Skip to main content
SpringerLink
Log in

Cardiovascular Infections

  • Chapter
  • First Online:
Infections in the Adult Intensive Care Unit

  • 1985 Accesses

Abstract

Infections related to intravascular catheters are a major complication of critical care. Central venous catheters (CVCs) and other intravascular catheters are needed for intensive patient care, but are associated with an increased burden of infection, mortality and length of stay. The main proposed mechanism of catheter-related infections is migration of skin organisms from the insertion site into the cutaneous catheter tract with colonization of the catheter tip. Colonization is extraluminal initially and is common with non-tunneled, non-cuffed short-term central venous catheters. With longer durations of catheterization, i.e. after 1–2 weeks, intraluminal colonization develops. Bloodstream infections (BSIs) originate both from extraluminal and intraluminal catheter colonization [1]. Within the catheter lumen bacteria are relatively “protected” from host defense mechanisms and antimicrobial agents by a biofilm layer [2]. This biofilm matrix is produced by bacteria and consists of an extracellular polymeric substance (exopolysaccharide), enriched by divalent metallic cations, such as calcium, magnesium and iron. Candida spp. can produce a similar slime in the presence of dextrose-containing fluids.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 84.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 169.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 109.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Safdar N, Maki DG. The pathogenesis of catheter-related bloodstream infection with noncuffed short-term central venous catheters. Intensive Care Med. 2004;30:62–7.

    Article  PubMed  Google Scholar 

  2. O’Grady NP, Alexander M, Burns LA, et al. Guidelines for the prevention of intravascular catheter-related infections. Am J Infect Control. 2011;39:S1–34.

    Article  PubMed  Google Scholar 

  3. Mermel LA, Allon M, Bouza E, 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;49:1–45.

    Article  PubMed  CAS  Google Scholar 

  4. Dudeck MA, Horan TC, Peterson KD, et al. National Healthcare Safety Network (NHSN) Report, data summary for 2010, device-associated module. Am J Infect Control. 2011;39:798–816.

    Article  PubMed  Google Scholar 

  5. Rosenthal VD, Bijie H, Maki DG, et al. International Nosocomial Infection Control Consortium (INICC) report, data summary of 36 countries, for 2004–2009. Am J Infect Control. 2012;40(5):396–407.

    Article  PubMed  Google Scholar 

  6. Ramritu P, Halton K, Collignon P, et al. A systematic review comparing the relative effectiveness of antimicrobial-coated catheters in intensive care units. Am J Infect Control. 2008;36:104–17.

    Article  PubMed  Google Scholar 

  7. Timsit JF, Schwebel C, Bouadma L, et al. Chlorhexidine-impregnated sponges and less frequent dressing changes for prevention of catheter-related infections in critically ill adults: a randomized controlled trial. JAMA. 2009;301:1231–41.

    Article  PubMed  CAS  Google Scholar 

  8. Arvaniti K, Lathyris D, Clouva-Molyvdas P, et al. Comparison of Oligon catheters and chlorhexidine-impregnated sponges with standard multilumen central venous catheters for prevention of associated colonization and infections in intensive care unit patients: a multicenter, randomized, controlled study. Crit Care Med. 2012;40:420–9.

    Article  PubMed  Google Scholar 

  9. OudeLashof AM, Rothova A, Sobel JD, et al. Ocular manifestations of candidemia. Clin Infect Dis. 2011;53:262–8.

    Article  Google Scholar 

  10. O’Horo JC, Silva GL, Safdar N. Anti-infective locks for treatment of central line-associated bloodstream infection: a systematic review and meta-analysis. Am J Nephrol. 2011;34:415–22.

    Article  PubMed  Google Scholar 

  11. Valentine KM. Ethanol lock therapy for catheter-associated blood stream infections in a pediatric intensive care unit. Pediatr Crit Care Med. 2011;12:e292–6.

