Catheter‐Tip Colonization as a Surrogate End Point in Clinical Studies on Catheter‐Related Bloodstream Infection: How Strong Is the Evidence?

Rijnders, Bart J. A.; Wijngaerden, Eric Van; Peetermans, Willy

doi:10.1086/342905

Cited by 121 publications

(82 citation statements)

References 57 publications

(32 reference statements)

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“…Nasal colonization by S. aureus in patients enrolled in our study was not assessed as a predisposing factor for this infection, but the presence of ≥200 CFU/20 cm 2 at the CVC insertion site was an independent risk factor for CR-BSI (OR=6.89). The bacterial load on the CVC tip is related to CVC culture positivity, and to finding of bacteria in blood culture and therefore to CR-BSI [52]. In our study, considering only cases of sepsis by S. aureus, ≥ 10 2 CFU catheter tip colonization was a significant factor (OR=7.85), based on multiple logistic regression analysis.…”

Section: Discussionmentioning

confidence: 59%

Central venous catheter-related bloodstream infection caused by Staphylococcus aureus: microbiology and risk factors

Sadoyma¹,

Filho²,

Filho³

2006

Braz J Infect Dis

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Although central vascular catheters (CVC) are indispensable in modern medicine, they are an important risk factor for primary bacteremias. We examined the incidence and risk factors associated with catheter-related bloodstream infection (CR-BSI) caused by Staphylococcus aureus in surgical patients. A prospective study was carried out in the Hospital das Clínicas da Universidade Federal de Uberlândia (HC-UFU) from September 2000 to December 2002. The skin insertion site, catheter tip, and blood were microbiologically analyzed. Demographics and risk factors were recorded for each patient, and cultures were identified phenotypically. Staphylococcus aureus was the most frequent pathogen, with an incidence rate of 4.9 episodes of CR-BSIs per 1,000 catheter/days. Based on logistic regression, the independent risk factors were: colonization on the insertion site =200 colony forming units (CFU)/20 cm 2 (p=0.03; odds ratio (OR) =6.89) and catheter tip (p=0.01; OR=7.95). The CR-BSI rate was high; it was mainly associated with S. aureus, and skin colonization at the insertion site and on the catheter tip were important risk factors for CR-BSI.

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Section: Discussionmentioning

confidence: 59%

Central venous catheter-related bloodstream infection caused by Staphylococcus aureus: microbiology and risk factors

Sadoyma¹,

Filho²,

Filho³

2006

Braz J Infect Dis

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“…Surrogate markers of a CRBSI include colonisation of the insertion site and catheter tip at removal. Since there is a strong correlation between the rates of catheter tip colonisation and CRBSI (r = 0.69, r 2 = 0.48, p < 0.001) 39 many studies measure and report the colonisation rates of CVCs. However, only a minority of colonised CVCs result in CRBSI.…”

Section: Surrogate Markersmentioning

confidence: 99%

The clinical effectiveness and cost-effectiveness of central venous catheters treated with anti-infective agents in preventing bloodstream infections: a systematic review and economic evaluation

Hockenhull¹,

Dwan²,

Boland³

et al. 2008

Health Technol Assess

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“…Microbial colonization was heaviest on the external surfaces of IVDs, suggesting that the devices are colonized down from the proximal end of the catheter toward the distal tip, possibly originating from the skin around the IVD insertion site. Our finding that microbial growth was heaviest on the surfaces of the proximal intravascular segment of the IVDs brings into question the current reliance on culturing only the tip of a catheter to diagnose CRBSI, [21][22][23] a choice based on the apparent assumption that regardless of microbial colonization of different parts of a catheter, the risk for blood-borne microbial dissemination does not begin to increase markedly until colonization at the tip reaches a level of more than 15 CFUs/mL. The number of CRBSIs in our study was insufficient to confirm this assumption.…”

Section: Proportion Remaining Uncolonizedmentioning

confidence: 94%

Density of Microbial Colonization on External and Internal Surfaces of Concurrently Placed Intravascular Devices

Koh

Robertson

Watts

et al. 2012

American Journal of Critical Care

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Background Intravascular devices provide essential vascular access for management of critically ill patients but can be associated with bloodstream infections. Objectives To determine colonization rates in segments of concurrently placed peripheral arterial, nontunnelled short-term central venous catheters and peripherally inserted central catheters and the pattern of heaviest colonization when the catheters are removed. Methods A prospective study was conducted on inpatients with intravascular devices in place for 9 days or more. At removal, each catheter was cut into 3 segments, and each segment was cultured separately. The density of colonization on external and internal surfaces of each segment was compared by estimating odds ratios by repeated-measures ordinal logistic regression. Results A total of 48 peripheral arterial, 135 central venous, and 106 peripherally inserted central catheters were obtained from 289 patients. Colonization was greatest at the proximal external segment of all catheters. On the external surface, colonization was lower on the middle (odds ratio, 0.70; P < .001) and distal (odds ratio, 0.56; P < .001) segments than on the proximal segments. On the internal surface, colonization was lower on the proximal (odds ratio, 0.39; P < .001), middle (odds ratio, 0.30; P < .001), and distal (odds ratio, 0.31; P < .001) segments than on the external proximal segments. This trend was similar for all catheter types. Conclusion Colonization of intravascular devices was heaviest on proximal segments.

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Catheter‐Tip Colonization as a Surrogate End Point in Clinical Studies on Catheter‐Related Bloodstream Infection: How Strong Is the Evidence?

Cited by 121 publications

References 57 publications

Central venous catheter-related bloodstream infection caused by Staphylococcus aureus: microbiology and risk factors

Central venous catheter-related bloodstream infection caused by Staphylococcus aureus: microbiology and risk factors

The clinical effectiveness and cost-effectiveness of central venous catheters treated with anti-infective agents in preventing bloodstream infections: a systematic review and economic evaluation

Density of Microbial Colonization on External and Internal Surfaces of Concurrently Placed Intravascular Devices

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