Catheter-Related Infections

Medical devices such as venous catheters (VCs) and urinary catheters (UCs) are widely used in the hospital setting. However, the implantation of these devices is often accompanied by complications. About 60 to 70% of nosocomial infections (NIs) are linked to biofilms. The main complication is the ability of microorganisms to adhere to surfaces and form biofilms which protect them and help them to persist in the host. Indeed, by crossing the skin barrier, the insertion of VC inevitably allows skin flora or accidental environmental contaminants to access the underlying tissues and cause fatal complications like bloodstream infections (BSIs). In fact, 80,000 central venous catheters-BSIs (CVC-BSIs)-mainly occur in intensive care units (ICUs) with a death rate of 12 to 25%. Similarly, catheter-associated urinary tract infections (CA-UTIs) are the most commonlyhospital-acquired infections (HAIs) worldwide.These infections represent up to 40% of NIs.In this review, we present a summary of biofilm formation steps. We provide an overview of two main and important infections in clinical settings linked to medical devices, namely the catheter-asociated bloodstream infections (CA-BSIs) and catheter-associated urinary tract infections (CA-UTIs), and highlight also the most multidrug resistant bacteria implicated in these infections. Furthermore, we draw attention toseveral useful prevention strategies, and advanced antimicrobial and antifouling approaches developed to reduce bacterial colonization on catheter surfaces and the incidence of the catheter-related infections.

BackgroundCentral catheter bloodstream infections (CRBSI) is a major cause of healthcare-associated infections. However, few factors are generally accepted and some studies have conflicting finding about some factors, possibly caused by limitation associated with an individual study. This study was to identify risk factors for CRBSI in intensive care units.MethodsWe searched the PubMed, Cochrane Library, Web of science and EMBASE databases and the 4 top Chinese-language databases, including WanFang data, China National Knowledge Infrastructure (CNKI), and Chinese Science and Technology Journal Database (VIP), China Biology Medicine disc (CBM) as of July 2023. Case control and cohort studies were included. Two authors independently screened the literature and evaluated the quality of the studies using the Newcastle-Ottawa scale (NOS). The pooled effect size was estimated using the odds ratio (OR), and the corresponding 95% confidence interval (CI) was calculated. The Cochrane Q (χ2) and I2 tests were used to assess heterogeneity among studies, and each risk factor was tested for its robustness using fixed- or random-effects models.FindingsA total of 32 studies enrolled, among which eleven factors were identified, they were divided into two categories: modifiable and unmodifiable factors. Modifiable factors: duration of catheterization (≥ 5d) (OR: 2.07, 95%CI: 1.41-3.03), duration of catheterization (≥ 7d) (OR: 3.62, 95%CI: 2.65-4.97), duration of catheterization (≥ 14d)(OR: 4.85, 95%CI: 3.35-7.01), total parenteral nutrition (OR: 2.27,95%CI: 1.56-3.29), use of multiple-lumen catheters(OR: 3.41, 95%CI: 2.27-5.11), times of tube indwelling (OR: 3.50, 95%CI: 2.93-4.17), length of ICU stay (OR: 4.05, 95%CI: 2.41-6.80), the position of indwelling(OR: 2.41, 95%CI: 2.03-2.85); Unmodifiable factors: APACHEII scores (OR: 1.84, 95%CI: 1.54-2.20), Age≥ 60 years old (OR: 2.19, 95%CI: 1.76-2.73), the extensive use of antibiotic (OR: 3.54, 95%CI: 1.65-7.61), Diabetes mellitus (OR: 3.06, 95%CI: 2.56-3.66), Immunosuppression (OR: 2.87, 95%CI: 2.08-3.95).ConclusionsEffective interventions targeting the above modifiable factors may reduce the risk of developing CRBSI in ICU and improve the clinical outcome of patients. Further prospective studies are needed to confirm these findings.

BackgroundCatheter-associated urinary tract infection (CAUTI) ranks second among nosocomial infections in elderly patients after lung infections. Improper treatment can lead to death. This study analysed the risk factors, pathogen distribution, clinical characteristics and outcomes of CAUTI in elderly inpatients with a large sample size to provide evidence for clinical prevention and control.MethodsBased on the HIS and LIS, a case‒control study was conducted on all hospitalized patients with indwelling urinary catheters ≥ 60 years old from January 1, 2019, to December 31, 2022, and the patients were divided into the CAUTI group and the non-CAUTI group.ResultsCAUTI occurred in 182 of 7295 patients, and the infection rate was 3.4/per 1000 catheter days. Urine pH ≥ 6.5, moderate dependence or severe dependence in the classification of self-care ability, age ≥ 74 years, male sex, hospitalization ≥ 14 days, indwelling urinary catheter ≥ 10 days, diabetes and malnutrition were independent risk factors for CAUTI (P ConclusionThe situation of CAUTI in the elderly is not optimistic, it is easy to have a one-person multi-pathogen infection, and the proportion of fungi infection is not low. Urine pH ≥ 6.5, moderate or severe dependence on others and malnutrition were rare risk factors for elderly CAUTI in previous studies. Our study analysed the clinical characteristics of CAUTI in the elderly through a large sample size, which provided a reliable basis for its diagnosis and identified the adverse outcome of CAUTI.

ImportanceIntravascular catheters are essential in health care but remain a major source of health care-associated infections. Optimal skin antisepsis before insertion is key, yet the most effective antiseptic agent, concentration, and formulation remain uncertain.ObjectiveTo determine the concentration and formulation of chlorhexidine gluconate (CHG) or povidone-iodine (PVI) associated with the lowest incidence of catheter-related infections (CRIs).Data sourcesPubMed, EMBASE, Cochrane Central, Scopus, Web of Science, and CINAHL were searched through January 7, 2025, without restrictions. Trial registries and reference lists of relevant studies and guidelines were reviewed.Study selectionRandomized clinical trials (RCTs) comparing CHG- or PVI-based skin antisepsis before insertion of intravascular catheters were eligible if they reported at least 1 CRI outcome (catheter-related bloodstream infection [CRBSI], catheter tip colonization, or local infection). Two independent reviewers screened titles, abstracts, and full texts.Data extraction and synthesisData were extracted independently by 2 reviewers following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Risk of bias was assessed with the Cochrane risk of bias 2 tool. A random-effects network meta-analysis (NMA) was performed to estimate relative risks (RRs) with 95% CIs.Main outcomes and measuresThe primary outcomes were incidence of CRBSIs, catheter tip colonization, and local infections associated with CHG or PVI formulations.ResultsSixteen RCTs (7803 patients; 11 985 catheters) met inclusion criteria. When compared with aqueous formulations, alcohol-based formulations were consistently associated with lower infections rates, with isopropyl alcohol being superior to ethanol. Compared with alcoholic PVI, alcoholic CHG was associated with lower CRBSIs (RR, 0.70 [95% CI, 0.45 to 1.08]), catheter tip colonizations (RR, 0.42 [95% CI, 0.37 to 0.48]), and local infections (RR, 0.40 [95% CI, 0.23 to 0.70]). High concentration CHG (1% or higher) further lowered CRBSIs (RR, 0.31 [95% CI, 0.19 to 0.52]) and colonization (RR, 0.36 [95% CI, 0.30 to 0.42]) compared with lower concentrations. Local adverse events were uncommon, slightly more frequent with alcohol-based formulations, and similar between CHG and PVI.Conclusions and relevanceIn this NMA of RCTs, high concentration CHG in isopropyl alcohol was associated with the lowest incidence of CRIs. These results suggest that alcoholic PVI and aqueous formulations should be reserved for situations in which CHG or alcohol cannot be used.