Intravascular Catheter-related Infections Research Articles

Legal Briefs: Devastating Consequences From Prolonged Use of an Umbilical Arterial Catheter

A 960-g, 26-3/7 weeks’ gestation male twin B was delivered by normal vaginal spontaneous delivery in the breech position to 31-year-old, healthy, gravida 3 para 1 mother whose pregnancy was complicated by preterm labor and diamniotic dichorionic twins. The mother received antibiotics, a partial course of betamethasone, and magnesium sulfate for tocolysis. At delivery, the infant had a heart rate (HR) less than 100 beats per minute, no respiratory effort, and was blue. The infant was intubated and required resuscitation, including chest compressions for 15 seconds, and 2 doses of epinephrine via an endotracheal tube (ETT). Apgar scores were 2 at 1 minute, 4 at 5 minutes, and 7 at 10 minutes. The infant was then admitted to the NICU, where an umbilical venous catheter (UVC) and an umbilical arterial catheter (UAC) were placed. The UVC was placed in the right atrium, where it remained until its removal several days later, and his UAC was placed appropriately at the seventh thoracic vertebrae and removed on day 13. The infant’s vital signs and blood pressure were normal. He had respiratory distress syndrome, for which he was given 3 doses of surfactant. Initially, the infant required 100% oxygen, but after several hours, the inspired oxygen was weaned to 30%, and the ventilator settings were low. His initial complete blood cell count revealed a white blood cell count (WBC) of 3.1 × 103/uL, a platelet count of 185 × 103/uL, and a hematocrit reading of 51% (0.51). The infant was given ampicillin and gentamicin after blood culture results were obtained, and he was started on low-dose indomethacin for intraventricular hemorrhage prophylaxis. On day 1, the fraction of inspired oxygen (Fio2) and ventilatory settings were low. The blood gas values were normal, with some permissive hypercarbia in the …

Transparent Guideline Methodology Needed

As part of learning at the Nordic Workshop of Evidence-based Medicine, we have read with interest the practice guidelines for central venous access, published in your Journal in 2012.1 We appraised the quality of this guideline using the checklist developed by The Evidence-Based Medicine Working Group.2 Similar criteria for guideline quality have been suggested elsewhere.3 Our conclusion was that this much needed guideline is currently unclear about several aspects of the methodology used in developing the recommendations. This means potential users cannot be certain that the recommendations are based on best currently available evidence.Our concerns are in two main categories: the rigor of development, including methodology of searching, evaluating, and combining the evidence; and editorial independence, including funding and possible conflicts of interest. The methodological issues that we would like to see clarified in the guideline are:The searches may have missed relevant information. The authors report their searches covered a period from 1968 to 2011, identifying over 2,000 citations. When we made a PubMed search until the end of 2011 using “central venous catheter” as the search term, we found 12,453 references; adding “infection” retained 4,729 of these; and adding “coated” resulted in 128 studies, including a cohort study of catheters coated with antibiotics published in 2011.4 This study shows such catheters significantly decreased infections “in a manner that was independent and complementary to the infection control precautions.” In the paragraph on Recommendations for Use of Catheters Containing Antimicrobial Agents, the guideline has no references. A clear description of the search strategies could explain such a discrepancy.The concept of “evidence linkage” is rather central for the methodology but not quite fully explained in the methods. Does it mean “a statement regarding potential relationships between clinical interventions and outcomes” (as in appendix 5)?In reporting the results, we would appreciate separating the recommendations based on published scientific evidence and opinion-based evidence. Reading the guideline, it was first unclear to us whether the letters (e.g., Category B2 evidence) referred to scientific evidence or opinion-based evidence. Getting to the footnote of appendix 5, it seems the categories refer to scientific evidence only. It would be interesting to learn whether the guideline group for the next version could consider using a more widely used grading system, such as the GRADE (The Grading of Recommendations Assessment, Development and Evaluation).5It may be that we have missed where the authors have referred to the methods used, although we did our best to study the publication and the Supplemental Digital Content carefully. We also searched the website of this Journal† to make sure we did not miss any information on guideline methodology. In many guidelines, for example in a recent one on the prevention of intravascular catheter-related infections,6 the methodology is provided on an external site.‡Finally, we would have appreciated seeing the conflict of interest statements for all authors, and a declaration of how this undoubtedly work-intensive process has been funded.Making the evidence more transparent would be helpful to guideline users. Our suggestions are anchored in principles of evidence-based medicine. Our aim with this letter is to encourage the authors to provide information which could increase our confidence in the guideline and thus promote its application in practice.We hope that this important guideline will be updated within a couple of years, and that the American Society of Anesthesiologists Task Force on Central Venous Access will consider adding the necessary methodological information in their guideline.

