Catheter-Related Bloodstream Infections (CRBSIs)

Fever in A Patient Who has A Central Venous Catheter in Place


Catheter-related bloodstream infections (CRBSIs) are common causes of hospital-associated illness. Although their rates have been declining over the past decades, they still contribute to significant morbidity and mortality and excess costs. CRBSIs usually present as fever without an apparent source but may be accompanied by suppurative complications at the insertion site of the catheter or evidence of hematogenous spread to other tissues and organs. Quantitative and semiquantitative blood cultures are usually performed to determine whether a catheter is infected, but if these methods are not available, and there is motivation to retain a catheter that might be infected, blood cultures of the same volume can be collected from a peripheral vein and from the catheter and then monitored for differential time to positivity. Coagulase-negative Staphlyococci, such as Staphylococcus epidermidis, are the most common microbiologic cause of CRBSI, although a vast array of different bacterial and fungal species have also been reported. Some etiologic agents can be particularly virulent, leading to signs of sepsis. Complications of CRBSIs include skin and soft tissue infection at the catheter insertion site. The bacteremia (or fungemia) associated with the contaminated intravascular device can lead to hematogenous seeding and infection of distal sites such as the cardiac valves, lungs, muscles, bones, and joints. The ideal treatment for any contaminated, implanted medical device, including intravascular catheters, is to remove them while administering appropriate antibiotics or antifungal medications. Bacterial and fungal contamination (infection) of medical hardware is notoriously difficult to eradicate using anti-infective medications alone. In many cases however, it may be impossible or impractical to remove an infected catheter.

The length of anti-infective therapy is dictated by the causative organism, the patient’s clinical response once antimicrobials are started, the presence of local or distant complications, and whether the infected catheter is retained or not. Decisions to retain infected catheters while attempting to eradicate the infection with antibiotics should always be made thoughtfully, considering the risks of complications that may arise during that effort and the likelihood that the effort will be successful. Salvaging the catheter is possible in many circumstances, although certain bacteria, such as Staphylococcus aureus and Pseudomonas species, and all fungi are virtually impossible to clear. The rate of metastatic infection complications caused by these, and other virulent pathogens, correlates directly with the length of time elapsed before the catheter is removed. Other feared complications include sepsis, tunnel-tract infections, pocket site infections, and suppurative thrombophlebitis. The presence of any one of these complications should prompt immediate efforts to remove the infected device. Many hospitals have been successful in decreasing their rates or even eliminating central line-associated bloodstream infections (CLABSIs) by using combinations of preventive strategies referred to as “bundle” approaches.


Central venous catheters Bloodstream infections CLABSI Central line-associated infection CRBSI Catheter-related bloodstream infection Line infection 


  1. 1.
    Broviac JW, Cole JJ, Scribner BH. A silicone rubber atrial catheter for prolonged parenteral alimentation. Surg Gynecol Obstet. 1973;136(4):602–6.PubMedGoogle Scholar
  2. 2.
    Hickman RO, Buckner CD, Clift RA, Sanders JE, Stewart P, Thomas ED. A modified right atrial catheter for access to the venous system in marrow transplant recipients. Surg Gynecol Obstet. 1979;148(6):871–5.PubMedGoogle Scholar
  3. 3.
    Niederhuber JE, Ensminger W, Gyves JW, Liepman M, Doan K, Cozzi E. Totally implanted venous and arterial access system to replace external catheters in cancer treatment. Surgery. 1982;92(4):706–12.PubMedGoogle Scholar
  4. 4.
    Liu C, Bayer A, Cosgrove SE, Daum RS, Fridkin SK, Gorwitz RJ, et al. Clinical practice guidelines by the infectious diseases society of america for the treatment of methicillin-resistant S. aureus infections in adults and children. Clin Infect Dis. 2011;52(3):e18–55.CrossRefPubMedGoogle Scholar
  5. 5.
