Pathogenesis and prevention of catheter-related septicemia

Sitges‐Serra, Antonio; Pi-Suñer, T.; Garcés, José M.; Segura, M.

doi:10.1016/0196-6553(95)90062-4

Cited by 28 publications

(14 citation statements)

References 32 publications

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“…Most of the phycians select the jugular vein for catheter insertion because it is easier to insert the catheter and due to low mechanical complication rate. According to our study and other reports, subclavian vein approach has a significant advantage with respect to insertion site colonization and infection [6,15,16]. Therefore, we suggest that the subclavian approach be utilized preferentially for catheterization, provided a serious bleeding diathesis is not present and risk of pneumothorax is not excessive.…”

Section: Discussionsupporting

confidence: 62%

Central venous catheter related infections: Risk factors and the effect of glycopeptide antibiotics

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Yıldırım

et al. 2003

Ann Clin Microbiol Antimicrob

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BackroundWe undertook a prospective study of all new central venous catheters inserted into patients in the intensive care units, in order to identify the risk factors and to determine the effect of glycopeptide antibiotics on catheter – related infections.MethodsDuring the study period 300 patients with central venous catheters were prospectively studied. The catheters used were nontunneled, noncuffed, triple lumen and made of polyurethane material. Catheters were cultured by semiquantitative method and blood cultures done when indicated. Data were obtained on patient age, gender, unit, primary diagnosis on admission, catheter insertion site, duration of catheterization, whether it was the first or a subsequent catheter and glycopeptide antibiotic usage.ResultsNinety-one (30.3%) of the catheters were colonized and infection was found with 50 (16.7%) catheters. Infection was diagnosed with higher rate in catheters inserted via jugular vein in comparison with subclavian vein (95% CI: 1.32–4.81, p = 0.005). The incidence of infection was higher in catheters which were kept in place for more than seven days (95% CI 1.05–3.87, p = 0.03). The incidence of infection was lower in patients who were using glycopeptide antibiotic during catheterization (95% CI: 1.49–5.51, p = 0.005). The rate of infection with Gram positive cocci was significantly lower in glycopeptide antibiotic using patients (p = 0.01). The most commonly isolated organism was Staphylococcus aureus (n = 52, 37.1%).ConclusionDuration of catheterization and catheter insertion site were independent risk factors for catheter related infection. Use of glycopeptide antibiotic during catheterization seems to have protective effect against catheter related infection.

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Section: Discussionsupporting

confidence: 62%

Central venous catheter related infections: Risk factors and the effect of glycopeptide antibiotics

Öncü

Özsüt

Yıldırım

et al. 2003

Ann Clin Microbiol Antimicrob

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“…Therefore, superficial cultures (cultures of skin surrounding the catheter insertion site and hubs) are recommended as a conservative technique for diagnosing catheter colonization and C-RBSI, as data suggest that patients with negative superficial culture results are unlikely to have C-RBSI (3,4,6,12). Obtaining hub culture samples involves manipulating the catheter and rubbing a swab inside the hub, a process that could potentially introduce microorganisms into the catheter lumen (8)(9)(10).…”

Section: Discussionmentioning

confidence: 99%

“…The negative predictive value of superficial culture (skin and hub) results for prediction of catheter tip colonization is very high (3)(4)(5)(6)(7). However, taking cultures from the hub requires a swab to be rubbed inside the catheter lumen, thus potentially leading to migration of microorganisms into the bloodstream (8)(9)(10).…”

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confidence: 99%

Cultures of Needleless Connectors Are Useful for Ruling Out Central Venous Catheter Colonization

