. Pediatr Infect Dis J 2005; 24:445.
- Guembe M, Rodríguez-Créixems M, Sánchez-Carrillo C, et al. How many lumens should be cultured in the conservative diagnosis of catheter-related bloodstream infections? Clin Infect Dis 2010; 50:1575.
- Weinstein MP. Current blood culture methods and systems: clinical concepts, technology, and interpretation of results. Clin Infect Dis 1996; 23:40.
- Norberg A, Christopher NC, Ramundo ML, et al. Contamination rates of blood cultures obtained by dedicated phlebotomy vs intravenous catheter. JAMA 2003; 289:726.
- Everts RJ, Vinson EN, Adholla PO, Reller LB. Contamination of catheter-drawn blood cultures. J Clin Microbiol 2001; 39:3393.
- DesJardin JA, Falagas ME, Ruthazer R, et al. Clinical utility of blood cultures drawn from indwelling central venous catheters in hospitalized patients with cancer. Ann Intern Med 1999; 131:641.
- Martinez JA, DesJardin JA, Aronoff M, et al. Clinical utility of blood cultures drawn from central venous or arterial catheters in critically ill surgical patients. Crit Care Med 2002; 30:7.
- Bekeris LG, Tworek JA, Walsh MK, Valenstein PN. Trends in blood culture contamination: a College of American Pathologists Q-Tracks study of 356 institutions. Arch Pathol Lab Med 2005; 129:1222.
- Little JR, Murray PR, Traynor PS, Spitznagel E. A randomized trial of povidone-iodine compared with iodine tincture for venipuncture site disinfection: effects on rates of blood culture contamination. Am J Med 1999; 107:119.
- Mimoz O, Karim A, Mercat A, et al. Chlorhexidine compared with povidone-iodine as skin preparation before blood culture. A randomized, controlled trial. Ann Intern Med 1999; 131:834.
- O'Grady NP, Alexander M, Dellinger EP, et al. Guidelines for the prevention of intravascular catheter-related infections. Centers for Disease Control and Prevention. MMWR Recomm Rep 2002; 51:1.
- Chaiyakunapruk N, Veenstra DL, Lipsky BA, Saint S. Chlorhexidine compared with povidone-iodine solution for vascular catheter-site care: a meta-analysis. Ann Intern Med 2002; 136:792.
- Mimoz O, Villeminey S, Ragot S, et al. Chlorhexidine-based antiseptic solution vs alcohol-based povidone-iodine for central venous catheter care. Arch Intern Med 2007; 167:2066.
- Chatzinikolaou I, Hanna H, Hachem R, et al. Differential quantitative blood cultures for the diagnosis of catheter-related bloodstream infections associated with short- and long-term catheters: a prospective study. Diagn Microbiol Infect Dis 2004; 50:167.
- Safdar N, Fine JP, Maki DG. Meta-analysis: methods for diagnosing intravascular device-related bloodstream infection. Ann Intern Med 2005; 142:451.
- Blot F, Schmidt E, Nitenberg G, et al. Earlier positivity of central-venous- versus peripheral-blood cultures is highly predictive of catheter-related sepsis. J Clin Microbiol 1998; 36:105.
- Blot F, Nitenberg G, Chachaty E, et al. Diagnosis of catheter-related bacteraemia: a prospective comparison of the time to positivity of hub-blood versus peripheral-blood cultures. Lancet 1999; 354:1071.
- Raad I, Hanna HA, Alakech B, et al. Differential time to positivity: a useful method for diagnosing catheter-related bloodstream infections. Ann Intern Med 2004; 140:18.
- Irwig L, Tosteson AN, Gatsonis C, et al. Guidelines for meta-analyses evaluating diagnostic tests. Ann Intern Med 1994; 120:667.
- Bouza E, Alvarado N, Alcalá L, et al. A randomized and prospective study of 3 procedures for the diagnosis of catheter-related bloodstream infection without catheter withdrawal. Clin Infect Dis 2007; 44:820.
- Washington JA 2nd, Ilstrup DM. Blood cultures: issues and controversies. Rev Infect Dis 1986; 8:792.
- Aronson MD, Bor DH. Blood cultures. Ann Intern Med 1987; 106:246.
- Bryant JK, Strand CL. Reliability of blood cultures collected from intravascular catheter versus venipuncture. Am J Clin Pathol 1987; 88:113.
- Raad II, Hanna HA, Darouiche RO. Diagnosis of catheter-related bloodstream infections: is it necessary to culture the subcutaneous catheter segment? Eur J Clin Microbiol Infect Dis 2001; 20:566.
- Brun-Buisson C, Abrouk F, Legrand P, et al. Diagnosis of central venous catheter-related sepsis. Critical level of quantitative tip cultures. Arch Intern Med 1987; 147:873.
- Maki DG, Weise CE, Sarafin HW. A semiquantitative culture method for identifying intravenous-catheter-related infection. N Engl J Med 1977; 296:1305.
- Cleri DJ, Corrado ML, Seligman SJ. Quantitative culture of intravenous catheters and other intravascular inserts. J Infect Dis 1980; 141:781.
- Sherertz RJ, Raad II, Belani A, et al. Three-year experience with sonicated vascular catheter cultures in a clinical microbiology laboratory. J Clin Microbiol 1990; 28:76.
- Mrozek N, Lautrette A, Aumeran C, et al. Bloodstream infection after positive catheter cultures: what are the risks in the intensive care unit when catheters are routinely cultured on removal? Crit Care Med 2011; 39:1301.
- 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; 91:197S.
- Douard MC, Arlet G, Longuet P, et al. Diagnosis of venous access port-related infections. Clin Infect Dis 1999; 29:1197.
- Longuet P, Douard MC, Arlet G, et al. Venous access port--related bacteremia in patients with acquired immunodeficiency syndrome or cancer: the reservoir as a diagnostic and therapeutic tool. Clin Infect Dis 2001; 32:1776.
- Whitman ED, Boatman AM. Comparison of diagnostic specimens and methods to evaluate infected venous access ports. Am J Surg 1995; 170:665.
- Schmitt SK, Knapp C, Hall GS, et al. Impact of chlorhexidine-silver sulfadiazine-impregnated central venous catheters on in vitro quantitation of catheter-associated bacteria. J Clin Microbiol 1996; 34:508.
- Schierholz JM, Bach A, Fleck C, et al. Measurement of ultrasonic-induced chlorhexidine liberation: correlation of the activity of chlorhexidine-silver-sulfadiazine-impregnated catheters to agar roll technique and broth culture. J Hosp Infect 2000; 44:141.