    Blot SI, Depuydt P, Annemans L, Benoit D, Hoste E, De Waele JJ, et al. Clinical and economic outcomes in critically ill patients with nosocomial catheter-related bloodstream infections. Clin Infect Dis. 2005;41(11):1591–8.PubMedCrossRefGoogle Scholar
  6. 6.
    Orsi GB, Di Stefano L, Noah N. Hospital-acquired, laboratory-confirmed bloodstream infection: increased hospital stay and direct costs. Infect Control Hosp Epidemiol. 2002;23(4):190–7.PubMedCrossRefGoogle Scholar
  7. 7.
    O’Grady NP, Alexander M, Burns LA, Dellinger EP, Garland J, Heard SO, et al. Guidelines for the prevention of intravascular catheter-related infections. Am J Infect Control. 2011;39(4 Suppl 1):S1–34.PubMedCrossRefGoogle Scholar
  8. 8.
    Mermel LA, Allon M, Bouza E, Craven DE, Flynn P, O'Grady NP, et al. Clinical practice guidelines for the diagnosis and management of intravascular catheter-related infection: 2009 update by the Infectious Diseases Society of America. Clin Infect Dis. 2009;49(1):1–45.PubMedPubMedCentralCrossRefGoogle Scholar
  9. 9.
    Ingram J, Weitzman S, Greenberg ML, Parkin P, Filler R. Complications of indwelling venous access lines in the pediatric hematology patient: a prospective comparison of external venous catheters and subcutaneous ports. Am J Pediatr Hematol Oncol. 1991;13(2):130–6.PubMedCrossRefGoogle Scholar
  10. 10.
    Fowler VG Jr, Justice A, Moore C, Benjamin DK Jr, Woods CW, Campbell S, et al. Risk factors for hematogenous complications of intravascular catheter-associated S. aureus bacteremia. Clin Infect Dis. 2005;40(5):695–703.PubMedCrossRefGoogle Scholar
  11. 11.
    Fowler VG Jr, Olsen MK, Corey GR, Woods CW, Cabell CH, Reller LB, et al. Clinical identifiers of complicated S. aureus bacteremia. Arch Intern Med. 2003;163(17):2066–72.PubMedCrossRefGoogle Scholar
  12. 12.
    Crowley AL, Peterson GE, Benjamin DK Jr, Rimmer SH, Todd C, Cabell CH, et al. Venous thrombosis in patients with short- and long-term central venous catheter-associated S. aureus bacteremia. Crit Care Med. 2008;36(2):385–90.PubMedCrossRefGoogle Scholar
  13. 13.
    Chirinos JA, Garcia J, Alcaide ML, Toledo G, Baracco GJ, Lichtstein DM. Septic thrombophlebitis: diagnosis and management. Am J Cardiovasc Drugs. 2006;6(1):9–14.PubMedCrossRefGoogle Scholar
  14. 14.
    Wilcox TA. Catheter-related bloodstream infections. Semin Interv Radiol. 2009;26(2):139–43. Epub 2009/06/01.CrossRefGoogle Scholar
  15. 15.
    Mayhall CG. Diagnosis and management of infections of implantable devices used for prolonged venous access. Curr Clin Top Infect Dis. 1992;12:83–110.PubMedGoogle Scholar
  16. 16.
    Safdar N, Maki DG. Inflammation at the insertion site is not predictive of catheter-related bloodstream infection with short-term, noncuffed central venous catheters. Crit Care Med. 2002;30(12):2632–5.PubMedCrossRefGoogle Scholar
  17. 17.
    Pedersen G, Norgaard M, Kiiveri M, Schonheyder HC, Larsson H, Stolberg E, et al. Risk of bacteremia in patients with hematological and other malignancies after initial placement of a central venous catheter. J Long-Term Eff Med Implants. 2007;17(4):303–11.PubMedCrossRefGoogle Scholar
  18. 18.
    Wisplinghoff H, Bischoff T, Tallent SM, Seifert H, Wenzel RP, Edmond MB. Nosocomial bloodstream infections in US hospitals: analysis of 24,179 cases from a prospective nationwide surveillance study. Clin Infect Dis. 2004;39(3):309–17. Epub 2004/08/13.PubMedCrossRefGoogle Scholar
  19. 19.
