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Appendix A

Examples of Clinical Definitions for Catheter-Related Infections

Localized Catheter Colonization

Significant growth of a microorganism (>15 CFU) from the catheter tip, subcutaneous segment of the catheter, or catheter hub

Exit Site Infection

Erythema or induration within 2 cm of the catheter exit site, in the absence of concomitant bloodstream infection (BSI) and without concomitant purulence

Clinical Exit Site Infection (Or Tunnel Infection)

Tenderness, erythema, or site induration >2 cm from the catheter site along the subcutaneous tract of a tunneled (e.g., Hickman or Broviac) catheter, in the absence of concomitant BSI

Pocket Infection

Purulent fluid in the subcutaneous pocket of a totally implanted intravascular catheter that might or might not be associated with spontaneous rupture and drainage or necrosis of the overlaying skin, in the absence of concomitant BSI

Infusate-Related BSI

Concordant growth of the same organism from the infusate and blood cultures (preferably percutaneously drawn) with no other identifiable source of infection

Catheter-Related BSI

Bacteremia/fungemia in a patient with an intravascular catheter with at least one positive blood culture obtained from a peripheral vein, clinical manifestations of infections (i.e., fever, chills, and/or hypotension), and no apparent source for the BSI except the catheter. One of the following should be present: a positive semiquantitative (>15 CFU/catheter segment) or quantitative (>103 CFU/catheter segment catheter) culture whereby the same organism (species and antibiogram) is isolated from the catheter segment and peripheral blood; simultaneous quantitative blood cultures with a >5:1 ratio CVC versus peripheral; differential period of CVC culture versus peripheral blood culture positivity of >2 hours.

Surveillance Definitions for Primary BSIs, National Nosocomial Infections Surveillance System

Laboratory-Confirmed BSI

Should meet at least one of the following criteria:
Criterion 1
: Patient has a recognized pathogen cultured from one or more blood cultures, and the pathogen cultured from the blood is not related to an infection at another site.
Criterion 2: Patient has at least one of the following signs or symptoms: fever (>100.4º F [>38º C]), chills, or hypotension, and at least one of the following:
1. Common skin contaminant (e.g., diphtheroids, Bacillus spp., Propionibacterium spp., coagulase-negative staphylococci, or micrococci) cultured from two or more blood cultures drawn on separate occasions.
2. Common skin contaminant (e.g., diphtheroids, Bacillus spp., Propionibacterium spp., coagulase-negative staphylococci, or micrococci) cultured from at least one blood culture from a patient with an intravenous line, and the physician institutes appropriate antimicrobial therapy.
3. Positive antigen test on blood (e.g., Hemophilus influenzae, Streptococcus pneumoniae, Neisseria meningitides, or group B streptococcus).
and
signs and symptoms with positive laboratory results are not related to an infection at another site.
Criterion 3
: Patient aged <1 year has at least one of the following signs or symptoms: fever (>100.4º F [>38º C]), hypothermia (<98.6º F [<37º C]), apnea, or bradycardia, and at least one of the following:
1. Common skin contaminant (e.g., diphtheroids, Bacillus spp., Propionibacterium spp., coagulase-negative staphylococci, or micrococci) cultured from two or more blood cultures drawn on separate occasions.
2. Common skin contaminant (e.g., diphtheroids, Bacillus spp., Propionibacterium spp., coagulase-negative staphylococci, or micrococci) cultured from at least one blood culture from a patient with an intravenous line, and the physician institutes appropriate antimicrobial therapy.
3. Positive antigen test on blood (e.g., Hemophilus influenzae, Streptococcus pneumoniae, Neisseria meningitides, or group B streptococcus).
and
signs and symptoms with positive laboratory results are not related to an infection at another site.

Clinical Sepsis

Should meet at least one of the following criteria:
Criterion 1
: Patient has at least one of the following clinical signs with no other recognized cause: fever (>100.4º F [>38º C]), hypotension (systolic pressure <90 mm Hg), or oliguria (<20 mL/hr), and blood culture not done or no organisms or antigen detected in blood and no apparent infection at another site, and physician institutes treatment for sepsis.
Criterion 2
: Patient aged <1 year has at least one of the following clinical signs or symptoms with no other recognized cause: fever (>100.4º F [>38º C]), hypothermia (<98.6º F [<37º C]), apnea, or bradycardia, and blood culture not done or no organisms or antigen detected in blood and no apparent infection at another site, and physician institutes treatment for sepsis.

Catheter-Associated BSI

Defined by the following:

  • Vascular access device that terminates at or close to the heart or one of the great vessels. An umbilical artery or vein catheter is considered a central line.
  • BSI is considered to be associated with a central line if the line was in use during the 48-hour period before development of the BSI. If the time interval between onset of infection and device use is >48 hours, there should be compelling evidence that the infection is related to the central line.
Arterial or Venous Infection

Included are arteriovenous graft, shunt, fistula, or intravenous cannulation. Should meet at least one of the following criteria:
Criterion 1
: Patient has organisms cultured from arteries or veins removed during a surgical operation and blood culture not done or no organisms cultured from blood.
Criterion 2
: Patient has evidence of arterial or venous infection seen during a surgical operation or histopathologic examination.
Criterion 3
: Patient has at least one of the following signs or symptoms with no other recognized cause: fever (>100.4º F [>38º C]), pain, erythema, or heat at involved vascular site and >15 CFUs cultured from an intravascular cannula tip using a semiquantitative culture method and blood culture not done or no organisms cultured from blood.
Criterion 4
: Patient has purulent drainage at the involved vascular site and blood culture not done or no organisms cultured from blood.
Criterion 5
: Patient aged <1 year has at least one of the following signs or symptoms with no other recognized cause: fever (>100.4º F [>38º C]), hypothermia (<98.6º F [<37º C]), apnea, bradycardia, lethargy, or pain, erythema or heat at involved vascular site and >15 colonies cultured from intravascular cannula tip using semiquantitative method and blood culture not done or no organisms cultured from blood.

 

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