Bacteraemia related to indwelling central venous catheters: Prevention, diagnosis and treatment

Abstract

Infective episodes in immunocompromised children with indwelling central venous catheters were studied prospectively for one year. Culture of catheter hubs and skin at catheter entry sites during the first six months suggested that hub contamination was important in the pathogenesis of catheter colonization. The incidence of catheter-related bacteraemia, and possible catheter-related bacteraemia, fell by 56.5% following alterations in the protocol for manipulative care of catheters, from 5.82 per 1000 catheter days in the first six months to 2.53 per 1000 catheter days in the subsequent six months. A firm diagnosis of catheter-related bacteraemia was made simply and economically by a pour-plate quantitative blood culture technique. Attempts at eradication of catheter-related bacteraemia without removal of the catheter were successful in all cases.

Central Venous Catheter Infection

“…By a quantitative pour plate method, Wing et al (1979) found blood taken via a central line associated with septicaemia gave 400x the number of organisms cultured from peripheral blood. In a larger study Weightman et al (1988) found at least a ten fold difference in catheter versus peripheral blood cultures in patients with bacteraemia.…”

Microorganisms Isolated From Catheter Tip Cultures: İbn-İ Si̇na Hospital 2002

“…Once catheter infection is decided the therapeutic approach will be affected by the severity and the type of infection, status of the patient and the necessity of the catheter and the type of the etiologic agent (7,8,9). The spectrum of microorganisms should be known to decide about the route of infection and to take preventive measures and to decide empirical antibioitic therapy.…”

Evaluation of New Anti-Infective Drugs for the Treatment of Vascular Access Device-Associated Bacteremia and Fungemia

“…(4) Local device-site care procedures, as addressed in the protocol, should be standardized as much as possible [7,11,12].…”

“…The protocol should state clearly the point at which such a conversion may take place and the measures that are planned to ensure adequate absorption of an orally administered drug. The duration of therapy should be clearly defined in the protocol (usually, a minimum of 7-10 days) [2,11,13].…”