Iranian Heart Journal

Iranian Heart Journal

A Longitudinal Study of Catheter-Related Infections: Challenges in Diagnosis and Management

Document Type : Original Article

Authors
Shokoufeh Hajsadeghi 1
Seyed Masoud Musavian 2
Shima Loni 3
Ali Mehrakizadeh 4
Shayan Mirshafiee 4
1 Research Center for Prevention of Cardiovascular Disease, Institute of Endocrinology and Metabolism, Iran University of Medical Sciences, Tehran, IR Iran.
2 Department of Cardiology, Rasoul Akram Hospital, Iran University of Medical Sciences, Tehran, IR Iran.
3 Department of Internal Medicine, Tehran University of Medical Sciences, Tehran, IR Iran.
4 Department of Cardiology, Tehran University of Medical Sciences, Tehran, IR Iran.
Abstract
Background: Central venous catheters (CVCs) are essential for vascular access but are associated with catheter-related bloodstream infections (CRBSIs), which can cause significant morbidity and mortality, particularly among hemodialysis patients.
 This study aimed to investigate risk factors for CVC infections, evaluate the role of echocardiography in diagnosis and prognosis, and assess outcomes of different catheter management strategies.
 
Methods: A longitudinal study of 166 patients with confirmed CVC infections was conducted at Rasoul Akram Hospital, Tehran, Iran, from 2014 through 2022. Data included demographics, comorbidities, catheter site/duration, microbiological cultures, echocardiographic findings, and treatment outcomes. Statistical analyses included the χ2 test, the t test, ANOVA, and regression methods using SPSS, version 26.
 
Results: Participants had a median age of 58 years (IQR, 45–67), and 54.8% were women. Fever was the most common presenting symptom (52.4%). Vegetations were detected in 52 patients (46.4%), most commonly at the catheter site. No significant difference in mortality was found between percutaneous and surgical catheter removal methods (P = 0.26). Vegetation size was not associated with mortality (P = 0.516). Patients with diabetes and transfusion history had longer hospital stays. Recurrence of infection was highest (37.9%) in those managed without catheter removal.
 
