Semiquantitative Culture of Subcutaneous Segment for Conservative Diagnosis of Intravascular Catheter‐Related Infection

Fortün, Jesús; Perez-Molina, José A.; Asensio, Ángel; Calderón, C. Fernández; Casado, José L.; Mir, Nuria; Moreno, Ana; Guerrero, A.

doi:10.1177/0148607100024004210

Cited by 29 publications

(11 citation statements)

References 20 publications

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“…[20] According to Fortun et al ., the rate of incidence of tip colonization was 2.9 per 1000 catheter-days and of bacteremia was 1.2 per 1000 catheter-days. [21] Similarly, Deshpande et al . in 2005 in their study reported that the incidence of catheter infection was 4.01/1000 catheter-days (2.29% catheter) and colonization was 5.07/1000 catheter-days (2.89% catheters), which was low.…”

Section: Discussionmentioning

confidence: 99%

Central venous catheter-related bloodstream infections in the intensive care unit

Patil

Ramteerthkar

et al. 2011

Indian Journal of Critical Care Medicine

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Context:Central venous catheter-related bloodstream infection (CRBSI) is associated with high rates of morbidity and mortality in critically ill patients.Aims:This study was conducted to determine the incidence of central venous catheter-related infections (CRIs) and to identify the factors influencing it. So far, there are very few studies that have been conducted on CRBSI in the intensive care unit in India.Settings and Design:This was a prospective, observational study carried out in the medical intensive care unit (MICU) over a period of 1 year from January to December 2004.Materials and Methods:A total of 54 patients with indwelling central venous catheters of age group between 20 and 75 years were included. The catheters were cultured using the standard semiquantitative culture (SQC) method. Statistical analysis used SPSS-10 version statistical software.Results:A total of 54 CVC catheters with 319 catheter days were included in this study. Of 54 patients with CVCs studied for bacteriology, 39 (72.22%) catheters showed negative SQCs and also negative blood cultures. A total of 15 (27.77%) catheters were positive on SQC, of which 10 (18.52%) were with catheter-associated infection and four (7.41%) were with catheter-associated bacteremia; the remaining one was a probable catheter-associated bacteremia. CRIs were high among catheters that were kept in situ for more than 3 days and emergency procedures where two or more attempts were required for catheterization (P < 0.05). In multivariate analysis of covariance duration of catheter in situ for >3 days, inexperienced venupucturist, more number of attempts and emergency CVC were associated with more incidence of CVCBSIs, with P <0.02. The duration of catheter in situ was negatively correlated (-0.53) and number of attempts required to put CVC was positively correlated (+0.39) with incidence of CVCBSIs. Sixty-five percent of the isolates belonged to the CONS group (13/20). Staphylococcus epidermidis showed maximum susceptibility to amikacin, doxycycline and amoxycillin with clavulanic acid and was susceptible to vancomycin (100%). Klebsiella pneumoniae was 100% susceptible to amikacin and ciprofloxacin. Escherichia coli was susceptible to amikacin and cefotaxime.Conclusions:The overall incidence of CRI was 27.77% (15/54). Catheter-associated BSIs were 47.31 per 1000 catheter-days. CRI was low in the catheters inserted by the experienced venipuncturists, elective procedure and CVC kept in situ for ≤3 days. S. epidermidis was the most common isolate.

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Section: Discussionmentioning

confidence: 99%

Central venous catheter-related bloodstream infections in the intensive care unit

Patil

Ramteerthkar

et al. 2011

Indian Journal of Critical Care Medicine

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“…These may prevent unnecessary catheter changes for diagnostic purposes. Sensitivity can be improved by swabbing and culturing not only the skin at the insertion site but also 1 cm of the subcutaneous portion of the catheter, once it has been pulled away to do so 69 . Besides, when superficial skin cultures are performed in patients with a high suspicion of CR-BSI, the positive predictive value rises to almost 100% 70 .…”

