Vascular catheter-related infection and sepsis.

BACKGROUND: Catheter-related sepsis is a clinical syndrome characterized by the presence of a catheter-associated infection along with a systemic inflammatory response. The continual increase in the use of central venous catheters (CVCs) has been associated with a substantial risk of infectious complications that prolong the hospital stay and increase costs.
METHODS: The literature on CVCs was reviewed to determine the incidence of catheterrelated sepsis, its diagnosis, and the role of biofilms in pathogenesis.
RESULTS: The European Sepsis Group recently reported that 28% of CVC infections in intensive care unit patients were associated with sepsis, 24% with severe sepsis, and 30% with septic shock. Clinical diagnosis remains difficult. After CVC insertion, the intravascular portion of the device is covered rapidly by a thrombin layer, rich in host-derived proteins, that forms a conditioning film and promotes surface adherence of microbial colonizers. These microorganisms then enter their sessile mode of growth, secreting an exopolysaccharide slime within which organism density is regulated by quorum-sensing molecules. Microorganisms are dispersed in clumps that can become septic emboli. Antiadhesive, antiseptic, and antibiotic coatings of catheters have demonstrated only modest clinical efficacy.
CONCLUSION: Our group is involved in the design and in vitro assessment of new polymeric matrices for controlled release of antimicrobial molecules, and in comparative clinical studies of conventional versus antibiotic-coated or -impregnated catheters.