[...]... a catheter in place and treating through an infection in certain situations We hope that this volume will provide the reader with insights into some of the most interesting and useful data in the field of catheter-related infection We hope too that the strategies highlighted to prevent infection will be implemented and will have a measurable impact in decreasing rates of infection in the intensive care... Catheter-Related Infections in the Critically Ill Finally, managing catheter infections in the intensive care unit has become increasingly challenging Often it is not so simple to take out one catheter and replace it with a new one Patients often have limited access, coagulopathies, or other anatomical and clinical considerations that preclude removing the central catheter There are data to support leaving a catheter... Unfortunately, the IVDs needed to establish reliable access are associated with significant potential for producing iatrogenic disease, particularly bacteremia and candidemia ( 1- 3 ), deriving from infection of the 2 Catheter-Related Infections in the Critically Ill percutaneous device used for vascular access or from contamination of the infusate administered through the device (4) The forms of infection... of IVD in place (Table 2) (16 ) The device that poses the greatest risk of IVDR BSI today is the CVC in its many forms: short-term noncuffed, single- or multilumen catheters inserted percutaneously into the subclavian, internal jugular or femoral vein have been associated with rates of catheter-related BSI in the range of 3 to 5% ( 2- 3 per 10 00 IVD-days) Far lower rates of infection occur with surgically...Preface Intravascular catheters are an integral part of the daily practice of medicine in the intensive care unit As such, management of these catheters poses significant challenges to the practitioner Vascular access is necessary in the intensive care setting, yet the devices themselves put patients at significant risk for infection As hospital infection rates are increasingly used as a surrogate... CARE INFECTIOUS DISEASES An Introduction to the Series Different models of intensive care medicine have been developed worldwide, involving surgeons, anesthetists, internists and critical care physicians All intensive care departments of hospitals have in common, the highest incidence of antibiotic consumption, the highest incidence of nosocomial infections and are grouping community-acquired infections. .. cost-effective as the use of antimicrobial-coated devices, and with no fear about resistance acquisition Given the changing types of catheters placed today, the epidemiology and pathogenesis of infection has also changed over the past ten years Data regarding biofilms and the role they play in catheter infections take on added significance when coupled with the extended dwell times of catheters xii Catheter-Related. .. venous catheters of every type, including noncuffed multilumen catheters, large dual-lumen catheters for hemodialysis, large introducers and flow-directed, balloon-tipped pulmonary artery (Swan-Ganz) catheters, cuffed and tunneled Hickman-like CVCs, arterial catheters used for hemodynamic monitoring, small peripheral venous catheters and, increasingly peripherally-inserted central venous catheters (PICCs)... however, these infections are associated with prolongation of hospital stay ( 7-9 , 14 ) and marginal cost to the health system of $33,000 to 35,000 per episode (7, 8, 14 ) The risk is greatly amplified in the ICU setting where at least 80,000 IVDR BSIs occur annually (3 ,15 ) with a marginal cost of $33,000 to $ 71, 000 per case (15 ) The magnitude of risk of IVD-related BSI varies with the type of IVD in place... for measuring patient safety and quality healthcare, preventing catheter-related infection takes on added importance It is the intent of this issue to provide the intensivist with a collection of reviews that detail a practical approach to the prevention and management of catheter-related infections and to highlight some of the recent advances in novel technologies and strategies to prevent infection . Preventing Catheter-Related Infections in the ICU Naomi P. O’Grady, M.D. Catheter-Related Infections in the Critically Ill vi 9. 10 . 11 . 12 . 8. 11 3 12 7 13 9 14 7 15 9 17 3 Index vii François Blot, M.D. Service. class="bi x0 y0 w0 h1" alt="" CATHETER-RELATED INFECTIONS IN THE CRITICALLY ILL CATHETER-RELATED INFECTIONS IN THE CRITICALLY ILL Naomi P. O’Grady, M.D. Critical Care Medicine Department Warren. candidemia ( 1- 3 ), deriving from infection of the 2 Catheter-Related Infections in the Critically Ill percutaneous device used for vascular access or from contamination of the infusate administered