[Conservative methods for diagnosing catheter-associated bacteremia].

Catheter-associated bacteremia (CAB) is a frequent cause of nosocomial infection in the critical patient and implies an increase in both morbidity--mortality and healthcare costs. The classical method for confirming CAB involves the concomitant isolation of the microorganism in blood cultures obtained by percutaneous puncture and from catheter tip cultures. This conventional procedure has the inconvenience of requiring catheter withdrawal in order to allow tip culture. In this context, there are arguments both in favor and against systematic catheter removal when suspecting CAB. In favor of withdrawal is the fact that many studies have reported a lesser mortality or duration of CAB when the catheter is removed. However, these studies pose the limitation of having a non-randomized design. In turn, the arguments against catheter withdrawal include: (I) the low yield of systematic catheter tip culture, with positive cultures in under 10% of all cases according to different series; (II) a randomized study has shown that routine catheter removal is not necessary in stable patients. The study included patients with suspected CAB, and excluded hemodynamically unstable subjects, immune depressed patients and individuals with signs of local infection. The patients were randomized to either routine catheter removal or catheter maintenance until the