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Skin versus hub cultures to predict colonization and infection of central venous catheter in intensive care patients

Prädiktiver Wert von Kulturen der Haut vs des Katheter-Ansatzstückes für Kolonisation und Infektion der Zentralvenenkatheter bei Intensivpatienten

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Summary

Central venous catheters (CVC) are an important source of nosocomial infection in intensive care units. The unnecessary removal of CVC suspected to be infected can probably be minimized. In order to test the accuracy of non-invasive methods for predicting catheter colonization, we prospectively compared the results of 50 consecutive CVC tip cultures, with cultures of the CVC hub and the skin at the insertion site. The CVC were separated into two groups based upon the underlying reason for CVC removal: group I (n=20), suspicion of infection; group II (n=30), no suspicion of infection. The skin culture (with a threshold of 15 CFU) was useful in both groups for assessing catheter colonization since it was always positive in cases of catheter colonization and always negative in the absence of catheter colonization. The contribution of the CVC hub cultures alone was minimal since there was no case of catheter colonization with negative skin cultures and positive hub cultures suggesting that the main route of catheter colonization was via the skin. Catheter-related bacteremia was identified in seven patients (six in group I and one in group II). In these patients, the ratio of bacterial colony counts (central/peripheral) was greater than 10 : 1 in only two cases.

Zusammenfassung

Zentralvenenkatheter sind eine wichtige Infektionsquelle für nosokomiale Infektionen auf Intensivstationen. Die unnötige Katheterentfernung bei Verdacht auf Infektion kann wahrscheinlich auf ein Minimum reduziert werden. Zur Überprüfung des prädiktiven Wertes nicht invasiver Methoden für eine Katheterkolonisation führten wir eine prospektive Vergleichsstudie durch, bei der 50 konsekutiv gelegte Zentralvenenkatheter untersucht und die Kulturen vom Katheter-Ansatzstück mit Kulturen von der Haut im Bereich der Kathetereintrittsstelle verglichen wurden. Nach der Ursache für die Katheterentfernung wurden zwei Gruppen gebildet: Gruppe I (n=20) Verdacht auf Infektion; Gruppe II (n=30) kein Verdacht auf Infektion. Die Hautkulturen (mit einem Grenzwert von 15 KBE) war in beiden Gruppen für die Beurteilung einer Katheterinfektion hilfreich. Sie war bei allen Fällen von Katheterinfektion positiv und bei allen Fällen, in denen keine Katheterinfektion vorlag, negativ. Die Kulturen von den Katheter-Ansatzstücken allein boten nur wenig Information, da in keinem Fall eine positive Kultur bei negativer Hautkultur gefunden wurde und somit angenommen werden kann, daß die Katheter-Kolonisation vor allem von der Haut ausging. Bei sieben Patienten (sechs in Gruppe 1 und einer in Grupe II) wurde eine Katheter-Bakteriämie festgestellt. Die Relation der Koloniebildnerzahlen (zentral/peripher) war bei diesen Patienten nur in zwei Fällen größer als 10 : 1.

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Authors and Affiliations

  1. Intensive Care Unit, France

    B. Guidet M. D., J. M. Gabillet M. D., E. Snoey M. D. & G. Offenstadt M. D.

  2. Bacteriology Laboratory, Saint Antoine Hospital, 184 rue du Fg Saint Antoine, F-75012, Paris, France

    I. Nicola M. D., V. Barakett M. D. & J. C. Petit M. D.

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Guidet, B., Gabillet, J.M., Snoey, E. et al. Skin versus hub cultures to predict colonization and infection of central venous catheter in intensive care patients. Infection 22, 43–48 (1994). https://doi.org/10.1007/BF01780765

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