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INTRAVENOUS LINE INFECTIONS

  • Author Footnotes
    * From the Infectious Disease Division, Winthrop-University Hospital, Mineola; and the State University of New York School of Medicine, Stony Brook, New York
    Burke A. Cunha
    Footnotes
    * From the Infectious Disease Division, Winthrop-University Hospital, Mineola; and the State University of New York School of Medicine, Stony Brook, New York
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  • Author Footnotes
    * From the Infectious Disease Division, Winthrop-University Hospital, Mineola; and the State University of New York School of Medicine, Stony Brook, New York
      Intravenous (IV) line related infections are an important problem in hospitalized patients and are particularly important in critical care units (CCUs). In CCUs, most IV line infections are related to central venous lines; peripheral IV lines are relatively unimportant in this setting. IV line infections are always a consideration in the CCU patient who develops fever with indwelling central lines. In IV line infections a bacteremia originates in the line and is due to the same quantitatively significant organism that is cultured from the catheter tip and is the same isolate that is grown from simultaneously obtained blood cultures.
      In the CCU IV line infections usually present as fever. Signs of infection at the catheter entry site usually are absent. Since local signs of infection usually are absent, IV line infections as a cause of fever in the CCU is a diagnosis of exclusion. Central line infections are related to aseptic technique in catheter insertion, catheter care, type of catheter material used, site of catheter insertion, and duration of catheterization. All other factors being equal, in general the longer the line is in place the more likely the possibility of infection.
      IV line infections are not only important medically, but also represent an economic burden to the health care system. It has been estimated that each bloodstream infection costs the hospital approximately $6000 and increases the length of stay by an additional week. Although the overall incidence of IV line infections from central lines in hospitalized patients is low—approximately 1%—the incidence in CCUs is higher, especially in patients with multiple central lines and prolonged intravenous cannulation.
      Most IV central line infections are caused by coagulase-negative staphylococci; less commonly they are due to Staphylococcus aureus. Even less commonly, central IV line infections are caused by “water organisms” (e.g., Serratia, Enterobacter, Pseudomonas cepacia, Citrobacter, Flavobacteria, etc.). These water organisms are common colonizers in the CCU. If they gain access to the infusate, they may cause bacteremia. In patients receiving total parenteral nutrition (TPN), Candida albicans and non-albicans Candida and Malassezia furfur are common causes of IV line infection.
      • Maki D.G.
      Infections due to infusion therapy.
      • Maki D.
      Infections caused by intravascular devices used for infusion therapy: pathogenesis, prevention and management.
      • Mayhall C.G.
      Diagnosis and management of infections of implantable devices used for prolonged venous access.
      • Raad I.I.
      • Body G.P.
      Infectious complications of indwelling vascular catheters.
      In compromised hosts, almost any organism can cause IV line infection. Therefore, unusual organisms isolated from IV lines in compromised hosts should be regarded as potential pathogens, not routinely considered as nonpathogenic commensals/specimen contaminants.
      • Gill M.V.
      • Klein N.A.
      • Cunha B.A.
      Unusual organisms causing intravenous line infections in compromised hosts: I. Bacterial and algal infections.
      • Klein N.C.
      • Gill M.V.
      • Cunha B.A.
      Unusual organisms causing intravenous line infections in compromised hosts: II. Fungal infections.
      The critical step in the treatment of central IV line infections is to remove the involved catheter. Antimicrobial therapy usually is given adjunctively, but is no substitute for catheter removal.
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      References

        • Abi-Nader J.A.
        Peripherally inserted central venous catheters in critical care patients.
        Heart Lung. 1993; 22: 428
        • Arnow P.M.
        • Quimosing E.M.
        • Brech M.
        Consequences of intravascular catheter sepsis.
        Clin Infect Dis. 1993; 16: 778
        • Cleri D.J.
        • Corrado M.L.
        • Seligman S.J.
        Quantitative culture of intravenous catheters and other intravascular inserts.
        J Infect Dis. 1987; 141: 781
        • Eyer S.
        • Brummitt C.
