Catheter-Related Bloodstream Infections in Critical Care

 Central line insertion is a very common procedure in critical care settings, and is associated with infectious complications such as local colonisation and bloodstream infection which leads to bacteremia and sepsis.  Causative microorganisms are commonly missed on blood cultures, so that empiric therapy must be started in absence of a known pathogen.  Diagnosis is based on clinical suspicion and microbiological confirmation by means of local and blood cultures (quantitative or semiquantiative).  The mainstay of treatment is a combination of early antibiotic treatment and catheter removal with insertion at a new site.  Prevention is the cornerstone of catheter-related infections.  Multimodular programs (education, surveillance and quality management) and the sophistication of catheter-associated devices have shown benefit on CRBSI rate reduction.  Strategies must be grouped into bundles.  CRBSI reduction plans are part of the general ICU quality improvement plan.  Team work is crucial to the construction and follow-up of the strategies aimed at reducing the infection rate in critically-ill patients.