Central venous catheter-associated bloodstream infection and colonisation of insertion site and catheter tip. What are the rates and risk factors in haematology patients?

Abstract

Skin colonisation is an important source for central venous catheter (CVC) colonisation and infection. This study intended to identify risk factors for skin colonisation prior to CVC placement (baseline colonisation) and within 10 days after CVC insertion (subsequent colonisation), for CVC-tip colonisation and for bloodstream infection (BSI). Within a randomised clinical trial, data of 219 patients with haematological malignancies and inserted CVC (with a total of 5,501 CVC-days and 4,275 days at risk) in two university hospitals were analysed. Quantitative skin cultures were obtained from the insertion site before CVC placement and at regular intervals afterwards. CVC-tip cultures were taken on CVC removal and data collection was performed. Statistical analysis included linear and logistic regression models. Age was an independent risk factor for colonisation prior to CVC placement (baseline colonisation). Independent risk factors for subsequent colonisation were baseline colonisation and male gender. High level of subsequent skin colonisation at the insertion site was a predictor of CVC-tip colonisation, and a predictor of BSI. High level of skin colonisation predicts catheter tip colonisation and possibly subsequent infection. Sustained reduction of bacterial growth at the CVC insertion site is therefore indispensable. Male patients are at particular risk for skin colonisation and may be a target population for additional insertion-site care before and during catheterisation.

Gender Differences in Risk of Bloodstream and Surgical Site Infections

“…The search revealed nine publications that reported differences between men and women with respect to incidence of BSI (Table 5, available online). [23][24][25][26][27][28][29][30][31] Controlling for a variety of covariates, three of the articles reported that men had significantly higher infection rates than women, and six reported no significant gender differences. Although the majority found no significant gender differences, the fact that all studies reporting significant differences found that males were at higher risk suggests a possible association.…”

“…Several studies have found that bacterial colonization of the skin surrounding a central venous catheter at the insertion site is greater on men than on women, even when controlling for baseline colonization. [19][20][21][22] In addition, it has been suggested that hair growth and shaving interfere with wound dressing adherence, which could lead to a higher risk of infection among men who have thicker, coarser hair. 22 The fact that our study revealed no gender differences in infection rates among young children supports this theory, since gender differences in skin quality and hair growth are not pronounced in childhood.…”

“…[19][20][21][22] In addition, it has been suggested that hair growth and shaving interfere with wound dressing adherence, which could lead to a higher risk of infection among men who have thicker, coarser hair. 22 The fact that our study revealed no gender differences in infection rates among young children supports this theory, since gender differences in skin quality and hair growth are not pronounced in childhood. Moreover, we found that among adolescents, in whom skin differentiation might begin to resemble that of adults, girls had significantly lower odds of community-associated BSI and lower odds of SSI, although this was not significant.…”

Surgical Replacement of Implantable Pulse Generators in Deep Brain Stimulation: Adverse Events and Risk Factors in a Multicenter Cohort

“…This is interesting since male gender has been indicated as a risk factor for postoperative infection after cardiac pacemaker implantations as well as in large studies of surgical site infections and community-acquired blood stream infections [14,15]. Theories explaining this include male susceptibility for bacterial colonization indicated by studies on central venous catheters and that male body hair may interfere with antiseptic scrubbing and wound dressings [15,16]. …”

Ensaio clínico randomizado do uso do curativo gel de clorexidina para a prevenção da colonização do cateter venoso central em pacientes adultos críticos

“…Luft (2010) relata ser indispensável à redução da carga microbiana na região de inserção do cateter e aponta a importância dessa contribuição para a prevenção antes que a colonização progrida para infecção.…”