Intravascular catheter-related bloodstream infection caused by Abiotrophia defectiva in a neutropenic child

Bacteraemia and endocarditis are the most frequently reported clinical infections due to Abiotrophia defectiva species. This species has been rarely implicated in infections in neutropenic patients. We report a rare case of long-term venous catheter-related infection caused by A. defectiva that occurred in a febrile child who had neutropenia and Langerhans' cell histiocytosis.

Reducing the risk of infection associated with vascular access devices through nanotechnology: a perspective

Intravascular catheter-related infections are still a major problem in health care and are associated with significant morbidity, mortality, and additional cost. The formation of microbial biofilm on catheters makes these infections particularly complicated, as microbial cells that detach from the biofilm can lead to infection, and because these microorganisms are highly resistant to many antimicrobial agents; thus, catheter removal is often required to successfully treat infection. To reduce the risks of catheter-related infections, many strategies have been applied, such as improvements in aseptic insertion and post-insertion care practices, implantation techniques, and antibiotic coated or impregnated materials. However, despite significant advances in using these methods, it has not been possible to completely eradicate biofilm infections. Currently, nanotechnology approaches seem to be among the most promising for preventing biofilm formation and resultant catheter-related bloodstream infection (especially with multi-resistant bacterial strains). In this review, current knowledge about catheter technology and design, the mechanisms of catheter-related bloodstream infection, and the insertion and care practices performed by medical staff, are discussed, along with novel, achievable approaches to infection prevention, based on nanotechnology.

Vascular access strategy for delivering long-term antimicrobials to patients with infective endocarditis: device type, risk of infection and mortality

This paper reports the use of different vascular access devices and the incidence of intravascular catheter-related infection (CRI) in patients receiving intravenous antibiotics for infective endocarditis (IE). To examine whether rates of infection vary with type of vascular access device, and assess the impact of CRI on mortality in IE. A prospective observational service evaluation of all inpatients who received intravenous antibiotics for IE was performed. In total, 114 inpatients were evaluated. All cases of CRI [including exit-site infection, intravascular catheter-related bloodstream infection (CRBSI) and mortality] were recorded. Tunnelled and non-tunnelled central venous catheters (CVCs), and peripherally inserted cannulae were used for antibiotic delivery. There were 15 episodes of CRI, 11 of which were CRBSI (all associated with CVC use). The remainder comprised uncomplicated exit-site infections. Use of tunnelled CVCs [hazard ratio (HR) 16.95, 95% confidence interval (CI) 2.13-134.93; P = 0.007] and non-tunnelled CVCs (HR 24.54, 95% CI 2.83-212.55; P = 0.004) was associated with a significantly increased risk of CRI. Risk of mortality increased significantly with Staphylococcus aureus as the cause of IE (P < 0.001) and CRBSI (P = 0.034). Risk of CRI in patients with IE is linked to the type of vascular access device used. Rates of CRBSI were greatest with CVCs, while peripheral venous cannulae were not associated with CRBSI or serious sequelae. Many patients (40%) tolerated complete treatment courses delivered via peripheral cannulae. These findings confirm the importance of device selection in reducing the risk of CRI; a potentially modifiable variable that impacts on outcome and mortality in IE.

