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Diagnosis of intravascular catheter-related infections

Jeffrey D Band, MD, FACP, FIDSA
Section Editors
Anthony Harris, MD, MPH
Sheldon L Kaplan, MD
Deputy Editor
Elinor L Baron, MD, DTMH


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) [3]. 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.

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Literature review current through: Nov 2017. | This topic last updated: Jun 29, 2017.
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  1. 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.
  2. Mermel LA. Prevention of intravascular catheter-related infections. Ann Intern Med 2000; 132:391.
  3. 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).
  4. 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.
  5. 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.
  6. 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.
  7. 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.
  8. Pearson ML. Guideline for prevention of intravascular device-related infections. Hospital Infection Control Practices Advisory Committee. Infect Control Hosp Epidemiol 1996; 17:438.
  9. Mayhall CG. Diagnosis and management of infections of implantable devices used for prolonged venous access. Curr Clin Top Infect Dis 1992; 12:83.
  10. 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.
  11. 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.
  12. Weinstein MP. Current blood culture methods and systems: clinical concepts, technology, and interpretation of results. Clin Infect Dis 1996; 23:40.
  13. Norberg A, Christopher NC, Ramundo ML, et al. Contamination rates of blood cultures obtained by dedicated phlebotomy vs intravenous catheter. JAMA 2003; 289:726.
  14. Everts RJ, Vinson EN, Adholla PO, Reller LB. Contamination of catheter-drawn blood cultures. J Clin Microbiol 2001; 39:3393.
  15. 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.
  16. 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.
  17. 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.
  18. 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.
  19. 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.
  20. 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.
  21. 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.
  22. 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.
  23. 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.
  24. Safdar N, Fine JP, Maki DG. Meta-analysis: methods for diagnosing intravascular device-related bloodstream infection. Ann Intern Med 2005; 142:451.
  25. 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.
  26. 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.
  27. 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.
  28. Irwig L, Tosteson AN, Gatsonis C, et al. Guidelines for meta-analyses evaluating diagnostic tests. Ann Intern Med 1994; 120:667.
  29. 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.
  30. Washington JA 2nd, Ilstrup DM. Blood cultures: issues and controversies. Rev Infect Dis 1986; 8:792.
  31. Aronson MD, Bor DH. Blood cultures. Ann Intern Med 1987; 106:246.
  32. Bryant JK, Strand CL. Reliability of blood cultures collected from intravascular catheter versus venipuncture. Am J Clin Pathol 1987; 88:113.
  33. 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.
  34. 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.
  35. Maki DG, Weise CE, Sarafin HW. A semiquantitative culture method for identifying intravenous-catheter-related infection. N Engl J Med 1977; 296:1305.
  36. Cleri DJ, Corrado ML, Seligman SJ. Quantitative culture of intravenous catheters and other intravascular inserts. J Infect Dis 1980; 141:781.
  37. 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.
  38. Ekkelenkamp MB, van der Bruggen T, van de Vijver DA, et al. Bacteremic complications of intravascular catheters colonized with Staphylococcus aureus. Clin Infect Dis 2008; 46:114.
  39. 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.
  40. 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.
  41. Douard MC, Arlet G, Longuet P, et al. Diagnosis of venous access port-related infections. Clin Infect Dis 1999; 29:1197.
  42. 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.
  43. Whitman ED, Boatman AM. Comparison of diagnostic specimens and methods to evaluate infected venous access ports. Am J Surg 1995; 170:665.
  44. 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.
  45. 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.