et al. 2015

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Semiquantitative cultures of skin surrounding intravascular catheter entry sites and catheter hubs have high negative predictive values for catheter tip colonization. However, culturing samples from the inner side of the hub requires the catheter to be manipulated, thus increasing the risk of migration of microorganisms into the bloodstream. Today, hubs are closed using needleless connectors (NCs). Cultures of NCs could predict catheter colonization. Our objective was to compare the yield of NC sonicate cultures for prediction of catheter colonization with that of hub cultures. For 6 months, we prospectively collected all short-term central lines and systems removed from patients admitted to the cardiac surgery postoperative care unit, irrespective of the reason for withdrawal. Hub cultures were obtained immediately before withdrawal and were cultured using a semiquantitative method. Catheter tips were cultured using the roll-plate technique and sonication, and NCs were cultured using a semiquantitative technique after sonication. We considered NCs to be colonized when >1 culture was positive. We collected a total of 75 central systems. The catheter colonization rate was 10.7%. The rates for hub and NC colonization were 6.7% and 12.0%, respectively. The validity values for hubs and NCs for prediction of catheter colonization were as follows: sensitivity, 25.0% and 87.5%; specificity, 95.5% and 97.0%; positive predictive value, 40.0% and 77.8%; negative predictive value, 91.4% and 98.5%; validity index, 88.0% and 96.0%, respectively. Cultures of closed NCs can be used to rule out catheter tip colonization and are superior to hub cultures in ruling out shortterm central venous catheter colonization. C atheter-related bloodstream infection (C-RBSI) is one of the most important nosocomial infections. It has high morbidity and mortality rates and occurs only in patients with colonized catheters (1, 2). The negative predictive value of superficial culture (skin and hub) results for prediction of catheter tip colonization is very high (3-7). However, taking cultures from the hub requires a swab to be rubbed inside the catheter lumen, thus potentially leading to migration of microorganisms into the bloodstream (8-10).Currently, short-term central venous catheter (CVC) hubs are closed with needleless connectors (NCs), which are easier to culture. We compared the negative predictive values for catheter tip colonization of cultures taken from inside the hubs and from the NCs. MATERIALS AND METHODSSetting. This prospective study was carried out in the laboratory of the clinical microbiology and infectious diseases department and the cardiac surgery postoperative care unit (PCU) of our institution.Laboratory procedures. Immediately before removing the CVC, we took culture samples from the inside of all catheter hubs and from the NC (Clave connector). After the CVC was removed, the catheter tip was sent to the microbiology laboratory for culture. Always before culture samples were taken, the investigator wore clean gloves and...

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“…However, we recognize that a variety of criteria, all of which influence the numerator, have been used to identify a CVC-associated BSI (3,10). For example, some define a CVCassociated BSI when blood cultures from two different sites grow the same organism and no other obvious source of infection is identified, while others require only one positive blood culture with no obvious source of infection (17)(18)(19)(20)(21). We acknowledge the limitation in the present study that the rate of CVC BSIs may have been influenced by the use of a 'possible' definition including a number of coagulase-negative staphylococci from a single blood culture, when in fact, this represented contamination.…”

Section: Central Venous Catheter Infectionsmentioning

confidence: 99%

Central Venous Catheter‐Associated Blood Stream Infections Occurring in Canadian Intensive Care Units: A Six‐Month Cohort Study

Holton

Paton²,

Conly³

et al. 2006

Canadian Journal of Infectious Diseases and Medical Microbiolog

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METHODS: Data were collected using a standardized format on all CVCs and patients when a CVC was inserted for more than 48 h. Results of microbiological studies and therapeutic interventions were recorded when a BSI occurred. RESULTS: There were 182 BSIs from 3696 CVC insertions in 2531 patients. Coagulase-negative staphylococci were responsible for 73% of the BSIs. Mean rates of CVC-associated BSIs per 1000 CVC days were 6.9, 6.8 and 5.0 in adult, neonatal and pediatric ICUs, respectively. Significant factors associated with BSI included duration of CVC insertion (OR=1.2, 95% CI 1.1 to 1.3), receiving total parenteral nutrition (OR=4.1, 95% CI 1.2 to 14.3) and having one or more CVCs (OR=3.1, 95% CI 1.5 to 6.5). In the case-control study, 80% of the variance in a backward elimination logistic regression analysis was explained by duration of CVC insertion (OR=1.2 per day), receiving chemotherapy (OR=6.1), more than one CVC insertion during the study (OR=3.5), insertion of a CVC with two or more lumens (OR=2.3), using the CVC to administer total parenteral nutrition (OR=1.6) and having a surgical wound other than a clean wound (OR=1.6). CONCLUSION: The present study identified risk factors explaining 80% of the variance associated with BSIs and is one of the largest reports on the rate of CVC-associated BSIs occurring in the ICU setting.

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Pathogenesis and prevention of catheter-related septicemia

Cited by 28 publications

References 32 publications

Central venous catheter related infections: Risk factors and the effect of glycopeptide antibiotics

Central venous catheter related infections: Risk factors and the effect of glycopeptide antibiotics

Cultures of Needleless Connectors Are Useful for Ruling Out Central Venous Catheter Colonization

Central Venous Catheter‐Associated Blood Stream Infections Occurring in Canadian Intensive Care Units: A Six‐Month Cohort Study

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