Bloodstream infections (BSI) constitute a significant public health problem and represent an important cause of morbidity and mortality in hospitalized patients, with an approximate incidence of one episode per hundred hospital admissions. Studies on BSI in HIV+ patients have identified
central venous catheters (CVC) as a risk factor, with an attributable mortality rate of 10-20%. The long-term CVC-related
infection risk appeared to be 5 to 10-fold higher with respect to the
infection rates among HIV- patients. CVC associated
infection rate ranges from 1.3 to 12
infections per 1,000
catheter-days. Staphylococcus aureus is the most common etiologic agent causative of CVC-related BSI, likely the result of the high skin and nasal carriage of this organism among HIV+ patients, mostly intravenous drug users.
Coagulase-negative staphylococci are also frequently identified as cause of CVC-related BSI, likely the result of breaches in infection control measures and in
antiseptic technique during CVC management. Treating
bacteremia without
catheter removal would be optimal, but the reported efficacy of systemic
antibiotic therapy alone is only 25-32%. Conversely, recent studies have shown that, using an
antibiotic-lock procedure, up to 90% of HIV-infected and uninfected patients achieved complete eradication of
catheter-related BSIs without
catheter removal. Clinical trials using new materials such as covalently linked
heparin on the CVC surface, electrically charged CVC, novel topical agents that interfere with bacterial colonization, antiadhesin molecules and agents that block the gene expression involved in the biofilm formation, are all needed to reduce the high
catheter-related infection risk among HIV+ patients.