정맥관 감염예방 근거중심 가이드라인의 권고강도 별 간호사의 지식 및 수행정도

Purpose: The objective of this study was to examine the relationships between nurses' knowledge and performance for the prevention of intravascular catheter-related infections (ICRI) according to the strength of recommendations in evidence based guidelines (EBG). Methods: The total participants were 144 nurses working for medical surgical unit and intensive care unit. Data were collected from July 12 to July 30, 2010 and analyzed by one way ANOVA and Pearson's correlation analysis. Results: The knowledge and performance mean scores were <TEX>$0.80{\pm}0.17$</TEX> and <TEX>$3.04{\pm}0.31$</TEX> for peripheral venous catheter (PVC) management, and <TEX>$0.83{\pm}0.17$</TEX> and <TEX>$3.00{\pm}0.30$</TEX> for central venous catheter (CVC) management respectively. The items of category IA had the highest knowledge score (F=44.70, p<.001) and the items of category II had the highest performance score (F=47.09, p<.001) in PVC management, while the items of category IA had the highest knowledge (F=20.04, p<.001) and performance scores (F=18.20, p<.001) in CVC management. Knowledge and performance scores were significantly correlated in CVC management (r=.24, p=.004), but not in PVC management (r=.03, p=.753). Conclusion: EBG for the prevention of ICRI was not fully implemented in clinical settings. These findings emphasize that clinical professions need to develope strategies to enhance nursing practices with evidence based guideline.

Procalcitonin and procalcitonin kinetics for diagnosis and prognosis of intravascular catheter-related bloodstream infections in selected critically ill patients: a prospective observational study

BackgroundProcalcitonin (PCT) has emerged as a valuable marker of sepsis. The potential role of PCT in diagnosis and therapy monitoring of intravascular catheter-related bloodstream infections (CRBSI) in intensive care unit (ICU) is still unclear and was evaluated.MethodsForty-six patients were included in the study, provided they were free of infection upon admission and presented the first episode of suspected CRBSI during their ICU stay. Patients who had developed any other infection were excluded. PCT was measured daily during the ICU hospitalization. Primary endpoint was proven CRBSI. Therapy monitoring as according to infection control was also evaluated.ResultsAmong the 46 patients, 26 were diagnosed with CRBSI. Median PCT on the day of infection suspicion (D0) was 7.70 and 0.10 ng/ml for patients with and without proven CRBSI, respectively (p < 0.001). The area under the curve (AUC) for PCT was 0.990 (95% CI; 0.972 – 1.000), whereas a cut-off value of 0.70 ng/ml provided sensitivity and specificity of 92.3 and 100% respectively. In contrast, the AUC for white blood cells (WBC) was 0.539 (95% CI; 0.369 – 0.709), and for C-reactive protein (CRP), 0.603 (95% CI; 0.438 – 0.768). PCT was the best predictor of proven infection. Moreover, an increase >0.20 ng/ml of PCT between the D0 and any of the 4 preceding days was associated with a positive predictive value exceeding 96%. PCT concentrations from the D2 to D6 after suspected infection tended to decrease in controlled patients, whereas remained stable in non-controlled subjects. A PCT concentration exceeding 1.5 ng/ml during D3 was associated with lack of responsiveness to therapy (p = 0.028).ConclusionsWe suggest that PCT could be a helpful diagnostic and prognostic marker of CRBSI in critically ill patients. Both absolute values and variations should be considered.

Fieber unklarer Ursache auf der Intensivstation

Fever is common in patients in intensive care units. Sources of fever can be infectious or non-infectious. The most common sources of infectious fever include ventilator-associated pneumonia, intravascular catheter-related infections, infection with Clostridium difficile or sinusitis. Typical examples of non-infectious fever include thromboembolic events, myocardial infarction, autoimmune disease, withdrawal symptoms or a drug-fever. Every new onset of fever prompts diagnostic decisions, treatment with antipyretics should be discussed critically.