    Harms D, Gortitz I, Lambrecht W, Kabisch H, Erttmann R, Janka-Schaub G. Infectious risks of Broviac catheters in children with neoplastic diseases: a matched pairs analysis. Pediatr Infect Dis J. 1992;11(12):1014–8.PubMedCrossRefGoogle Scholar
  20. 20.
    Tokars JI, Cookson ST, McArthur MA, Boyer CL, McGeer AJ, Jarvis WR. Prospective evaluation of risk factors for bloodstream infection in patients receiving home infusion therapy. Ann Intern Med. 1999;131(5):340–7. Epub 1999/09/04.PubMedCrossRefGoogle Scholar
  21. 21.
    Piedra PA, Dryja DM, LaScolea LJ Jr. Incidence of catheter-associated gram-negative bacteremia in children with short bowel syndrome. J Clin Microbiol. 1989;27(6):1317–9.PubMedPubMedCentralGoogle Scholar
  22. 22.
    Sahli F, Feidjel R, Laalaoui R. Hemodialysis catheter-related infection: rates, risk factors and pathogens. J Infect Public Health. 2017; 10(4):403–8.PubMedCrossRefGoogle Scholar
  23. 23.
    Ball LK, George CA, Duval L, Hedrick NN. Reducing blood stream infection in patients on hemodialysis: incorporating patient engagement into a quality improvement activity. Hemodial Int. 2016;20(Suppl 1):S7–S11.PubMedCrossRefGoogle Scholar
  24. 24.
    Fang L, Wang F, Sun K, Zhou T, Gong Y, Peng Y. Analysis on the prevalence of central venous catheter-related infection in burn patients and its risk factors. Zhonghua shao shang za zhi = Zhonghua shaoshang zazhi = Chin J Burns. 2016;32(4):243–8. Epub 2016/04/21.Google Scholar
  25. 25.
    Erbay A, Ergonul O, Stoddard GJ, Samore MH. Recurrent catheter-related bloodstream infections: risk factors and outcome. Int J Infect Dis. 2006;10(5):396–400.PubMedCrossRefGoogle Scholar
  26. 26.
    Devraj A, Siva Tez Pinnamaneni V, Biswal M, Ramachandran R, Jha V. Extranasal S. aureus colonization predisposes to bloodstream infections in patients on hemodialysis with noncuffed internal jugular vein catheters. Hemodial Int. 2017;21(1):35–40.PubMedCrossRefGoogle Scholar
  27. 27.
    Dahan M, O'Donnell S, Hebert J, Gonzales M, Lee B, Chandran AU, et al. CLABSI risk factors in the NICU: potential for prevention: a PICNIC study. Infect Control Hosp Epidemiol. 2016;37(12):1446–52.PubMedCrossRefGoogle Scholar
  28. 28.
    Reunes S, Rombaut V, Vogelaers D, Brusselaers N, Lizy C, Cankurtaran M, et al. Risk factors and mortality for nosocomial bloodstream infections in elderly patients. Eur J Intern Med. 2011;22(5):e39–44. Epub 2011/09/20.PubMedCrossRefGoogle Scholar
  29. 29.
    Ge X, Cavallazzi R, Li C, Pan SM, Wang YW, Wang FL. Central venous access sites for the prevention of venous thrombosis, stenosis and infection. Cochrane Database Syst Rev. 2012;3:CD004084. Epub 2012/03/16.Google Scholar
  30. 30.
    Merrer J, De Jonghe B, Golliot F, Lefrant JY, Raffy B, Barre E, et al. Complications of femoral and subclavian venous catheterization in critically ill patients: a randomized controlled trial. JAMA. 2001;286(6):700–7. Epub 2001/08/10.PubMedCrossRefGoogle Scholar
  31. 31.
    Mitchell A, Atkins S, Royle GT, Kettlewell MG. Reduced catheter sepsis and prolonged catheter life using a tunnelled silicone rubber catheter for total parenteral nutrition. Br J Surg. 1982;69(7):420–2.PubMedCrossRefGoogle Scholar
  32. 32.