    Article  PubMed  Google Scholar 

  12. Lopez J, Revilla A, Vilacosta I, et al. Definition, clinical profile, microbiological spectrum, and prognostic factors of early-onset prosthetic valve endocarditis. Eur Heart J. 2007;28:760–5.

    Article  PubMed  Google Scholar 

  13. Benito N, Miro JM, de Lazzari E, et al. Health care-associated native valve endocarditis: importance of non-nosocomial acquisition. Ann Intern Med. 2009;150:586–94.

    PubMed  Google Scholar 

  14. Lalani T, Cabell CH, Benjamin DK, et al. Analysis of the impact of early surgery on in-hospital mortality of native valve endocarditis: use of propensity score and instrumental variable methods to adjust for treatment-selection bias. Circulation. 2010;121:1005–13.

    Article  PubMed  Google Scholar 

  15. Wang A, Athan E, Pappas PA, et al. Contemporary clinical profile and outcome of prosthetic valve endocarditis. JAMA. 2007;297:1354–61.

    Article  PubMed  CAS  Google Scholar 

  16. Thuny F, Fournier PE, Casalta JP, et al. Investigation of blood culture-negative early prosthetic valve endocarditis reveals high prevalence of fungi. Heart. 2010;96:743–7.

    Article  PubMed  Google Scholar 

  17. Li JS, Sexton DJ, Mick N, et al. Proposed modifications to the Duke criteria for the diagnosis of infective endocarditis. Clin Infect Dis. 2000;30:633–8.

    Article  PubMed  CAS  Google Scholar 

  18. Botelho-Nevers E, Thuny F, Casalta JP, et al. Dramatic reduction in infective endocarditis-related mortality with a management-based approach. Arch Intern Med. 2009;169:1290–8.

    Article  PubMed  Google Scholar 

  19. Fournier PE, Thuny F, Richet H, et al. Comprehensive diagnostic strategy for blood culture-negative endocarditis: a prospective study of 819 new cases. Clin Infect Dis. 2010;51:131–40.

    Article  PubMed  CAS  Google Scholar 

  20. Thuny F, Grisoli D, Collart F, Habib G, Raoult D. Management of infective endocarditis: challenges and perspectives. Lancet. 2012;379:965–75.

    Article  PubMed  Google Scholar 

  21. Baddour LM, Wilson WR, Bayer AS, et al. Infective endocarditis: diagnosis, antimicrobial therapy, and management of complications: a statement for healthcare professionals from the Committee on Rheumatic Fever, Endocarditis, and Kawasaki Disease, Council on Cardiovascular Disease in the Young, and the Councils on Clinical Cardiology, Stroke, and Cardiovascular Surgery and Anesthesia, American Heart Association: endorsed by the Infectious Diseases Society of America. Circulation. 2005;111:e394–434.

    Article  PubMed  Google Scholar 

  22. Gould FK, Denning DW, Elliott TS, et al. Guidelines for the diagnosis and antibiotic treatment of endocarditis in adults: a report of the Working Party of the British Society for Antimicrobial Chemotherapy. J Antimicrob Chemother. 2012;67:269–89.

    Article  PubMed  CAS  Google Scholar 

  23. Habib G, Hoen B, Tornos P, et al. Guidelines on the prevention, diagnosis, and treatment of infective endocarditis (new version 2009): the Task Force on the Prevention, Diagnosis, and Treatment of Infective Endocarditis of the European Society of Cardiology (ESC) Endorsed by the European Society of Clinical Microbiology and Infectious Diseases (ESCMID) and the International Society of Chemotherapy (ISC) for Infection and Cancer. Eur Heart J. 2009;30:2369–413.

    Article  PubMed  Google Scholar 

  24. Kang DH, Kim YJ, Kim SH, et al. Early surgery versus conventional treatment for infective endocarditis. N Engl J Med. 2012;28(366):2466–73.

    Article  PubMed  Google Scholar 

  25. Sonneville R, Mirabel M, Hajage D, et al. Neurologic complications and outcomes of infective endocarditis in critically ill patients: the ENDOcardite en REAnimation prospective multicenter study. Crit Care Med. 2011;39:1474–81.

