In critically ill patients, catheter-related bloodstream infections (CRBSIs) are associated with increased mortality, length of stay in the ICU and extra costs. The relative risk of infection can be best determined by analyzing rates of catheter-related bloodstream infections per 1000 catheter-days. Coagulase-negative staphylococci, Staphylococcus aureus and Candida spp are the pathogens found most commonly both on catheter tips and in blood. The commonly used definitions of intravascular catheter- related infections are summarized in this review. Clinical signs of catheter-related infections are unreliable because of their poor sensitivity and specificity. Therefore diagnosis is mainly dependent on microbiological techniques. The available diagnostic tests can be classified as methods requiring removal of the central venous catheter and methods not requiring removal of the catheter. The reliability of the various methods is described; none of the described methods has a 100% sensitivity and specificity, and there- fore diagnosing CRBSI is still problematic. Finally a diagnostic approach to catheter-related infection is proposed.
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