Blood cultures

British Journal of Hospital MedicineVol. 73, No. 4 Tips From The Shop FloorBlood culturesSusan DawsonSusan DawsonSearch for more papers by this authorSusan DawsonPublished Online:16 Aug 2013https://doi.org/10.12968/hmed.2012.73.sup4.C53AboutSectionsView articleView Full TextPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareShare onFacebookTwitterLinked InEmail View article References Alahmadi YM, Aldeyab MA, McElnay JC et al. (2011) Clinical and economic impact of contaminated blood cultures within the hospital setting. J Hosp Infect 77: 233–6 Crossref, Medline, Google ScholarBennett IL, Beeson PB (1954) Bacteremia: a consideration of some experimental and clinical aspects. Yale J Biol Med 26: 241–62 Medline, Google ScholarCaldeira D, David C, Sampaio C (2011) Skin antiseptics in venous puncture-site disinfection for prevention of blood culture contamination: systematic review with meta-analysis. J Hosp Infect 77: 223–32 Crossref, Medline, Google ScholarDark PM, Dean P, Warhurst G (2009) Bench-to-bedside review: The promise of rapid infection diagnosis during sepsis using polymerase chain reaction-based pathogen detection. Crit Care 13: 217 Crossref, Medline, Google ScholarDepartment of Health (2007) Taking Blood Cultures A summary of best practice. Department of Health, London Google ScholarDepartment of Health (2010) Taking Blood Cultures A summary of best practice. http://hcai.dh.gov.uk/files/2011/03/Document_Blood_culture_FINAL_100826.pdf (accessed 12 March 2012) Google ScholarDwivedi S, Bhalla R, Hoover DR, Weinstein MP (2009) Discarding the initial aliquot of blood does not reduce contamination rates in intravenous-catheter-drawn blood cultures. J Clin Microbiol 47(9): 2950–1 Crossref, Medline, Google ScholarGeneral Medical Council (2009) Tomorrow's Doctors Outcomes and standards for undergraduate medical education. General Medical Council, London Google ScholarGould FK, Denning DW, Elliott TSJ et al. (2012) Guidelines for the diagnosis and antibiotic treatment of endocarditis in adults: a report of the Working Party of the British Society for Antimicrobial Chemotherapy. J Antimicrobl Chemother 67(2): 269–89 Crossref, Medline, Google ScholarHall KK, Lyman JA (2006) Updated review of blood culture contamination. Clin Microbiol Rev 19(4): 788–802 Crossref, Medline, Google ScholarJumaa PA, Chattopadhyay B (1994) Pseudobacteraemia. J Hosp Infect 27: 167–77 Crossref, Medline, Google ScholarLarkin S, Baker N, Anderson R, Ward S, Forde S (2010) An interactive approach to reducing blood culture contamination. J Hosp Infect 76: 273–5 Crossref, Medline, Google ScholarMermel LA, Allon M, Bonza E et al. (2009) Clinical Practice Guidelines for the diagnosis and management of intravascular catheter-related infection: 2009 Update by the Infectious Diseases Society of America. Clin Infect Dis 49: 1–45 Crossref, Medline, Google ScholarMylotte Jm, Tayara A (2000) Blood Cultures: Clinical aspects and controversies. Eur J Clin Microbiol Infect Dis 19: 157–63 Crossref, Medline, Google ScholarReidel S, Bourbeau P, Swartz B et al. (2008) Timing of specimen collection for blood cultures from febrile patients with bacteraemia. J Clin Microbiol 46(4): 1381–5 Crossref, Medline, Google ScholarSchifman RB, Strand CL, Meier FA, Howanitz PJ (1998) Blood culture contamination: A College of American Pathologists Q-Probes study involving 640 institutions and 497134 specimens from adult patients. Arch Pathol Lab Med 122: 216–21 Medline, Google ScholarShore A, Sandoe J (2008) Blood cultures. Student BMJ 16: 324–5 Google ScholarSpitalnic SJ, Woolard RH, Mermel LA (1995) The significance of changing needles when inoculating blood cultures: a meta-analysis. Clin Infect Dis 21: 1103–6 Crossref, Medline, Google ScholarThomas S, Cheesbrough J, Plumb S et al. (2011) Impact of a blood culture collection kit on the quality of blood culture sampling: fear and the law of unintended consequences. J Hosp Infect 78: 256–9 Crossref, Medline, Google ScholarThompson F, Madeo M (2009) Blood cultures: towards zero false positives. J Infect Prevent 10(1): s24–26 Crossref, Google ScholarWeinstein MP (2003) Blood Culture Contamination: Persisting Problems and Partial Progress. J Clin Microbiol 41(6): 2275–8 Crossref, Medline, Google Scholar FiguresReferencesRelatedDetailsCited byImpact of novel blood culture collection bundle to reduce blood culture contamination rates: An important continuous quality improvement indicator of laboratory medicineJournal of Patient Safety and Infection Control, Vol. 7, No. 3 1 April 2012Volume 73Issue 4ISSN (print): 1750-8460ISSN (online): 1759-7390 Metrics History Published online 16 August 2013 Published in print 1 April 2012 Information© MA Healthcare LimitedPDF download

Incidence of Catheter-Associated Bloodstream Infection After Introduction of Minocycline and Rifampin Antimicrobial-Coated Catheters in a Pediatric Burn Population

