Catheter-Related Bloodstream Infection

Catheter-related bloodstream infection (CRBSI) is bacteremia or fungemia in a patient with an intravascular catheter where the catheter is implicated as the source by paired blood cultures or by quantitative culture techniques. It is a major cause of healthcare-associated bloodstream infection, particularly in critical care, oncology, and dialysis patients.

Pathogens enter through one of four routes: skin colonization at the insertion site (most common short-term catheters), contamination of catheter hubs (most common long-term catheters), hematogenous seeding from a distant source, or contaminated infusate (rare but devastating). Coagulase-negative staphylococci are the most common organisms, followed by Staphylococcus aureus, gram-negative rods, and Candida species.

Prevention is the most effective strategy. The CDC central-line bundle includes hand hygiene, maximal sterile barrier precautions during insertion, chlorhexidine skin antisepsis, optimal catheter site selection (subclavian preferred over femoral), and daily review of catheter necessity. These measures have reduced CRBSI rates by over 50% in many institutions.