    Mermel LA, McCormick RD, Springman SR, Maki DG. The pathogenesis and epidemiology of catheter-related infection with pulmonary artery Swan-Ganz catheters: a prospective study utilizing molecular subtyping. Am J Med. 1991;91(3B):197S–205S.PubMedCrossRefGoogle Scholar
  33. 33.
    Raad II, Hohn DC, Gilbreath BJ, Suleiman N, Hill LA, Bruso PA, et al. Prevention of central venous catheter-related infections by using maximal sterile barrier precautions during insertion. Infect Control Hosp Epidemiol. 1994;15(4 Pt 1):231–8.PubMedCrossRefGoogle Scholar
  34. 34.
    Yilmaz G, Koksal I, Aydin K, Caylan R, Sucu N, Aksoy F. Risk factors of catheter-related bloodstream infections in parenteral nutrition catheterization. JPEN J Parenter Enteral Nutr. 2007;31(4):284–7.PubMedCrossRefGoogle Scholar
  35. 35.
    Gahlot R, Nigam C, Kumar V, Yadav G, Anupurba S. Catheter-related bloodstream infections. Int J Crit Illn Inj Sci. 2014;4(2):162–7. Epub 2014/07/16.PubMedPubMedCentralCrossRefGoogle Scholar
  36. 36.
    Clinical and Laboratory Standards Institute (CLSI). M47-A principles and procedures for blood cultures; approved guidelines. 2007;27(17).Google Scholar
  37. 37.
    Garcia RA, Spitzer ED, Beaudry J, Beck C, Diblasi R, Gilleeny-Blabac M, et al. Multidisciplinary team review of best practices for collection and handling of blood cultures to determine effective interventions for increasing the yield of true-positive bacteremias, reducing contamination, and eliminating false-positive central line-associated bloodstream infections. Am J Infect Control. 2015;43(11):1222–37.PubMedCrossRefGoogle Scholar
  38. 38.
    Guembe M, Rodriguez-Creixems M, Sanchez-Carrillo C, Perez-Parra A, Martin-Rabadan P, Bouza E. How many lumens should be cultured in the conservative diagnosis of catheter-related bloodstream infections? Clin Infect Dis. 2010;50(12):1575–9.PubMedCrossRefGoogle Scholar
  39. 39.
    Siegman-Igra Y, Anglim AM, Shapiro DE, Adal KA, Strain BA, Farr BM. Diagnosis of vascular catheter-related bloodstream infection: a meta-analysis. J Clin Microbiol. 1997;35(4):928–36.PubMedPubMedCentralGoogle Scholar
  40. 40.
    Peterson LR, Smith BA. Nonutility of catheter tip cultures for the diagnosis of central line-associated bloodstream infection. Clin Infect Dis. 2015;60(3):492–3. Epub 2014/10/31.PubMedCrossRefGoogle Scholar
  41. 41.
    Flynn L, Zimmerman LH, Rose A, Zhao J, Wahby K, Dotson B, et al. Vascular catheter tip cultures for suspected catheter-related blood stream infection in the intensive care unit: a tradition whose time has passed? Surg Infect. 2012;13(4):245–9. Epub 2012/07/17.CrossRefGoogle Scholar
  42. 42.
    Maki DG, Weise CE, Sarafin HW. A semiquantitative culture method for identifying intravenous-catheter-related infection. N Engl J Med. 1977;296(23):1305–9. Epub 1977/06/09.PubMedCrossRefGoogle Scholar
  43. 43.
    Brun-Buisson C, Abrouk F, Legrand P, Huet Y, Larabi S, Rapin M. Diagnosis of central venous catheter-related sepsis. Critical level of quantitative tip cultures. Arch Intern Med. 1987;147(5):873–7. Epub 1987/05/01.PubMedCrossRefGoogle Scholar
  44. 44.
    Cleri DJ, Corrado ML, Seligman SJ. Quantitative culture of intravenous catheters and other intravascular inserts. J Infect Dis. 1980;141(6):781–6. Epub 1980/06/01.PubMedCrossRefGoogle Scholar
  45. 45.
