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Chapter 6 : Pathogenesis of Vascular Catheter Infection

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Abstract:

The pathogenesis of vascular catheter infections has recently been extensively reviewed. This chapter summarizes existing understandings and presents details of new work published on vascular catheter infections since the recent reviews. Many factors have been shown to affect the risk of catheters becoming infected. These include the unique abilities of certain organisms, , , and , to cause catheter-related infections. Molecular typing studies increasingly are improving our understanding of the pathogenesis of /CoNS catheter-related infection. Recent studies with isogenic mutants increasingly suggest that production of a polysaccharide adhesin is crucial to the pathogenesis of foreign-body infection. This polysaccharide, first named PS/A, was initially described as a virulence factor in association with work examining the pathogenesis of endocarditis. Two additional findings of relevance to the pathogenesis of endocarditis and possibly vascular catheter infections are that binding to platelets facilitates endocarditis and strains causing endocarditis are much more likely to be resistant to platelet microbicidal proteins. The pathogenesis of catheter-related thrombosis has been studied in greater depth in recent years. With peripheral catheters, ultrasonographic imaging has shown that early thrombus formation (<24 h after insertion) occurs near the site of insertion, whereas later thrombus formation (>24 h after insertion) occurs near the catheter tip. Recent in vitro studies have shown that surface manipulations of polyurethane can lead to differences in protein and platelet deposition with associated differences in bacterial adherence.

Citation: Sherertz R. 2000. Pathogenesis of Vascular Catheter Infection, p 111-125. In Waldvogel F, Bisno A (ed), Infections Associated with Indwelling Medical Devices, Third Edition. ASM Press, Washington, DC. doi: 10.1128/9781555818067.ch6

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Catheter-Related Bloodstream Infections
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Pulsed-Field Gel Electrophoresis
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Figure 1

Vascular catheter biofilm showing staphylococci in association with proteins and glycocalyx.

Citation: Sherertz R. 2000. Pathogenesis of Vascular Catheter Infection, p 111-125. In Waldvogel F, Bisno A (ed), Infections Associated with Indwelling Medical Devices, Third Edition. ASM Press, Washington, DC. doi: 10.1128/9781555818067.ch6
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Image of Figure 2
Figure 2

Quantitative relationship between the number of CFU of removed by sonication and gross purulence observed in a rabbit model of foreign-body infection. This is a new analysis of data from Sherertz et al. ( ).

Citation: Sherertz R. 2000. Pathogenesis of Vascular Catheter Infection, p 111-125. In Waldvogel F, Bisno A (ed), Infections Associated with Indwelling Medical Devices, Third Edition. ASM Press, Washington, DC. doi: 10.1128/9781555818067.ch6
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Image of Figure 3
Figure 3

Quantitative relationship between the number of organisms removed from 207 catheters by sonication and the frequency of positive blood cultures for the same organism. The solid line is the linear regression line; the dashed lines are the 95% confidence limits. (Reproduced with permission, Sherertz et al. [ ].)

Citation: Sherertz R. 2000. Pathogenesis of Vascular Catheter Infection, p 111-125. In Waldvogel F, Bisno A (ed), Infections Associated with Indwelling Medical Devices, Third Edition. ASM Press, Washington, DC. doi: 10.1128/9781555818067.ch6
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Image of Figure 4
Figure 4

Sources of vascular catheter infection. (Reprinted with permission from reference .)

Citation: Sherertz R. 2000. Pathogenesis of Vascular Catheter Infection, p 111-125. In Waldvogel F, Bisno A (ed), Infections Associated with Indwelling Medical Devices, Third Edition. ASM Press, Washington, DC. doi: 10.1128/9781555818067.ch6
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Tables

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Table 1

Estimated risk of catheter-associated bloodstream infection for different types of vascular access

Citation: Sherertz R. 2000. Pathogenesis of Vascular Catheter Infection, p 111-125. In Waldvogel F, Bisno A (ed), Infections Associated with Indwelling Medical Devices, Third Edition. ASM Press, Washington, DC. doi: 10.1128/9781555818067.ch6
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Table 2

Intrinsic factors shown to alter the risk of vascular catheter infections

Citation: Sherertz R. 2000. Pathogenesis of Vascular Catheter Infection, p 111-125. In Waldvogel F, Bisno A (ed), Infections Associated with Indwelling Medical Devices, Third Edition. ASM Press, Washington, DC. doi: 10.1128/9781555818067.ch6
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Table 3.

Extrinsic factors shown to alter the risk of vascular catheter infections

Citation: Sherertz R. 2000. Pathogenesis of Vascular Catheter Infection, p 111-125. In Waldvogel F, Bisno A (ed), Infections Associated with Indwelling Medical Devices, Third Edition. ASM Press, Washington, DC. doi: 10.1128/9781555818067.ch6

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