The Centers for Disease Control and Prevention guidelines for prevention of intravascular catheter-related infections suggest that antimicrobial-coated catheters can decrease the risk of developing catheter-related bloodstream infection in a variety of adult patient populations. There are limited data on their efficacy in the pediatric population, particularly among children with burn injuries. A study was conducted at Shriners Hospitals for Children®, Boston, to determine whether minocycline/rifampin (MR)-coated catheters could decrease the incidence of catheter-associated bloodstream infection (CABSI) in a pediatric burn population. A historical control group included all patients with double- or triple-lumen catheters inserted in the 18-month period from January 2006 to June 2007. The study group included all patients with MR antimicrobial double- or triple-lumen catheters inserted in the subsequent 18-month period, July 2007 to December 2008. Data collected included name, age, date of burn/injury, date of admission, percent TBSA area burn injury or other diagnosis, catheter site (subclavian, internal jugular, or femoral), method of insertion (new percutaneous stick or guidewire), type of catheter (double or triple lumen), date inserted, duration of catheter placement (days), and positive blood cultures recovered while the central venous catheter was in place. CABSI was defined using the Centers for Disease Control and Prevention definition of laboratory-confirmed bloodstream infection. There were a total of 66 patients with 252 catheters (1780 catheter days) in the control group and 75 patients with 263 catheters (1633 catheter days) in the study group. Age, percent burn injury, catheter site, and method of insertion were not statistically different between the two groups. The percentage of infected catheters and the rate of infection were significantly different for the two groups, with the MR antimicrobial catheters only half as likely to become infected. In a subset of these patients with catheters in place for more than 4 days, the percentage of infected catheters and rate of infection were also significantly different with results similar to those in the entire group. MR antimicrobial-coated catheters significantly reduced the incidence of CABSI in this pediatric burn population compared with noncoated catheters.

Prevention of Intravascular Central Venous Catheter-Related Infections: 0.5% Concentration of Chlorhexidine Preparation With Alcohol for Skin Preparation and Femoral Vein for Renal Replacement Therapy

Prevention of Intravascular Central Venous Catheter-Related Infections: 0.5% Concentration of Chlorhexidine Preparation With Alcohol for Skin Preparation and Femoral Vein for Renal Replacement Therapy

Systematic review and cross cultural adaptation of clinical guidelines for the prevention of intravascular catheter-related bloodstream infections in Taiwan

Systematic review and cross cultural adaptation of clinical guidelines for the prevention of intravascular catheter-related bloodstream infections in Taiwan

Managing intravascular catheter-related infections in heart transplant patients

This study discusses the applicability to heart transplant patients of recently issued guidelines on the diagnosis, management and prevention of catheter-related bloodstream infections (CR-BSIs). It also updates newly available information of possible interest to the care of heart transplant patients. Catheters remain the leading cause of early bloodstream infections in heart transplant patients. The cause of CR-BSI is mainly attributable to Gram-positive microorganisms. Very frequently, the origin of a bloodstream infection in a heart transplant patient with multiple catheters is not clear, and a precise diagnosis is required. Management without catheter removal may be undertaken when indicated. Empiric therapy should cover Gram-positive, multidrug resistant and Gram-negative bacteria along with Candida. Prolonged antibiotic treatment exceeding 14 days is recommended and should be continued up to 4-6 weeks in the case of Staphylococcus aureus. Prevention measures include education and training, maximal sterile barrier precautions during catheter insertion, a 2% chlorhexidine preparation for skin antisepsis, avoiding routine replacement of catheters and using antimicrobial/antiseptic impregnated short-term central vein catheters (CVCs) and chlorhexidine sponge dressings. Until confirmatory data are obtained, present guidelines for diagnosing, managing and preventing CR-BSI can be applied to heart transplant patients. We would nevertheless highlight that the additional precautions should be taken of broader empiric antimicrobial therapy followed by longer duration treatment in these patients.

