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.