Ultrastructural Analysis of Indwelling Vascular Catheters: A Quantitative Relationship between Luminal Colonization and Duration of Placement

Abstract

To assess the degree of luminal and extraluminal colonization of long-term central venous catheters (CVC), 359 indwelling silicone CVC from 340 consecutive cancer patients were examined. All CVC were cultured by the roll-plate and sonication quantitative culture techniques. Semiquantitative electron microscopy was done on 39 CVC associated with catheter infections and on 26 culture-negative controls. An additional 10 culture-negative CVC obtained after death were also studied by electron microscopy. Ultrastructural colonization and biofilm formation was universal and quantitatively independent of clinical catheter-related infections. Ultrastructural colonization and biofilm formation was predominantly luminal in long-term CVC (> 30 days). Based on a composite definition, the sensitivity of the roll-plate catheter tip culture was 42%-45% compared with 65%-72% for the sonication of the tip. Colonization of indwelling catheters is universal regardless of culture results. For long-term CVC, colonization becomes predominantly luminal and extraluminal quantitative catheter cultures are of limited diagnostic sensitivity.

Totally implantable venous catheters for chemotherapy: experience in 500 patients

“…Nonetheless, in 62.7% of the cases we only observed fever without a determinate focus. It is difficult to obtain diagnostic proof through laboratory tests (cultures) in bacteremia cases because of the low sensitivity of such tests, [18][19][20][21][22][23] and for this reason the clinical condition must be utilized for indicating the need for catheter removal. Even cultures from the catheter present low sensitivity and thus must not be used as definitive diagnostic criteria.…”

Guidelines for the prevention of intravascular catheter-related infections

“…Contamination of the catheter hub contributes substantially to intraluminal colonization of long-term catheters [23][24][25]. Occasionally, catheters might become hematogenously seeded from another focus of infection.…”

Leaving previously implanted central venous catheters (ports) in place does not increase morbidity in patients undergoing autologous peripheral stem cell transplantation

“…This use makes these ICs comparable to percutaneous CVCs in which the rate of infection increases with time, probably because prolonged catheterization is associated with more hub manipulation and increased intraluminal colonization. 12 ICs have been available since 1982. 1,2 The main complications associated with ICs are thrombosis and infection.…”