A prospective study of a new protocol for ‘in situ’ diagnosis of central venous catheter related bacteraemia

Segura, M.; Lladó, Laura; Guirao, Xavier; Piracés, Mercè; Herms, R.; Alia, C.; Sitges‐Serra, Antonio

doi:10.1016/0261-5614(93)90059-d

Cited by 25 publications

(7 citation statements)

References 17 publications

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“…With a suspicion of infection, the probability of finding an episode of CRB when the TSS is positive was 44.4%. On the other hand, the negative predictive value for CRB in patients with a suspicion of infection was high (94.4%), although it was lower than that in previous studies (7,20). Since the possibility of an episode of CRB when the TSS is negative cannot be ruled out, the risk of serious consequences incurred by delaying diagnosis and the maintenance of persistent bacteria in critically ill patients are causes for concern.…”

Section: Discussionmentioning

confidence: 71%

“…Thus, a means of establishing a reliable conservative diagnosis would represent a real breakthrough. In recent years, several investigators have proposed surveillance skin and catheter hub cultures (3,5,7,9,16,20,22) for anticipating or excluding catheter-related infection (CRI). However, few studies have assessed the dynamics of colonization of superficial sites by means of strain delineation, which affirm that once the organism(s) colonizes the site it persists there until catheter withdrawal.…”

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confidence: 99%

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Serial surveillance cultures of skin and catheter hub specimens from critically ill patients with central venous catheters: molecular epidemiology of infection and implications for clinical management and research

et al. 1997

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A prospective study of 45 central venous catheters was conducted to assess, by strain delineation, the turnover of skin and catheter hub (superficial) colonization and the relative contributions of catheter hub and skin colonization to catheter tip colonization. Serial quantitative cultures of skin and catheter hub were performed. Catheter tip, blood, and specimens for culture from targeted superficial sites (TSSs) were also collected at the time of catheter removal. Strains from 17 tip-positive catheters were delineated by pulsed-field gel electrophoresis. Only 12 (28.6%) of 42 skin strains and 14 (31.1%) of 45 catheter hub strains were found to be present at the time of catheter removal. In addition, only 9 (29.0%) of the 31 tip-colonizing strains were present on TSSs. Moreover, 15 (48.4%) of the 31 tip-colonizing strains had a superficial origin, and the other 16 (51.6%) were of unknown origin. In catheters suspected of infection, cultures of TSSs had a negative predictive value for catheter-related bacteremia of 94.4% but a positive predictive value of 44.4%. When the causative agent was identified (to the strain level) these values dropped to 80.9 and 18.7%, respectively. The study shows that skin and catheter hub colonization is a common, dynamic phenomenon. Strains recovered from TSSs showed a low level of correlation with strains from previous cultures of specimens from superficial sites and catheter tip isolates. Consequently, TSSs cannot be recommended for use in determining the therapy. However, catheter-related bacteremia is uncommon when cultures of TSSs are negative.

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Section: Discussionmentioning

confidence: 71%

mentioning

confidence: 99%

Serial surveillance cultures of skin and catheter hub specimens from critically ill patients with central venous catheters: molecular epidemiology of infection and implications for clinical management and research

et al. 1997

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“…Compared to the other endpoints, more prospective diagnostics and dedicated attention to the matching of the catheter tip and blood culture results are required. CRBSI establishes a causal relationship but secondary hematogenous seeding to the catheter cannot be excluded, although uncommon [94,95]. In addition, prompt empiric antibiotic therapy may increase the rate of false negative blood culture results.…”

Section: Catheter-related Bloodstream Infectionmentioning

confidence: 99%

Validity of surrogate endpoints assessing central venous catheter-related infection: evidence from individual- and study-level analyses

Grooth

Timsit

Mermel

et al. 2020

Clinical Microbiology and Infection

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Objectives: The prevention of catheter-related bloodstream infection (CRBSI) has been an area of intense research, but the heterogeneity of endpoints used to define catheter infection makes the interpretation of randomized controlled trials (RCTs) problematic. The aim of this study was to determine the validity of different endpoints for central venous catheter infections. Data sources: (a) Individual-catheter data were collected from 9428 catheters from four large RCTs; (b) study-level data from 70 RCTs were identified with a systematic search. Eligible studies were RCTs published between January 1987 and October 2018 investigating various interventions to reduce infections from short-term central venous catheters or short-term dialysis catheters. For each RCT the prevalence rates of CRBSI, quantitative catheter tip colonization, catheter-associated infection (CAI) and central line-associated bloodstream infection (CLABSI) were extracted for each randomized study arm. Methods: CRBSI was used as the gold-standard endpoint, for which colonization, CAI and CLABSI were evaluated as surrogate endpoints. Surrogate validity was assessed as (1) the individual partial coefficient of determination (individual-pR 2 ) using individual catheter data; (2) the coefficient of determination (study-R 2 ) from mixed-effect models regressing the therapeutic effect size of the surrogates on the effect size of CRBSI, using study-level data. Results: Colonization showed poor agreement with CRBSI at the individual-patient level (pR 2 ¼ 0.33 95% CI 0.28e0.38) and poor capture at the study level (R 2 ¼ 0.42, 95% CI 0.21e0.58). CAI showed good agreement with CRBSI at the individual-patient level (pR 2 ¼ 0.80, 95% CI 0.76e0.83) and moderate capture at the study level (R 2 ¼ 0.71, 95% CI 0.51e0.85). CLABSI showed poor agreement with CRBSI at the individual patient level (pR 2 ¼ 0.34, 95% CI 0.23e0.46) and poor capture at the study level (R 2 ¼ 0.28, 95% CI 0.07e0.76).

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“…There are three routes by which micro-organisms can enter to contaminate vascular catheters: extra-luminal, intraluminal and via haematogenous spread (Mermel, 2011; Segura et al, 1993). Both intra- and extra-luminal routes are considered important (Mermel, 2011).…”

Section: The Nc Is the Catheter’s Microbial Gatekeepermentioning

confidence: 99%

Needleless connectors: the vascular access catheter’s microbial gatekeeper

Curran

2016

Journal of Infection Prevention

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Needleless connectors (NCs) are essential devices which connect to the end of vascular catheters and enable catheter access for infusion and aspiration. There are various different designs which make it difficult for purchasers to identify the features which present the least risk and greatest safety. The NC is the microbial gatekeeper for vascular catheters; how it is disinfected pre access determines if, and how many, organisms enter and how quickly biofilm will form. This paper will consider these design variations and how differences in antiseptic testing methods have made it difficult to determine the best antiseptic practice pre access. One specific design characteristic is considered: the fluid pathway. The NC's fluid pathway creates a flow which can be either direct to produce a laminar flow or indirect which creates a turbulent flow. At present, the evidence does not support there being an advantage for a specific fluid pathway design in reducing infection risks.

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A prospective study of a new protocol for ‘in situ’ diagnosis of central venous catheter related bacteraemia

Cited by 25 publications

References 17 publications

Serial surveillance cultures of skin and catheter hub specimens from critically ill patients with central venous catheters: molecular epidemiology of infection and implications for clinical management and research

Serial surveillance cultures of skin and catheter hub specimens from critically ill patients with central venous catheters: molecular epidemiology of infection and implications for clinical management and research

Validity of surrogate endpoints assessing central venous catheter-related infection: evidence from individual- and study-level analyses

Needleless connectors: the vascular access catheter’s microbial gatekeeper

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