Persons using assistive technology might not be able to fully access information in this file. For assistance, please send e-mail to: mmwrq@cdc.gov. Type 508 Accommodation and the title of the report in the subject line of e-mail.
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.
Use of trade names and commercial sources is for identification only and does not imply endorsement by the U.S. Department of
Health and Human Services.References to non-CDC sites on the Internet are
provided as a service to MMWR readers and do not constitute or imply
endorsement of these organizations or their programs by CDC or the U.S.
Department of Health and Human Services. CDC is not responsible for the content
of pages found at these sites. URL addresses listed in MMWR were current as of
the date of publication.
Disclaimer
All MMWR HTML versions of articles are electronic conversions from ASCII text
into HTML. This conversion may have resulted in character translation or format errors in the HTML version.
Users should not rely on this HTML document, but are referred to the electronic PDF version and/or
the original MMWR paper copy for the official text, figures, and tables.
An original paper copy of this issue can be obtained from the Superintendent of Documents,
U.S. Government Printing Office (GPO), Washington, DC 20402-9371; telephone: (202) 512-1800.
Contact GPO for current prices.
**Questions or messages regarding errors in formatting should be addressed to
mmwrq@cdc.gov.