Guidelines for the Prevention of Intravascular Catheter-related Infections

Guidelines for the Prevention of Intravascular Catheter-related Infections

The D&amp;T Report

The D&amp;T Report

Summary of Recommendations: Guidelines for the Prevention of Intravascular Catheter-related Infections

These guidelines have been developed for healthcare personnel who insert intravascular catheters and for persons responsible for surveillance and control of infections in hospital, outpatient, and home healthcare settings. This report was prepared by a working group comprising members from professional organizations representing the disciplines of critical care medicine, infectious diseases, healthcare infection control, surgery, anesthesiology, interventional radiology, pulmonary medicine, pediatric medicine, and nursing. The working group was led by the Society of Critical Care Medicine

Guidelines for the prevention of intravascular catheter-related infections

These guidelines have been developed for healthcare personnel who insert intravascular catheters and for persons responsible for surveillance and control of infections in hospital, outpatient, and home healthcare settings. This report was prepared by a working group comprising members from professional organizations representing the disciplines of critical care medicine, infectious diseases, healthcare infection control, surgery, anesthesiology, interventional radiology, pulmonary medicine, pediatric medicine, and nursing. The working group was led by the Society of Critical Care Medicine

Working formulation for the standardization of definitions of infections in patients using ventricular assist devices

In 2009, the International Society for Heart and Lung Transplantation (ISHLT) recognized the importance of infectionrelated morbidity and mortality in patients using ventricular assist devices (VADs) and the growing need for a consensusbased expert opinion to provide standard definitions of infections in these patients. The aim of these standard definitions is to improve clinical-investigator communication, allowing meaningful comparison in practice and outcomes between different centers and different VAD devices. In 2010, a core group of experts, including infectious diseases specialists, cardiologists, pathologists, radiologists, and cardiothoracic surgeons, formed an ISHLT Infectious Diseases Working Group to develop agreed criteria for definitions of infections in VAD patients. These definitions have been created by adapting and expanding on existing standardized definitions, which are based on the pathophysiology of equivalent infectious processes in prosthetic devices, such as cardiac prosthetic valve infections, intravascular catheter-related infections, and prosthetic joint infections. These definitions have been divided into 3 sections: VAD-specific infections, VAD-related infections, and non-VAD infections. Owing to the constant shortage of donor organs, new allocation systems, and improved medical therapies for congestive cardiac failure, the overwhelming trend in cardiac transplantation has been toward listing principally the most critically ill patients, that is, those requiring inpatient inotropic therapy for mechanical circulatory support (MCS). The ventricular assist device (VAD) has an expanding role in the management of these patients, both as a bridge to transplantation and as a destination therapy (ie, alternative to transplantation). According to United Network of Organ Sharing (UNOS) registry data, 9,000 transplant candidates have undergone MCS since 1999, comprising 33% of all listed patients and 75% of all listed inpatients. 1

Impact of microbial attachment on intravascular catheter-related infections

Intravascular catheters (IVCs) are the most frequently used medical devices in hospitals. However, they are associated with life-threatening IVC-related bloodstream infection (IVC-BSI), which is one of the main hospital-acquired infections, and continue to be associated with morbidity, mortality and additional medical cost. Most published studies focus on measuring the rate of IVC-BSIs and addressing their importance, but only a few studies have mentioned the possible routes for microbes entering the bloodstream, which would help in developing effective prevention methods, and large trial studies are lacking. Some studies on IVC-BSIs have reported the most frequently isolated microbes, but caution needs to be made since many fastidious microbes are not isolated under current laboratory conditions. Although it is known that microbes colonise IVC surfaces and develop biofilms, leading to IVC-BSI, the relationships of microbial biofilms with patients’ symptoms or outcomes remain unclear. Here we discuss the knowledge gained from microbial research in other (non-IVC) medical and non-medical applications that may be helpful in understanding the IVC context. In addition, published theory and data regarding microbial colonisation and biofilm development specifically in IVCs are reviewed. More research is needed to explore mechanisms of IVC-BSI and to provide superior prevention strategies.

Update on pathogenesis and diagnosis of intravascular catheter-related infections

Infections associated with the use of intravascular catheters cause a substantial morbidity and mortality. New knowledge in the pathogenesis of catheter related bloodstream infections has led to advances in the prevention and management of these infections. The purpose of the present chapter is to review the most relevant data published recently on pathogenesis and diagnosis of intravascular catheter-related infections. It is focus in four different aspects: a) pathogenesis of catheter-related infections and particularly factors affecting biofilm formation and modulation; b) pathogenesis of intravascular catheter-related infections caused by Staphylococcus lugdunensis; c) news on microbiological diagnosis of catheter-related bacteremia; and d) evaluation of current use of blood cultures in the era of continuous monitoring blood cultures systems.