Catheter-related

bloodstream infection
( CRBSI )
Laurence Chandrawan
112014047
Anastesi-RSUD
Tarakan,jakarta

 Also called catheter-related sepsis :

the presence of bacteraemia
originating from an i.v catheter
The most frequent, lethal and costly
complication of central venous
catheterization
Most common cause of nosocomial
bacteraemia

EPIDEMIOLOGY
CRBSI occurs in 3% of catherizations
However the incidence may be as
high as 16%
Represent 2-30 episodes per 1000
catheter days.
Originate from peripheral i.v and
intra-arterial cannulae ( rare )

PATHOGENESIS
Immediatly the surfaces of CVC
become coated with plasma proteins,
particularly fibrin. Bacteria migrate
from skin along the catheter track
and/or from the catheter hubs down
the lumen and become embedded in
this protein sheath ( this process is
termed colonization ).

 CRBSI triggers a systemic

inflammatory respose, ranging from
fever and leucocytosis trough septic
shock and multiple organ failure
Mortality rate 3 to 25%
Metastatic infection is possible :
septic arthitis, septic trombosis,
endocarditis.

DIAGNOSIS
The presence of a CVC
Sing of catheter insertion site
infection
Clinical symptoms and signs of
bacteremia
Resolution of the symptom and sign
of bacteraemia after removal of the
suspect CVC
Positive blood culture
Growth of the same organism

 Gold standart diagnosis :

combination of the positive blood
culture with the same organism
isolated from the catheter

ASSOCIATED FACTORS
Immunosuppresion, either relative or
absolute ( critically ill , malignancy )
The microbiological enviroment also
influnces the rate of CRBSI with higer rate (
ICU )
Frequent accessing of the catheter and
poor aseptic technique
Subclavian CVCs have the lowest infection
rate followed by internal jugular and
femoral catheters.

Treatment
The catheter should be removed if CRBSI is
suspected
If the removed catheter proven on
microbiological examination to be the source of
sepsis : selected another site
Antibiotic therapy based on the culture reports
One weeks treatment after the catheter has
been removed
Two weeks if the infection caused by
staphylococcus aureus or fungi
Prolong if needed or failure treatment

PREVENTION
Selection of catheter type
Single lumen, long term use
( implantable and tunnelled catheter ),
high risk ( antimicrobacterial catheter )
Selection of catheter insertion site
Aseptic tecnique during insertion
Catheter and catheter site care
Replacement strategies

CONCLUSION
CRBSI is an iatrogenic problem that
causes significant morbidity,
mortality, excess length of stay and
excess costs. Local protocols to
minimize CRBSI should be in place