Central Venous Catheter Infections

Decker, Michael D.; Edwards, Kathryn M.

doi:10.1016/s0031-3955(16)36473-2

Cited by 177 publications

(63 citation statements)

References 146 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…In the case of Broviac/Hickman-type catheters, the majority of infections have been cured without catheter removal. For example, 75% of 135 infections of Broviac-type catheters in pediatric patients were cured without catheter removal [9]. The cure rate is pathogen-dependent, with the highest cure rate for infections due to coagulase-negative staphylococci and lowest cure rates for infections due to S. aureus or yeasts [10].…”

Section: Discussionmentioning

confidence: 99%

Cure of Implantable Venous Port–Associated Bloodstream Infections in Pediatric Hematology‐Oncology Patients without Catheter Removal

et al. 1999

View full text Add to dashboard Cite

The efficacy of antibiotic treatment of port-associated bloodstream infection without device removal has not been systematically studied. We analyzed the outcome of 43 consecutive portassociated bloodstream infections in pediatric hematology-oncology patients. Etiologies included Staphylococcus epidermidis (30) and Staphylococcus aureus (6). Antibiotics were given through the port for a median of 11 days. Four ports were removed within 72 hours. In 36 (92%) of the remaining 39 episodes, there was a response to antibiotic therapy (defervescence and negative blood culture). In 78% of episodes in which there was a response (excluding two in which the catheters were removed because of mechanical problems), the infections were cured without port removal. Two of the four relapses were cured with a second course of antibiotics. The cure rate was 92% for S. epidermidis infections and 67% for S. aureus infections. Thus, the majority of port-associated bloodstream infections in pediatric hematology-oncology patients can be cured without device removal.There are two types of surgically placed, subcutaneously tunneled Silastic (Dow Corning, Midland, MI) central venous catheters designed for long-term use. Broviac-or Hickmantype catheters exit through the skin after being passed through a subcutaneous tunnel, and totally implantable venous access ports ("ports") end in a subcutaneous reservoir after being passed through a subcutaneous tunnel (as, for example, with Mediport [Norfolk, Medina, NY] and Port-A-Cath [Pharmacia Deltec, St. Paul] ports). Ports are accessed by means of a special needle through intact skin. In pediatric oncology patients, ports are associated with a lower rate of catheterrelated bloodstream infection than are Broviac/Hickman catheters [1][2][3][4].Although cure of bloodstream infections related to nontunneled vascular catheters generally requires catheter removal, we and others have found that ϳ75% of Broviac/Hickman catheter-related bloodstream infections are cured without catheter removal [3][4][5][6]. In contrast, there are limited data concerning the efficacy of antibiotic treatment of port-associated bloodstream infection without port removal. To determine the advisability of initial antibiotic therapy without device removal, we studied the outcome of consecutive catheter-related bloodstream infections occurring in pediatric hematologyoncology patients with totally implantable venous access ports. MethodsPatient population. All pediatric hematology-oncology patients cared for at the Schneider Children's Hospital (New Hyde Park, NY) between 1 January 1991 and 31 December 1993 were identified through a log book of all patients seen by the division of pediatric hematology/oncology. Patients with a port were identified by review of the comprehensive flow sheets maintained for each patient by that division, on which data on all surgically placed vascular catheters, hospital admissions, infections, courses of antibiotic therapy, and vascular catheter removal are tabulated prospectively.To ensure that a...

show abstract

Section: Discussionmentioning

confidence: 99%

Cure of Implantable Venous Port–Associated Bloodstream Infections in Pediatric Hematology‐Oncology Patients without Catheter Removal

et al. 1999

View full text Add to dashboard Cite

show abstract

“…However, in eight reported series of Broviac-type catheter infections reviewed by Decker and Edwards (15), eradication of the organism causing sepsis was accomplished without removal of the central line in 75% of the infections and, more recently, in 61% of episodes reported by Benezra et al (4). Most of the current methods require that the catheter be removed to confidently characterize a septic episode as catheter related.…”

Section: Catheter-related Sepsis (Crs)mentioning

confidence: 99%

“…In addition, larger numbers of actual catheter infections need to be studied to determine the range of central-to-peripheral bacterial count ratios that occur so that the sensitivity, specificity, and predictive values of this method for the diagnosis of CRS can be established. Processing blood cultures by quantitative methods provides additional information, but that information has not yet been demonstrated to be necessary to management or to correlate with outcome of CRS (15).…”