        • Crossley K.
        • et al.
        Catheter-related sepsis: Prospective, randomized study of three different methods of long-term catheter maintenance.
        Crit Care Med. 1990; 18: 1073
        • Gil R.T.
        • Kruse J.A.
        • Thill-Baharozian M.C.
        • et al.
        Triple- versus single-lumen central venous catheters. A prospective study in a critically ill population.
        Arch Intern Med. 1989; 149: 1139
        • Gill M.V.
        • Klein N.A.
        • Cunha B.A.
        Unusual organisms causing intravenous line infections in compromised hosts: I. Bacterial and algal infections.
        Infect Dis Clin Pract. 1996; 5: 244
        • Klein N.C.
        • Gill M.V.
        • Cunha B.A.
        Unusual organisms causing intravenous line infections in compromised hosts: II. Fungal infections.
        Infect Dis Clin Pract. 1996; 5: 303
        • Maki D.G.
        • Weise C.E.
        • Sarafin H.W.
        A semiquantitative culture method for identifying intravenous catheter-related infection.
        N Engl J Med. 1997; 296: 1305
        • Maki D.G.
        Infections due to infusion therapy.
        in: Bennett J.V. Brachman P.S. Hospital Infections. ed 3. Little, Brown, Boston1992
        • Maki D.
        Infections caused by intravascular devices used for infusion therapy: pathogenesis, prevention and management.
        in: Bisno A.L. Waldvogel F.A. Infections Associated with Indwelling Medical Devices. ed 2. American Society for Microbiology, Washington1994: 155
        • McCarthy M.C.
        • Shives J.K.
        • Robison R.J.
        • et al.
        Prospective evaluation of single and triple lumen catheters in total parenteral nutrition.
        J Parenter Enteral Nutr. 1987; 11: 259
        • Mayhall C.G.
        Diagnosis and management of infections of implantable devices used for prolonged venous access.
        in: Remington J.S. Swartz M.N. Current Clinical Topics in Infectious Diseases. ed 12. Blackwell Scientific, Boston1992: 83
        • Mayhall C.G.
        Peripheral venous catheters.
        in: Seifert H. Jansen B. Farr B. Catheter-Related Infections. Marcel Dekker, New York1997: 217
        • Michel L.A.
        • Bradpiece H.A.
        • Randour P.
        • et al.
        Safety of venous catheter change over a guide wire for suspected catheter-related sepsis: A prospective randomized trial.
        Int Surg. 1988; 73: 180
        • Pinilla J.C.
        • Ross D.F.
        • Martin T.
        • et al.
        Study of the incidence of intravascular catheter infection and associated septicemia in critically ill patients.
        Crit Care Med. 1983; 11: 21
        • Pittet D.
        • Tarara D.
        • Wenzel R.P.
        Nosocomial bloodstream infection in critically ill patients: Excess length of stay, extra costs, and attributable mortality.
        JAMA. 1994; 271: 1598
        • Raad I.I.
        • Body G.P.
        Infectious complications of indwelling vascular catheters.
        Clin Infect Dis. 1992; 15: 197
        • Schfeckelhoff D.J.
        • Mirtallo J.M.
        • Ayers L.W.
        • et al.
        Growth of bacteria and fungi in total parenteral nutrient admixture.
        Am J Hosp Pharm. 1986; 43: 73
        • Sitzmann J.V.
        • Townsend T.R.
        • Siler M.C.
        • et al.
        Septic and technical complications of central venous catheterization: A prospective study of 200 consecutive patients.
        Ann Surg. 1985; 202: 766
        • Ullman R.F.
        • Gurevich I.
        • Schoch P.E.
        • et al.
        Colonization and bacteremia related to duration of triple-lumen intravascular catheter placement.
        Am J Infect Control. 1990; 18: 201
        • Zinner S.H.
        • Denny-Brown B.C.
        • Braun P.
        • et al.
        Risk of infection with indwelling intravenous catheters: Effect of application of antibiotic ointment.
        J Infect Dis. 1969; 120: 616