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.
9
,
10
,
12
,
17
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.
6
,
7
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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Article info
Footnotes
Address reprint requests to, Burke A. Cunha, MD, Chief, Infectious Disease Division, Winthrop-University Hospital, Mineola, NY 11501
Identification
Copyright
© 1998 W. B. Saunders Company. Published by Elsevier Inc. All rights reserved.
