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Central Venous Catheters for Dialysis (CVCDs)
Catheter Related Bloodstream Infection (CRBSI) |
The magnitude of catheter-related
bloodstream infection (CRBSI) in the U.S and abroad is staggering.
According to the United States Centers for Disease Control (CDC),
there are an estimated 200,000 to 400,000 episodes of CRBSI annually. Nearly
1 in every 10 hemodialysis catheters fail each month as a result
of a CRBSI and the numbers are even greater in non-tunneled catheters
(16.5% per month) used in the acute care setting. The morbidity
and mortality rates of patients acquiring a CRBSI and the accompanying
financial burden are very significant. Studies
have shown mortality rates of CRBSI range from 12 – 25% and
annual healthcare costs associated with treatment will likely exceed
$2 billion ($25k- $55k per incident) this year.
Another growing
concern of CRBSI (and infections in general) is the alarming rates
of bacterial antibiotic resistance. The most common organisms
associated with catheter-related bloodstream infections are Staphylococcus
aureus and epidermis, Enterococcus faecalis, Escherichia coli, Pseudomonas
aeruginosa, and Candida albicans. It is estimated that greater
than 70% of bacteria associated with CRBSI are resistant to at least
one antibiotic. There has been a growing movement within the
past few years from the Federal government, State legislatures and
the pharmaceutical industry to enhance awareness, education and techniques
for improved “infection control & reporting”. As
of today, five states in the U.S. are now requiring hospitals to
report their incidence of infections and more are likely to pass
legislation in the near future.
Crisis: Antibiotic-Resistance
Growing Resistance to Antibiotics

MRSE=Methicillin-Resistant Staphylococcus
epidermis
MRSE=Methicillin-Resistant Staphylococcus aureus
PNSP=Penicillin Non-susceptible Streptococcus Pneumoniae
VRE=Vancomycin-Resistant Enterococci
VRSA=Vancomycin-Resistant Staphylococcus aureus
The
caregiver, a patient’s environment, catheter material / placement,
biofilm, etc. are all potential sources of a CRBSI. Some of
the more common causes of actually acquiring CRBSI include:
- Exit site infections from patient exposure to their environment,
caregiver, etc. may lead to the migration of bacteria into the
catheter and ultimately in the bloodstream
- Intraluminal bacterial migration from contaminated catheter hubs
- Bacterial growth in biofilm on the surface of the catheter walls
- Migration of bacteria throughout the bloodstream exposing all
cells
Needless to say, the environment for an escalation
in the incidence of CRBSI is conducive. The aging population, potential rise
in immunocompromised patients, increased use of invasive devices
and procedures and a growing antibiotic resistance may all contribute
to the higher incidences in the coming years. Therefore, it
is essential to continue to be aggressive educating the medical community
and general public about the implications of CRBSI as well as expedite
the development of new therapeutic solutions to prevent & combat
this deadly disease. |