Section: Catheter-related Sepsis (Crs)mentioning

confidence: 99%

Quantitative aspects of septicemia

1990

View full text Add to dashboard Cite

For years, quantitative blood cultures found only limited use as aids in the diagnosis and management of septic patients because the available methods were cumbersome, labor intensive, and practical only for relatively small volumes of blood. The development and subsequent commercial availability of lysis-centrifugation direct plating methods for blood cultures have addressed many of the shortcomings of the older methods. The lysis-centrifugation method has demonstrated good performance relative to broth-based blood culture methods. As a result, quantitative blood cultures have found widespread use in clinical microbiology laboratories. Most episodes of clinical significant bacteremia in adults are characterized by low numbers of bacteria per milliliter of blood. In children, the magnitude of bacteremia is generally much higher, with the highest numbers of bacteria found in the blood of septic neonates. The magnitude of bacteremia correlates with the severity of disease in children and with mortality rates in adults, but other factors play more important roles in determining the patient's outcome. Serial quantitative blood cultures have been used to monitor the in vivo efficacy of antibiotic therapy in patients with slowly resolving sepsis, such as disseminated Mycobacterium avium-M. intracellulare complex infections. Quantitative blood culture methods were used in early studies of bacterial endocarditis, and the results significantly contributed to our understanding of the pathophysiology of this disease. Comparison of paired quantitative blood cultures obtained from a peripheral vein and the central venous catheter has been used to help identify patients with catheter-related sepsis and is the only method that does not require removal of the catheter to establish the diagnosis. Quantitation of bacteria in the blood can also help distinguish contaminated from truly positive blood cultures; however, no quantitative criteria can invariably differentiate contamination from bacteremia.

show abstract

“…[4][5][6] According to a recent report by Oudiz et al, at least 10% of their patients with a catheter infection required admission to critical care wards and several patients died as a direct consequence of the catheter infection, although the incidence of catheter-related infections in patients with PAH receiving EPO was lower than that in patients with other diseases. It has already been reported that the catheter hub was the most important source of catheter-related infections 8,9 and thus several closed hub systems have been introduced.…”

mentioning

confidence: 99%

Prevention of Catheter-Related Infections Using A Closed Hub System in Patients With Pulmonary Arterial Hypertension

Akagi

Matsubara

Ogawa

et al. 2007

Circ J

View full text Add to dashboard Cite

ulmonary arterial hypertension (PAH) is a rare disease of poor prognosis. Recently, continuous intravenous epoprostenol (EPO) was introduced as a treatment for PAH with the consequent improvement of the patients' quality of life. 1 Although therapy with EPO improves the patients' exercise capacity and prognosis, various complications related to the central venous catheters arise during long-term treatment with EPO. 2,3 Among them, catheter-related infection is a serious problem, because the infections aggravate the primary disease.The incidence of catheter-related infections was reported to be 0.3-9.1 infections per 1,000 patient-days in patients with long-term, indwelling central venous catheters for various diseases. [4][5][6] According to a recent report by Oudiz et al, at least 10% of their patients with a catheter infection required admission to critical care wards and several patients died as a direct consequence of the catheter infection, although the incidence of catheter-related infections in patients with PAH receiving EPO was lower than that in patients with other diseases. It has already been reported that the catheter hub was the most important source of catheter-related infections 8,9 and thus several closed hub systems have been introduced. 10,11 In the present study, we adopted the closed hub system for patients with PAH receiving EPO to prevent bacterial invasion from the catheter hub. Methods Closed Hub SystemWe introduced the closed hub system after March 2002. This system consists of 2 parts (Fig 1). One part is the Hickman catheter connected to an extension tube (Figs 1A, B,D), and the other part is the infusion port for EPO in medication baggage (Fig 1C). The connection between the Hickman catheter and extension tube is a commercially available catheter connection system (I-system; Nipro Corporation, Japan). The I-system consists of an I-plug (a cap with a latex end injection plug with a male screw) and an I-set (a 21-gauge needle with a Luer -Lock female screw) (Fig 1B). The I-plug is applied to the hub of the Hickman catheter (Fig 1A). The needle of the I-set is inserted into the latex end of the I-plug. Then, the I-plug and I-set are fixed together by the Luer -Lock. The infusion port for EPO in the medication baggage consists of a plug made of latex (Fig 1C). Study PopulationFrom Background Most of the patients with pulmonary arterial hypertension (PAH) receiving intravenous epoprostenol have experienced catheter-related infections during long-term treatment. Catheter hub was reported to be the most important source of catheter-related infections. To prevent the catheter-related infections, we have introduced a closed hub system and compared the incidence of catheter-related infections with that in patients using a non-closed hub system. Methods and ResultsWe evaluated the results obtained on 24 occasions in 20 patients with PAH between June 1999 and December 2005. On 11 occasions, a non-closed hub system was used and on 13 cases a closed hub system. We classified the catheter-related ...

show abstract

Central Venous Catheter Infections

Cited by 177 publications

References 146 publications

Cure of Implantable Venous Port–Associated Bloodstream Infections in Pediatric Hematology‐Oncology Patients without Catheter Removal

Cure of Implantable Venous Port–Associated Bloodstream Infections in Pediatric Hematology‐Oncology Patients without Catheter Removal

Quantitative aspects of septicemia

Prevention of Catheter-Related Infections Using A Closed Hub System in Patients With Pulmonary Arterial Hypertension

Contact Info

Product

Resources

About