Purpose: To review the mechanisms, diagnosis, treatment and prophylaxis of catheter-related sepsis in intensive care unit patients.
Data sources: A Medline research of the English- or French-language reports published between 1966 and 2000 and a manual research of references of relevant papers.
Study selection: Experimental, clinical and basic research studies related to catheter-related sepsis.
Data extraction: Data in selected articles were reviewed, and relevant clinical information was extracted.
Data synthesis: Infection remains the major complication related to catheter insertion. No bacteriological exam or systematic catheter change is required in the absence of infection suspicion. In the intensive care unit, and without septic shock, the surveillance of skin cultures at the catheter insertion site or the time to positivity of hub-blood versus peripheral-blood culture determination may reduce the number of unnecessary removed catheters. Catheter change over a guidewire is not recommended because of the risk of dissemination of infection. When the catheter is removed, a quantitative culture is warranted. The treatment of catheter-related sepsis is based on catheter removal. The use of antibiotics is limited to some organisms or when the infection is complicated. The persistence of fever and positive blood cultures 72 h after catheter removal require to look for dissemination of infection or septic thrombophlebitis, especially if S. aureus or Candida are incriminated. The treatment of infection without catheter removal is not recommended in the intensive care unit because of a high risk of treatment failure. Compliance with catheter care guidelines and continuing quality improvement programs are the two major procedures in reducing catheter infection.
Conclusions: Improved understanding of the pathophysiology of catheter-related sepsis has led to improved prevention. Compliance with catheter care guidelines and continuing quality improvement programs are majors procedures to reduce the risk of catheter infection.