Prospective study of infections in indwelling central venous catheters using quantitative blood cultures

Benezra, Diane; Kiehn, Timothy E.; Gold, Jonathan W. M.; Brown, Arthur E.; Turnbull, A. D.; Armstrong, Donald

doi:10.1016/s0002-9343(88)80084-6

Cited by 175 publications

(61 citation statements)

References 15 publications

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“…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%

Quantitative aspects of septicemia

1990

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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.

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Section: Catheter-related Sepsis (Crs)mentioning

confidence: 99%

Quantitative aspects of septicemia

1990

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“…Although P. aeruginosa and Candida spp. are the causes of 3% and 10% of all CR-BSI, respectively, they are, however, associated with high morbidity and mortality (1,34). Furthermore, although antibiotic-coated CVCs are highly effective in the clinical setting, there is a potential for these devices to select for resistant gram-negative bacteria and Candida organisms, leading to breakthrough bacteremias and fungemias.…”

Section: Discussionmentioning

confidence: 99%

Comparative In Vitro Efficacies and Antimicrobial Durabilities of Novel Antimicrobial Central Venous Catheters

Hanna

Bahna

Reitzel

et al. 2006

Antimicrob Agents Chemother

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We investigated the efficacies and durability of novel antimicrobial central venous catheters (CVCs) in preventing the adherence of microbial organisms to the surfaces of the CVCs. Novel antimicrobial CVCs investigated in this in vitro study were impregnated with antibiotics (minocycline and rifampin), with Oligon agent (silver, platinum, and carbon black), with approved antiseptics (chlorhexidine and silver sulfadiazine), or with a novel antiseptic agent, gendine, which contains gentian violet and chlorhexidine. When tested against methicillin-resistant Staphylococcus aureus (MRSA) and Pseudomonas aeruginosa, gendine-coated CVC segments provided protection against bacterial adherence significantly more than all other types of tested CVCs (P < 0.05). Gendine-coated CVCs also provided better protection against Candida albicans and Candida parapsilosis than CVCs impregnated with antibiotics or with silver, platinum, and carbon (P < 0.02). After 28 days of being soaked in serum, the CVCs impregnated with chlorhexidine and silver sulfadiazine and the CVCs impregnated with silver, platinum, and carbon had lost antimicrobial activity against MRSA, P. aeruginosa, and C. parapsilosis, and the CVCs impregnated with minocycline and rifampin had lost activity against P. aeruginosa and C. parapsilosis. The CVCs impregnated with gendine maintained antimicrobial activities against MRSA, P. aeruginosa, and C. parapsilosis after 28 days of being soaked in serum. Central venous catheters impregnated with the novel investigational antiseptic gendine showed in vitro efficacy and provided protection against bacterial adherence more than other approved novel antimicrobial-coated CVCs.

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“…For Gram-negative catheter infections, particularly P. aeruginosa, catheter removal is usually required. 10 Similarly, catheter infections with S. aureus, 11 Bacillus species, 12 and fungi 13 may respond poorly to antibiotic therapy alone and often require catheter removal for eradication of infection. In contrast, many authors have reported successful treatment of coagulase-negative Staphylococci catheter infections with antibiotics, obviating the need to remove the catheter.…”

Section: Discussionmentioning

confidence: 99%

Corynebacterium jeikeium bacteremia in bone marrow transplant patients with Hickman catheters

Mattson

Wald

2001

Bone Marrow Transplant

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Summary:Prior studies suggest that Corynebacterium jeikeium bacteremia in immunocompromised patients results in frequent morbidity that may be decreased by prompt removal of the indwelling catheter. To summarize recent experience, charts of 53 bone marrow transplant recipients with Hickman catheters and C. jeikeium bacteremia were reviewed. Forty-one patients were treated with vancomycin without catheter removal and 10 patients underwent catheter removal with subsequent vancomycin therapy. No patient in either group died with C. jeikeium bacteremia as the proximate cause. Salvage of the intravascular catheter was successful in 38 of 41 (93%) attempts. Three patients (7%) in the cathetersalvage group and one patient (10%) in the catheterremoval group experienced recurrent bacteremia. In both catheter-salvage and catheter-removal groups, median time to negative blood culture was 2 days. Thus, time to clearance of bacteremia and patient clinical outcome did not differ between treatment groups. In many patients with Hickman catheters, C. jeikeium bacteremia may be treated successfully with vancomycin and without removal of the catheter. Bone Marrow Transplantation (2001) 27, 445-449.

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Prospective study of infections in indwelling central venous catheters using quantitative blood cultures

Cited by 175 publications

References 15 publications

Quantitative aspects of septicemia

Quantitative aspects of septicemia

Comparative In Vitro Efficacies and Antimicrobial Durabilities of Novel Antimicrobial Central Venous Catheters

Corynebacterium jeikeium bacteremia in bone marrow transplant patients with Hickman catheters

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