Conclusions: Echocardiography plays a critical role in the diagnosis and prognosis of CVC infections. Catheter removal, whether percutaneous or surgical, did not influence in-hospital mortality, even in cases with large vegetations. However, failure to remove infected catheters increased the recurrence risk. (Iranian Heart Journal 2026; 27(2): 54-64)
Keywords
catheter infection
echocardiography
catheter removal
endocarditis
longitudinal study
1.         Dickinson, G.M. and A.L. Bisno, Infections associated with indwelling devices: concepts of pathogenesis; infections associated with intravascular devices. Antimicrobial agents and chemotherapy, 1989. 33(5): p. 597-601.
2.         Raad, I., Intravascular-catheter-related infections. The Lancet, 1998. 351(9106): p. 893-898.
3.         Banerjee, S.N., et al., Secular trends in nosocomial primary bloodstream infections in the United States, 1980–1989. The American journal of medicine, 1991. 91(3): p. S86-S89.
4.         Eggimann, P., H. Sax, and D. Pittet, Catheter-related infections. Microbes and infection, 2004. 6(11): p. 1033-1042.
5.         Szeto, C.-C., et al., ISPD catheter-related infection recommendations: 2017 update. Peritoneal Dialysis International, 2017. 37(2): p. 141-154.
6.         Abraham, G., et al., Natural history of exit-site infection (ESI) in patients on continuous ambulatory peritoneal dialysis (CAPD). Peritoneal Dialysis International, 1988. 8(3): p. 211-216.
7.         Flanigan, M.J., et al., Continuous ambulatory peritoneal dialysis catheter infections: diagnosis and management. Peritoneal dialysis international, 1994. 14(3): p. 248-254.
8.         Greene, J.N., Catheter-related complications of cancer therapy. Infectious Disease Clinics, 1996. 10(2): p. 255-295.
9.         Mun, S.J., et al., Role of echocardiography in uncomplicated Staphylococcus aureus catheter-related bloodstream infections. Medicine, 2021. 100(18): p. e25679.
10.      J. Antony, S., Catheter related line sepsis resulting from Mycobacterium chelonae infection in an immunocompromised host. Infectious Disorders-Drug TargetsDisorders), 2015. 15(2): p. 135-137.
11.      Smith, R.L., S.M. Meixler, and M.S. Simberkoff, Excess mortality in critically III patients with nosocomial bloodstream infections. Chest, 1991. 100(1): p. 164-167.
12.      Safdar, N., D.M. Kluger, and D.G. Maki, A review of risk factors for catheter-related bloodstream infection caused by percutaneously inserted, noncuffed central venous catheters: implications for preventive strategies. Medicine, 2002. 81(6): p. 466-479.
13.      Bouza, E., et al., A randomized and prospective study of 3 procedures for the diagnosis of catheter-related bloodstream infection without catheter withdrawal. Clinical Infectious Diseases, 2007. 44(6): p. 820-826.
14.      Fätkenheuer, G., O. Cornely, and H. Seifert, Clinical management of catheter-related infections. Clinical microbiology and infection, 2002. 8(9): p. 545-550.
15.      Pearson, M.L. and H.I.C.P.A. Committee, Guideline for prevention of intravascular-device–related infections. Infection Control & Hospital Epidemiology, 1996. 17(7): p. 438-473.
16.      Guembe, M., et al., Differential time to positivity (DTTP) for the diagnosis of catheter-related bloodstream infection: do we need to obtain one or more peripheral vein blood cultures? European journal of clinical microbiology & infectious diseases, 2012. 31: p. 1367-1372.
17.      Oguzhan, N., et al., Locking tunneled hemodialysis catheters with hypertonic saline (26% NaCl) and heparin to prevent catheter-related bloodstream infections and thrombosis: a randomized, prospective trial. Renal Failure, 2012. 34(2): p. 181-188.
18.      Chovanec, K., et al., Association of CLABSI with hospital length of stay, readmission rates, and mortality: A retrospective review. Worldviews on Evidence‐Based Nursing, 2021. 18(6): p. 332-338.
19.      Raad, I., Management of intravascular catheter-related infections. Journal of Antimicrobial Chemotherapy, 2000. 45(3): p. 267-270.
20.      Wenzel, R.P. and M.B. Edmond, The evolving technology of venous access. The New England journal of medicine, 1999. 340(1): p. 48-50.
21.      Scheer, B.V., A. Perel, and U.J. Pfeiffer, Complications of peripheral arterial catheters used for haemodynamic monitoring in anaesthesia and intensive care medicine. Critical Care, 2002. 6: p. 199-204.
22.      Mermel, L.A., et al., Guidelines for the management of intravascular catheter-related infections. Infection Control & Hospital Epidemiology, 2001. 22(4): p. 222-242.
23.      Boersma, R., et al., Thrombotic and infectious complications of central venous catheters in patients with hematological malignancies. Annals of oncology, 2008. 19(3): p. 433-442.
24.      Lee, G.J., et al., A case-control study to identify risk factors for totally implantable central venous port-related bloodstream infection. Cancer Research and Treatment: Official Journal of Korean Cancer Association, 2014. 46(3): p. 250.
25.      Hsieh, C.-C., et al., Analysis of risk factors for central venous port failure in cancer patients. World journal of gastroenterology: WJG, 2009. 15(37): p. 4709.
26.      Lipitz-Snyderman, A., et al., Long-term central venous catheter use and risk of infection in older adults with cancer. Journal of clinical oncology, 2014. 32(22): p. 2351.
27.      Parienti, J.-J., et al., Intravascular complications of central venous catheterization by insertion site. New England Journal of Medicine, 2015. 373(13): p. 1220-1229.
28.      Baang, J.H., et al., Inpatient Diagnosis and Treatment of Catheter-Related Bloodstream Infection. 2023.
