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Epidemiology, pathogenesis, and microbiology of intravascular catheter infections

Authors
Robert Gaynes, MD
Jeffrey D Band, MD, FACP, FIDSA
Section Editor
Anthony Harris, MD, MPH
Deputy Editor
Elinor L Baron, MD, DTMH

INTRODUCTION

Nosocomial (hospital-acquired) bloodstream infections (BSIs) are an important cause of morbidity and mortality, with an estimated 250,000 cases occurring each year in the United States [1,2]. BSIs may be either primary or secondary. Secondary infections are related to infections at other sites, such as the urinary tract, lung, postoperative wounds, and skin. Most nosocomial BSIs are primary, as illustrated by the United States Centers for Disease Control and Prevention’s National Nosocomial Infection Surveillance system, in which 64 percent of the nosocomial BSIs reported were primary BSIs [3]. While some primary BSIs have no identifiable source, most are associated with intravascular catheters, and central venous catheters (CVCs) in particular [3,4].

CVCs are increasingly used in the inpatient and outpatient setting to provide long-term venous access. Infection of CVCs remains a major problem. It is estimated, for example, that approximately 90 percent of annual catheter-related bloodstream infections in the United States occur with CVCs [5].

The epidemiology, risk factors, pathogenesis, and microbiology of intravascular catheter infections will be reviewed here. The diagnosis, treatment, and prevention of CVC-associated infections are discussed separately. (See "Diagnosis of intravascular catheter-related infections" and "Treatment of intravascular catheter-related infections" and "Prevention of intravascular catheter-related infections".)

EPIDEMIOLOGY

Catheter-related bloodstream infections (CR-BSIs) are an important cause of morbidity and mortality worldwide although may be decreasing in incidence in some areas, possibly as a result of widespread prevention efforts. As an example, the incidence of CR-BSI associated with central lines among patients hospitalized in intensive care units (ICUs) in the United States decreased from 3.64 to 1.65 infections per 1000 central line days between 2001 and 2009 [6,7]. These decreases in the United States have continued through 2015 and appear to be sustained [8,9]. This amounted to an estimated 18,000 central line–related infections in 2009. A similar trend of decreasing incidence has been observed in Canada [10]. In contrast, the reported pooled incidence of central line–associated BSI across 422 ICUs in 36 countries in Latin America, Asia, Africa, and Europe from 2004 to 2009 was substantially higher, 6.8 events per 1000 central line days [11]. Many of these sites are in resource-limited areas, and the high incidence is thought to be related to a lack of official regulations regarding catheter care.

Although ICU patients are generally exposed to more medical devices and are more severely ill than other hospitalized patients, CR-BSIs remain common in hospital wards outside the ICU. As an example, an estimated 23,000 central line–associated BSIs occurred among patients in inpatient wards in the United States in 2009 [6]. In a prospective analysis from the Surveillance and Control of Pathogens of Epidemiologic Importance (SCOPE) database, which evaluated the characteristics of 24,179 nosocomial BSIs from 49 hospitals in the United States between 1995 and 2002, the following findings were noted [4]:

              

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