    Mosca R, Curtas S, Forbes B, Meguid MM. The benefits of Isolator cultures in the management of suspected catheter sepsis. Surgery. 1987;102(4):718–23.PubMedGoogle Scholar
  46. 46.
    Safdar N, Fine JP, Maki DG. Meta-analysis: methods for diagnosing intravascular device-related bloodstream infection. Ann Intern Med. 2005;142(6):451–66.PubMedCrossRefGoogle Scholar
  47. 47.
    DesJardin JA, Falagas ME, Ruthazer R, Griffith J, Wawrose D, Schenkein D, et al. Clinical utility of blood cultures drawn from indwelling central venous catheters in hospitalized patients with cancer. Ann Intern Med. 1999;131(9):641–7.PubMedCrossRefGoogle Scholar
  48. 48.
    Salzman MB, Isenberg HD, Shapiro JF, Lipsitz PJ, Rubin LG. A prospective study of the catheter hub as the portal of entry for microorganisms causing catheter-related sepsis in neonates. J Infect Dis. 1993;167(2):487–90.PubMedCrossRefGoogle Scholar
  49. 49.
    Safdar N, Kluger DM, Maki DG. A review of risk factors for catheter-related bloodstream infection caused by percutaneously inserted, noncuffed central venous catheters: implications for preventive strategies. Medicine (Baltimore). 2002;81(6):466–79.CrossRefGoogle Scholar
  50. 50.
    Salzman MB, Isenberg HD, Rubin LG. Use of disinfectants to reduce microbial contamination of hubs of vascular catheters. J Clin Microbiol. 1993;31(3):475–9.PubMedPubMedCentralGoogle Scholar
  51. 51.
    Beekmann SE, Diekema DJ, Huskins WC, Herwaldt L, Boyce JM, Sherertz RJ, et al. Diagnosing and reporting of central line-associated bloodstream infections. Infect Control Hosp Epidemiol. 2012;33(9):875–82.PubMedCrossRefGoogle Scholar
  52. 52.
    Bouza E, Alvarado N, Alcala L, Perez MJ, Rincon C, Munoz P. A randomized and prospective study of 3 procedures for the diagnosis of catheter-related bloodstream infection without catheter withdrawal. Clin Infect Dis. 2007;44(6):820–6.PubMedCrossRefGoogle Scholar
  53. 53.
    Gaur AH, Flynn PM, Heine DJ, Giannini MA, Shenep JL, Hayden RT. Diagnosis of catheter-related bloodstream infections among pediatric oncology patients lacking a peripheral culture, using differential time to detection. Pediatr Infect Dis J. 2005;24(5):445–9.PubMedCrossRefGoogle Scholar
  54. 54.
    Park KH, Lee MS, Lee SO, Choi SH, Sung H, Kim MN, et al. Diagnostic usefulness of differential time to positivity for catheter-related candidemia. J Clin Microbiol. 2014;52(7):2566–72.PubMedPubMedCentralCrossRefGoogle Scholar
  55. 55.
    Raad I, Hanna H, Maki D. Intravascular catheter-related infections: advances in diagnosis, prevention, and management. Lancet Infect Dis. 2007;7(10):645–57.PubMedCrossRefGoogle Scholar
  56. 56.
    Niedner MF, Huskins WC, Colantuoni E, Muschelli J, Harris JM 2nd, Rice TB, et al. Epidemiology of central line-associated bloodstream infections in the pediatric intensive care unit. Infect Control Hosp Epidemiol. 2011;32(12):1200–8.PubMedCrossRefGoogle Scholar
  57. 57.
    See I, Freifeld AG, Magill SS. Causative organisms and associated antimicrobial resistance in healthcare-associated, central line-associated bloodstream infections from oncology settings, 2009–2012. Clin Infect Dis. 2016;62(10):1203–9.PubMedPubMedCentralCrossRefGoogle Scholar
  58. 58.