29.      Narducci, M.L., et al., Usefulness of intracardiac echocardiography for the diagnosis of cardiovascular implantable electronic device–related endocarditis. Journal of the American College of Cardiology, 2013. 61(13): p. 1398-1405.
30.      Pigrau, C., et al., Management of catheter-related Staphylococcus aureus bacteremia: when may sonographic study be unnecessary? European Journal of Clinical Microbiology and Infectious Diseases, 2003. 22: p. 713-719.
31.      Hajsadeghi, S., S. Kalantari, and S. Mirshafiee, Uncommon site of Brucella endocarditis in a double discordant heart. European Heart Journal-Case Reports, 2024. 8(11): p. ytae562.
32.      Mermel, L.A., et al., Clinical practice guidelines for the diagnosis and management of intravascular catheter-related infection: 2009 Update by the Infectious Diseases Society of America. Clinical infectious diseases, 2009. 49(1): p. 1-45.
33.      Böll, B., et al., Central venous catheter–related infections in hematology and oncology: 2020 updated guidelines on diagnosis, management, and prevention by the Infectious Diseases Working Party (AGIHO) of the German Society of Hematology and Medical Oncology (DGHO). Annals of hematology, 2021. 100: p. 239-259.
34.      Hentrich, M., et al., Central venous catheter-related infections in hematology and oncology: 2012 updated guidelines on diagnosis, management and prevention by the Infectious Diseases Working Party of the German Society of Hematology and Medical Oncology. Annals of Oncology, 2014. 25(5): p. 936-947.
35.      Martín-Dávila, P., et al., Analysis of mortality and risk factors associated with native valve endocarditis in drug users: the importance of vegetation size. American heart journal, 2005. 150(5): p. 1099-1106.
36.      Mihos, C.G. and F. Nappi, A narrative review of echocardiography in infective endocarditis of the right heart. Annals of Translational Medicine, 2020. 8(23).
37.      Shmueli, H., et al., Right‐sided infective endocarditis 2020: challenges and updates in diagnosis and treatment. Journal of the American Heart Association, 2020. 9(15): p. e017293.
38.      Vilacosta, I., et al., The diagnostic ability of echocardiography for infective endocarditis and its associated complications. Expert review of cardiovascular therapy, 2015. 13(11): p. 1225-1236.
39.      Microbiology, E.b.t.E.S.o.C., 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). European heart journal, 2009. 30(19): p. 2369-2413.
40.      Okonta, K.E. and Y.B. Adamu, What size of vegetation is an indication for surgery in endocarditis? Interactive cardiovascular and thoracic surgery, 2012. 15(6): p. 1052-1056.
41.      Young, W.J., et al., Echocardiography in patients with infective endocarditis and the impact of diagnostic delays on clinical outcomes. The American journal of cardiology, 2018. 122(4): p. 650-655.
42.      Shafiyi, A., et al., Repeat transesophageal echocardiography in infective endocarditis: An analysis of contemporary utilization. Echocardiography, 2020. 37(6): p. 891-899.
43.      Hajsadeghi, S., et al., The relationship between global longitudinal strain and pulmonary function tests in patients with scleroderma and normal ejection fraction and pulmonary artery pressure: a case–control study. The International Journal of Cardiovascular Imaging, 2020. 36: p. 883-888.
44.      Hajsadeghi, S., et al., Comparison of Qanadli score with conventional risk stratifiers in non-massive pulmonary emboli. Journal of International Medical Research, 2024. 52(9): p. 03000605241276481.
45.      Labriola, L. and M. Jadoul, Haemodialysis is a major risk factor for infective endocarditis. The Lancet, 2016. 388(10042): p. 339-340.
46.      Pericàs, J.M., et al., Infective endocarditis in patients on chronic hemodialysis. Journal of the American College of Cardiology, 2021. 77(13): p. 1629-1640.
47.      Sadeghi, M., S. Behdad, and F. Shahsanaei, Infective endocarditis and its short and long-term prognosis in hemodialysis patients: a systematic review and meta-analysis. Current Problems in Cardiology, 2021. 46(3): p. 100680.
48.      George, B., et al., A novel approach to percutaneous removal of large tricuspid valve vegetations using suction filtration and veno‐venous bypass: a single center experience. Catheterization and Cardiovascular Interventions, 2017. 90(6): p. 1009-1015.
49.      Rusia, A., A.J. Shi, and R.N. Doshi, Vacuum-assisted vegetation removal with percutaneous lead extraction: a systematic review of the literature. Journal of Interventional Cardiac Electrophysiology, 2019. 55: p. 129-135.
50.      Boulet, N., et al., Central venous catheter-related infections: a systematic review, meta-analysis, trial sequential analysis and meta-regression comparing ultrasound guidance and landmark technique for insertion. Critical Care, 2024. 28(1): p. 378.
51.      Cosme, V., et al., Central venous catheter-related infection: does insertion site still matter? A French multicentric cohort study. Intensive Care Medicine, 2024. 50(11): p. 1830-1840.
52.      Cobb, D.K., et al., A controlled trial of scheduled replacement of central venous and pulmonary-artery catheters. New England Journal of Medicine, 1992. 327(15): p. 1062-1068.
53.      Cook, D., et al., Central venous catheter replacement strategies: a systematic review of the literature. Critical care medicine, 1997. 25(8): p. 1417-1424.
54.      Hecht, S.M., et al., Central venous catheter management in high-risk children with bloodstream infections. The Pediatric Infectious Disease Journal, 2020. 39(1): p. 17-22.
55.      Zhong, Y., et al., Association of immediate reinsertion of new catheters with subsequent mortality among patients with suspected catheter infection: a cohort study. Annals of Intensive Care, 2022. 12(1): p. 38.
Iranian Heart Journal
Volume 27, Issue 2
Spring 2026
Pages 54-64