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Catheter-associated infections

Among the MD-associated infections, catheter-associated infections are predominantly found due to their increased use in therapy or diagnosis. About 25% of hospitalized patients need at a certain time a urological catheter, and consequently, the urinary catheter-associated infections are the most common of catheter-associated infections (Saint et al., 2000; Saint and Chenoweth, 2003; Humphreys et al., 2008). The presence of a urinary tract catheter and duration of in situ use are factors that can favor the growth of microbial biofilms (Saint and Chenoweth, 2003). It has been estimated that the risk of acquiring an infection increases by 5% every day for an in situ catheter (Saint et al., 2000; Humphreys et al., 2008), so that the risk for a patient to develop an infection associated with catheterization is 35-39% (Maki, 2001). Urinary tract infections associated with catheters are leading to increased morbidity and mortality and hospitalization period (Guidelines for the Prevention, 2011; Holroyd-Leduc et al., 2007).

Data collected from 97 hospitals in the UK during the period from 1997 to 2002 showed that urinary tract infections associated with catheters are the primary source of systemic infections in 8.5% of cases (Ovbiagele et al., 2006). Studies performed in Ireland in 2004-05 concerning the control of nosocomial infections showed that 3.8% of cases of bacteremia were originally catheter-associated urinary tract infections (Oza and Cunney, 2006). In 2006 hospitals provided epidemiological data on the prevalence of nosocomial infections in the Irish Republic, which have estimated that nosocomial urinary tract infections are the most common (22.5%), of which 56.2% are associated with catheters (Smith, 2005). An epidemiological study conducted in 2009, in long-term care centers, which included 14,672 patients from 13 European countries showed that urinary tract infections account for 30% of cases of nosocomial infections (Latour and Jans, 2009). The etiological agents of urinary tract infections associated with catheters may originate from patient perineal microbiota or from the hands of medical staff, and is represented by E.coli and species of the genera Pseudomonas, Klebsiella, Enterobacter, and Candida (Guidelines for the Prevention, 2011; Nicolle, 2001).

Central venous catheters (CVC) used in the intensive care are frequently involved in nosocomial infections, which affect 250,000 patients in the US with a 35% mortality index. In 74 pediatric intensive care units from the USA, it was reported that 1.3-11.9% of patients had bacteremia associated with central venous catheters. CVC can be either placed on short term up to 6 weeks, or for a period of 6-12 weeks in case of intermediate CVC (e.g., CVC for hemodialysis, type Sheldon). The CVC can be also placed subcutaneously for long term (e.g., catheters type Hickman-Broviac used for the administration of anticancer medication in patients with malignant tumors, and for the parenteral nutrition of patients with short bowel syndrome). Other types of catheters involved in nosocomial infections are the Tenckhof catheters used for peritoneal dialysis, peripheral venous catheters (associated with phlebitis) and so on (Guggenbichler et al., 2011).

Microorganisms frequently isolated from CVC-related infections are mostly represented by coagulase-negative staphylococci (S. epidermidis) and S. aureus, followed by enterococci, Candida sp., P. aeruginosa, and K. pneumoniae (Donlan, 2001).

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