    Lorente L, Jimenez A, Santana M, Iribarren JL, Jimenez JJ, Martin MM, et al. Microorganisms responsible for intravascular catheter-related bloodstream infection according to the catheter site. Crit Care Med. 2007;35(10):2424–7.PubMedCrossRefGoogle Scholar
  59. 59.
    Fernandez-Hidalgo N, Almirante B, Calleja R, Ruiz I, Planes AM, Rodriguez D, et al. Antibiotic-lock therapy for long-term intravascular catheter-related bacteraemia: results of an open, non-comparative study. J Antimicrob Chemother. 2006;57(6):1172–80.PubMedCrossRefGoogle Scholar
  60. 60.
    Dato VM, Dajani AS. Candidemia in children with central venous catheters: role of catheter removal and amphotericin B therapy. Pediatr Infect Dis J. 1990;9(5):309–14.PubMedCrossRefGoogle Scholar
  61. 61.
    Peces R, Gago E, Tejada F, Laures AS, Alvarez-Grande J. Relapsing bacteraemia due to Micrococcus luteus in a haemodialysis patient with a Perm-Cath catheter. Nephrol Dial Transplant. 1997;12(11):2428–9.PubMedCrossRefGoogle Scholar
  62. 62.
    Cotton DJ, Gill VJ, Marshall DJ, Gress J, Thaler M, Pizzo PA. Clinical features and therapeutic interventions in 17 cases of Bacillus bacteremia in an immunosuppressed patient population. J Clin Microbiol. 1987;25(4):672–4.PubMedPubMedCentralGoogle Scholar
  63. 63.
    Blue SR, Singh VR, Saubolle MA. Bacillus licheniformis bacteremia: five cases associated with indwelling central venous catheters. Clin Infect Dis. 1995;20(3):629–33.PubMedCrossRefGoogle Scholar
  64. 64.
    Messing B, Peitra-Cohen S, Debure A, Beliah M, Bernier JJ. Antibiotic-lock technique: a new approach to optimal therapy for catheter-related sepsis in home-parenteral nutrition patients. JPEN J Parenter Enteral Nutr. 1988;12(2):185–9.PubMedCrossRefGoogle Scholar
  65. 65.
    Wolf J, Allison KJ, Tang L, Sun Y, Hayden RT, Flynn PM. No evidence of benefit from antibiotic lock therapy in pediatric oncology patients with central line-related bloodstream infection: results of a retrospective matched cohort study and review of the literature. Pediatr Blood Cancer. 2014;61(10):1811–5.PubMedCrossRefGoogle Scholar
  66. 66.
    Bookstaver PB, Gerrald KR, Moran RR. Clinical outcomes of antimicrobial lock solutions used in a treatment modality: a retrospective case series analysis. Clin Pharmacol. 2010;2:123–30.PubMedPubMedCentralGoogle Scholar
  67. 67.
    Del Pozo JL, Alonso M, Serrera A, Hernaez S, Aguinaga A, Leiva J. Effectiveness of the antibiotic lock therapy for the treatment of port-related enterococci, Gram-negative, or Gram-positive bacilli bloodstream infections. Diagn Microbiol Infect Dis. 2009;63(2):208–12.PubMedCrossRefGoogle Scholar
  68. 68.
    Alvarez-Moreno CA, Valderrama-Beltran SL, Rosenthal VD, Mojica-Carreno BE, Valderrama-Marquez IA, Matta-Cortes L, et al. Multicenter study in Colombia: impact of a multidimensional International Nosocomial Infection Control Consortium (INICC) approach on central line-associated bloodstream infection rates. Am J Infect Control. 2016;44(11):e235–e41.PubMedCrossRefGoogle Scholar
  69. 69.
    McMullan R, Gordon A. Impact of a central line infection prevention bundle in newborn infants. Infect Control Hosp Epidemiol. 2016;37(9):1029–36.PubMedCrossRefGoogle Scholar
  70. 70.
