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Intravascular Catheter-Related Infections
New Horizons and Recent Advances
Issam I. Raad, MD;
Hend A. Hanna, MD, MPH
Arch Intern Med. 2002;162:871-878.
Background Central venous catheters have become essential devices for the management
of critically and chronically ill patients; however, their use is often complicated
by catheter-related bloodstream infections (CRBSIs), many of which could be
prevented.
Methods This report is based on a literature review of more than 100 published
articles in intravascular catheter-related infections. This review focuses
on the most recent advances in the methods of diagnosis of CRBSI as they relate
to its pathogenesis and on novel preventive techniques and approaches to management.
Results Catheter-related bloodstream infections may be diagnosed by different
methods, including simultaneous quantitative blood cultures, with the central
blood culture yielding at least 5-fold colony-forming units greater than the
peripheral blood culture, and simultaneous blood cultures, whereby the catheter-drawn
blood culture becomes positive at least 2 hours before the peripheral blood
culture. Novel preventive techniques include the use of ionic silver, an anticoagulant/antimicrobial
flush solution, a new aseptic hub, and antimicrobial impregnation of catheters
and dressings. Management of CRBSIs should be based on whether the infection
is complicated or uncomplicated.
Conclusions Novel technologies that have been proved to aid in the diagnosis and
prevention of CRBSIs should be considered in clinical practice. The management
approach should be based on the type of microorganism causing the infection
and on whether the infection is complicated or uncomplicated.
From the Department of Infectious Diseases, Infection Control, and
Employee Health, The University of Texas M. D. Anderson Cancer Center, Houston.
Dr Raad is a coinventor on 2 patents related to antibiotic-coated catheters.
These patents are licensed to Cook Critical Care, Bloomington, Ind, with royalty
rights to 2 institutions (The University of Texas M. D. Anderson Cancer Center
and Baylor College of Medicine, Houston). A percentage of the royalties goes
to the inventors according to the royalty policies of each institution.
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