Development of bacteraemia or fungaemia after removal of colonized central venous catheters in patients with negative concomitant blood cultures

Abstract

There are limited data on the clinical significance of positive central venous catheter (CVC) tip cultures associated with concomitant negative blood cultures performed at the time of CVC removal. A retrospective cohort study of all patients who yielded isolated positive CVC tip cultures was conducted in a tertiary-care hospital with 2200 beds during a 10-year period. All patients with isolated positive CVC tip cultures were observed for the development of subsequent bacteraemia or fungaemia between 2 and 28 days after CVC removal. An isolated positive CVC tip culture was defined as a case in which (i) a CVC tip culture yielded > or = 15 colonies using a semiquantitative culture method and (ii) at least two sets of blood samples revealed no organism at, or close to, the time of CVC removal (48 h before to 48 h after CVC removal). During the study period, 312 patients with isolated positive CVC cultures were enrolled. Eight (2.6%; 95% CI 1.2-5.1) of the 312 patients yielding isolated bacterial or fungal CVC tip cultures developed subsequent bloodstream infection (BSI) caused by the same species as that isolated from the tip culture (Staphylococcus aureus, 1: Enterococcus spp.; 2: Pseudomonas aeruginosa; and 3: Candida spp.). Among 125 patients from whose CVC tips the above four organisms were grown, seven (12.3%) of 57 patients who did not receive appropriate antibiotic therapy within 48 h after CVC removal subsequently developed BSI, but only one (1.5%) of 68 patients who did receive appropriate therapy developed BSI (OR 0.11, p 0.02).

Estimating the burden of disease from unsafe injections in India: A cost-benefit assessment of the auto-disable syringe in a country with low blood-borne virus prevalence

“…In hospitalized patients with a bacterial culture positive intravenous catheter, 61% had a concomitant bacterial infection. (46) Injection equipment prepared for reuse by boiling is frequently culture positive (e.g., 33% contamination rate in one assay in Tanzania), and by implication injection equipment reused without sterilization is likely to be infectious. (47) In countries with a low prevalence of blood-borne viruses, the primary benefit of preventing injection equipment reuse may be the prevention of potentially serious bacterial infections.…”

Central venous catheter colonization with Staphylococcus aureus is not always an indication for antimicrobial therapy

“…Park et al . [8] recently showed that bloodstream infection was rare subsequent to the removal of colonized central venous catheters in patients with negative concomitant blood cultures. In his study, most patients with catheter‐related S. aureus bacteraemia had positive blood cultures before the tip result was available and only two patients of the 58 with S. aureus isolated from the central venous catheter tip culture developed subsequent bacteraemia (3.4%).…”

“…Park et al [8] recently showed that bloodstream infection was rare subsequent to the removal of colonized central venous catheters in patients with negative concomitant blood cultures. In his study, most patients with catheter-related [4].…”

Diagnosis, prevention and treatment of haemodialysis catheter-related bloodstream infections (CRBSI): a position statement of European Renal Best Practice (ERBP)

“…In a recent study [63] on 312 patients with a positive catheter culture and a negative blood culture, only eight patients (2.6%) subsequently developed CRBSI with the same germ as the one cultured from the tip, suggesting a low yield for this costly and time-consuming strategy.…”