    O’Neil C, Ball K, Wood H, McMullen K, Kremer P, Jafarzadeh SR, et al. A central line care maintenance bundle for the prevention of central line-associated bloodstream infection in non-intensive care unit settings. Infect Control Hosp Epidemiol. 2016;37(6):692–8.PubMedPubMedCentralCrossRefGoogle Scholar
  71. 71.
    Kawano T, Kaji T, Onishi S, Yamada K, Yamada W, Nakame K, et al. Efficacy of ethanol locks to reduce the incidence of catheter-related bloodstream infections for home parenteral nutrition pediatric patients: comparison of therapeutic treatment with prophylactic treatment. Pediatr Surg Int. 2016;32(9):863–7.PubMedCrossRefGoogle Scholar
  72. 72.
    Sofroniadou S, Revela I, Kouloubinis A, Makriniotou I, Zerbala S, Smirloglou D, et al. Ethanol combined with heparin as a locking solution for the prevention of catheter related blood stream infections in hemodialysis patients: a prospective randomized study. Hemodial Int. 2017;21(4):498–506.PubMedCrossRefGoogle Scholar
  73. 73.
    Ardura MI, Lewis J, Tansmore JL, Harp PL, Dienhart MC, Balint JP. Central catheter-associated bloodstream infection reduction with ethanol lock prophylaxis in pediatric intestinal failure: broadening quality improvement initiatives from hospital to home. JAMA Pediatr. 2015;169(4):324–31.PubMedCrossRefGoogle Scholar
  74. 74.
    Davidson JB, Edakkanambeth Varayil J, Okano A, Whitaker JA, Bonnes SL, Kelly DG, et al. Prevention of subsequent catheter-related bloodstream infection using catheter locks in high-risk patients receiving home parenteral nutrition. JPEN J Parenter Enteral Nutr. 2017;41(4):685–90.PubMedCrossRefGoogle Scholar
  75. 75.
    Yahav D, Rozen-Zvi B, Gafter-Gvili A, Leibovici L, Gafter U, Paul M. Antimicrobial lock solutions for the prevention of infections associated with intravascular catheters in patients undergoing hemodialysis: systematic review and meta-analysis of randomized, controlled trials. Clin Infect Dis. 2008;47(1):83–93.PubMedCrossRefGoogle Scholar
  76. 76.
    Snaterse M, Ruger W, Scholte Op Reimer WJ, Lucas C. Antibiotic-based catheter lock solutions for prevention of catheter-related bloodstream infection: a systematic review of randomised controlled trials. J Hosp Infect. 2010;75(1):1–11.PubMedCrossRefGoogle Scholar
  77. 77.
    Broom JK, Krishnasamy R, Hawley CM, Playford EG, Johnson DW. A randomised controlled trial of Heparin versus EthAnol Lock THerapY for the prevention of Catheter Associated infecTion in Haemodialysis patients–the HEALTHY-CATH trial. BMC Nephrol. 2012;13:146.PubMedPubMedCentralCrossRefGoogle Scholar
  78. 78.
    Souweine B, Lautrette A, Gruson D, Canet E, Klouche K, Argaud L, et al. Ethanol lock and risk of hemodialysis catheter infection in critically ill patients. A randomized controlled trial. Am J Respir Crit Care Med. 2015;191(9):1024–32.PubMedCrossRefGoogle Scholar

Further Reading

  1. Mermel LA, Allon M, Bouza E, Craven DE, Flynn P, O’Grady NP, et al. Clinical practice guidelines for the diagnosis and management of intravascular catheter-related infection: 2009 update by the Infectious Diseases Society of America. Clin Infect Dis. 2009;49(1):1–45.PubMedPubMedCentralCrossRefGoogle Scholar
  2. Zakhour R, Chaftari AM, Raad II. Catheter-related infections in patients with haematological malignancies: novel preventive and therapeutic strategies. Lancet Infect Dis. 2016;16(11):e241–50. Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2019

Authors and Affiliations

  1. 1.University of Mississippi Medical Center, Department of Pediatrics, Division of Pediatric Infectious DiseasesJacksonUSA
  2. 2.Children’s Mercy Kansas City, Division of Infectious DiseasesKansas CityUSA

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