Section: Conservative-procedures To Assess Crimentioning

confidence: 99%

Catheter-Related Infections: Diagnosis and Intravascular Treatment

Bouza

Burillo

Muñóz

2001

Journal of Chemotherapy

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The diagnosis of catheter-related infections relies on the presence of clinical manifestations of infection and the evidence of colonization of the catheter tip by bacteria, mycobacteria or fungi. The reference method to confirm the latter requires the withdrawal of the catheter for culturing, which frequently turns out to be inconvenient, unnecessary and costly. New methods try to avoid these inconveniences and to assess the presence of tip colonization without withdrawal. One of these methods uses quantitative blood cultures with a jump (> or = 5) in colony counts between blood obtained from the catheter lumen and simultaneously from a peripheral vein. It has a high sensitivity (>80%) and specificity (94%-100%) but is cumbersome and requires both an easy backflow of blood in the catheter and the existence of bacteremia. Cytocentrifugation and acridine orange staining of blood withdrawn from an infected catheter lumen has a sensitivity and a specificity of over 90% for the diagnosis of tip colonization. "Superficial cultures" consist in the semiquantitative culture of the hub, of the skin surrounding the catheter entrance and of the first (1 cm) subcutaneous portion of the catheter after swabbing. Sensitivity of this method is >90% and specificity is >80%, and positive and negative predictive values for catheters (considering together those with and without clinical data of infection) are 66% and 97%, respectively. Endoluminal brushing has turned out to be an impractical and unreliable procedure, at least in our experience. New methods based on the speed of bacterial growth to detectable levels of microorganisms in conventional blood cultures are a new and interesting way of assessing catheter-related infections. Besides, as use of antimicrobial-coated catheters becomes more prevalent, the existing definitions of catheter colonization and catheter-related infection may need to be modified, because such coatings may lead to false-negative culture results. Many catheter infections, diagnosed without catheter withdrawal, can be handled nowadays with the so-called "antibiotic lock-in technique", which consists in locking the infected catheter lumen with a solution containing antibiotics. A high proportion of infected catheters, mainly those with coagulase-negative staphylococci, can be maintained in place and sterilized with this technique, including catheters in patients with therapeutic failure after receiving conventional intravenous antibiotic therapy. New diagnostic and therapeutic techniques may avoid the unnecessary withdrawal of thousands of efficient, difficult to replace and expensive intravascular lines.

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“…Cultures of the hub alone do not improve the situation, as hub sensitivity was found to be 61% [41]. However, when cultures of both the skin and the hub are taken in combination, sensitivity improved to 86%, though specificity and the positive predictive value remain low.…”

Section: Skin And/or Hub Culturesmentioning

confidence: 95%

“…The area chosen is swabbed then the swab is streaked onto agar and cultured semiquantitatively [40]. Fortun et al [41] found that skin culturing, as a diagnostic test for catheterrelated infection, yielded less than or equal to 61% sensitivity, 72% specificity, and 62% positive predictive value. However, in cases where infection is suspected and quantitative skin cultures of the CVCs are taken, sensitivity rises to 75%, specificity to greater than 90%, and the positive predictive value to 100% [42].…”

Section: Skin And/or Hub Culturesmentioning

confidence: 99%

Diagnosis of catheter-related bloodstream infection

Hanna

Raad

2005

Curr Infect Dis Rep

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Catheter-related bloodstream infection is a potentially serious condition with a mortality rate of 12% to 25%. Catheter-related bacteremia is difficult to diagnose, and clinical manifestations of the condition have proved to be unspecific and often inconclusive. Microbiologic techniques to diagnose catheter-related bloodstream infection have been developed, some of which require catheter removal whereas others do not. Differential time to positivity has demonstrated marked accuracy and practicality as it allows the catheter to remain in place. Many other methods, such as skin or hub cultures, show less remarkable results, and some, such as intraluminal brushing, may produce adverse effects. Once a catheter-related bloodstream infection is diagnosed, it is classified as either complicated or uncomplicated and treated accordingly.

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Semiquantitative Culture of Subcutaneous Segment for Conservative Diagnosis of Intravascular Catheter‐Related Infection

Abstract: These results indicate that the combined subcutaneous segment and hub culture constitutes an easy, effective procedure for the conservative diagnosis of catheter colonization.

Cited by 29 publications

References 20 publications

Central venous catheter-related bloodstream infections in the intensive care unit

Central venous catheter-related bloodstream infections in the intensive care unit

Catheter-Related Infections: Diagnosis and Intravascular Treatment

Diagnosis of catheter-related bloodstream infection

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