    Article  PubMed  Google Scholar 

  26. Sohail MR, Uslan DZ, Khan AH, et al. Management and outcome of permanent pacemaker and implantable cardioverter-defibrillator infections. J Am Coll Cardiol. 2007;49:1851–9.

    Article  PubMed  Google Scholar 

  27. Baddour LM, Epstein AE, Erickson CC, et al. Update on cardiovascular implantable electronic device infections and their management: a scientific statement from the American Heart Association. Circulation. 2010;121:458–77.

    Article  PubMed  Google Scholar 

  28. Malouf JF, Chandrasekaran K, Orszulak TA. Mycotic aneurysms of the thoracic aorta: a diagnostic challenge. Am J Med. 2003;115:489–96.

    Article  PubMed  CAS  Google Scholar 

  29. Legout L, Sarraz-Bournet B, D’Elia PV, et al. Characteristics and prognosis in patients with prosthetic vascular graft infection: a prospective observational cohort study. Clin Microbiol Infect. 2012;18:352–8.

    Article  PubMed  Google Scholar 

  30. Ali AT, Modrall JG, Hocking J, et al. Long-term results of the treatment of aortic graft infection by in situ replacement with femoral popliteal vein grafts. J Vasc Surg. 2009;50:30–9.

    Article  PubMed  CAS  Google Scholar 

  31. FitzGerald SF, Kelly C, Humphreys H. Diagnosis and treatment of prosthetic aortic graft infections: confusion and inconsistency in the absence of evidence or consensus. J Antimicrob Chemother. 2005;56:996–9.

    Article  PubMed  CAS  Google Scholar 

  32. Bruggink JL, Glaudemans AW, Saleem BR, et al. Accuracy of FDG-PET-CT in the diagnostic work-up of vascular prosthetic graft infection. Eur J Vasc Endovasc Surg. 2010;40:348–54.

    Article  PubMed  Google Scholar 

  33. Wasselius J, Malmstedt J, Kalin B, et al. High 18 F-FDG Uptake in synthetic aortic vascular grafts on PET/CT in symptomatic and asymptomatic patients. J Nucl Med. 2008;49:1601–5.

    Article  PubMed  Google Scholar 

  34. Tegler G, Sorensen J, Bjorck M, Savitcheva I, Wanhainen A. Detection of aortic graft infection by 18-fluorodeoxyglucose positron emission tomography combined with computed tomography. J Vasc Surg. 2007;45:828–30.

    Article  PubMed  Google Scholar 

  35. O’Connor S, Andrew P, Batt M, Becquemin JP. A systematic review and meta-analysis of treatments for aortic graft infection. J Vasc Surg. 2006;44:38–45.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Beaumont Hospital The Royal College of Surgeons in Ireland, Dublin, Ireland

    Hilary Humphreys

  2. Queen’s Medical Centre University Hospital Nottingham, Nottingham, UK

    Bob Winter

  3. Rabin Medical Center Beilinson Hospital Unit of Infectious Diseases Sackler Faculty of Medicine Tel-Aviv University, Petach Tikva/Tel-Aviv, Israel

    Mical Paul

Authors
  1. Hilary Humphreys
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Bob Winter
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Mical Paul
    View author publications

    You can also search for this author in PubMed Google Scholar

Rights and permissions

Reprints and permissions

Copyright information

© 2013 Springer-Verlag London

About this chapter

Cite this chapter

Humphreys, H., Winter, B., Paul, M. (2013). Cardiovascular Infections. In: Infections in the Adult Intensive Care Unit. Springer, London. https://doi.org/10.1007/978-1-4471-4318-5_7

Download citation

  • DOI: https://doi.org/10.1007/978-1-4471-4318-5_7

  • Published:

  • Publisher Name: Springer, London

  • Print ISBN: 978-1-4471-4317-8

  • Online ISBN: 978-1-4471-4318-5

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation