The challenge of anticipating catheter tip colonization in major heart surgery patients in the intensive care unit: Are surface cultures useful?

Bouza, Emilio; Muñóz, Patricia; Burillo, Almudena; López-Rodríguez, Javier; Fernández-Pérez, Cristina; Pérez, María Jesús; Rincón, Cristina

doi:10.1097/01.ccm.0000171842.63887.c1

Cited by 43 publications

(21 citation statements)

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“…It has high morbidity and mortality rates and occurs only in patients with colonized catheters (1,2). The negative predictive value of superficial culture (skin and hub) results for prediction of catheter tip colonization is very high (3)(4)(5)(6)(7). However, taking cultures from the hub requires a swab to be rubbed inside the catheter lumen, thus potentially leading to migration of microorganisms into the bloodstream (8)(9)(10).…”

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Cultures of Needleless Connectors Are Useful for Ruling Out Central Venous Catheter Colonization

et al. 2015

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Semiquantitative cultures of skin surrounding intravascular catheter entry sites and catheter hubs have high negative predictive values for catheter tip colonization. However, culturing samples from the inner side of the hub requires the catheter to be manipulated, thus increasing the risk of migration of microorganisms into the bloodstream. Today, hubs are closed using needleless connectors (NCs). Cultures of NCs could predict catheter colonization. Our objective was to compare the yield of NC sonicate cultures for prediction of catheter colonization with that of hub cultures. For 6 months, we prospectively collected all short-term central lines and systems removed from patients admitted to the cardiac surgery postoperative care unit, irrespective of the reason for withdrawal. Hub cultures were obtained immediately before withdrawal and were cultured using a semiquantitative method. Catheter tips were cultured using the roll-plate technique and sonication, and NCs were cultured using a semiquantitative technique after sonication. We considered NCs to be colonized when >1 culture was positive. We collected a total of 75 central systems. The catheter colonization rate was 10.7%. The rates for hub and NC colonization were 6.7% and 12.0%, respectively. The validity values for hubs and NCs for prediction of catheter colonization were as follows: sensitivity, 25.0% and 87.5%; specificity, 95.5% and 97.0%; positive predictive value, 40.0% and 77.8%; negative predictive value, 91.4% and 98.5%; validity index, 88.0% and 96.0%, respectively. Cultures of closed NCs can be used to rule out catheter tip colonization and are superior to hub cultures in ruling out shortterm central venous catheter colonization. C atheter-related bloodstream infection (C-RBSI) is one of the most important nosocomial infections. It has high morbidity and mortality rates and occurs only in patients with colonized catheters (1, 2). The negative predictive value of superficial culture (skin and hub) results for prediction of catheter tip colonization is very high (3-7). However, taking cultures from the hub requires a swab to be rubbed inside the catheter lumen, thus potentially leading to migration of microorganisms into the bloodstream (8-10).Currently, short-term central venous catheter (CVC) hubs are closed with needleless connectors (NCs), which are easier to culture. We compared the negative predictive values for catheter tip colonization of cultures taken from inside the hubs and from the NCs. MATERIALS AND METHODSSetting. This prospective study was carried out in the laboratory of the clinical microbiology and infectious diseases department and the cardiac surgery postoperative care unit (PCU) of our institution.Laboratory procedures. Immediately before removing the CVC, we took culture samples from the inside of all catheter hubs and from the NC (Clave connector). After the CVC was removed, the catheter tip was sent to the microbiology laboratory for culture. Always before culture samples were taken, the investigator wore clean gloves and...

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Cultures of Needleless Connectors Are Useful for Ruling Out Central Venous Catheter Colonization

et al. 2015

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“…For 139 central venous catheter tips, superficial cultures had a positive predictive value of 66.2% and a negative predictive value of 96.7% in the diagnosis of catheter colonization. In patients with bloodstream infection, the hub is frequently the source of CR-BSI, and negative hub and skin culture results almost rule out catheter colonization and CR-BSI [8,12,[32][33][34][35]. In the present study, sterile semiquantitative cultures of the hubs and skin had a negative predictive value of 96.4% for the catheter origin of a bloodstream episode.…”

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confidence: 79%

“…In addition, 150% of catheter tips cultured in microbiology laboratories are found to be sterile [5,6,12,14,28,29]. Furthermore, some CR-BSIs in hemodynamically stable patients can be handled in situ using antibiotic or antiseptic lock therapy.…”

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confidence: 99%

A Randomized and Prospective Study of 3 Procedures for the Diagnosis of Catheter-Related Bloodstream Infection without Catheter Withdrawal

Bouza

Alvarado

Alcalá

et al. 2007

Clinical Infectious Diseases

166

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CR-BSI can be assessed without catheter withdrawal in patients without neutropenia or blood disorders who have catheters inserted for a short time and are hospitalized in the intensive care unit. Convenience, use of resources, and expertise should determine the technique of choice in different medical contexts. Because of ease of performance, low cost, and wide availability, we recommend combining semiquantitative superficial cultures and peripheral vein blood cultures to screen for CR-BSI, leaving differential quantitative blood cultures as a confirmatory and more specific technique.

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“…Catheter-related bloodstream infections (CR-BSI) are the main cause of documented sepsis (4,5) in modern hospitals (2,20,27) and are mainly produced by coagulase-negative staphylococci (CNS) (6,26,32). The confirmed definition of a CR-BSI requires the isolation of one or more identical microorganism/s from blood and the catheter tip (19).…”

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Comparison of Phenotypic with Genotypic Procedures for Confirmation of Coagulase-Negative Staphylococcus Catheter-Related Bloodstream Infections

et al. 2006

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We sought here to review the present definition of catheter-related bloodstream infections (CR-BSI) due to coagulase-negative staphylococci (CNS) by comparing the routine phenotypic methods with a genotypic procedure that considers different morphotypes. Our phenotypic characterization of CNS isolates included routine identification with biotype and antibiotype. The genotypic diagnosis was based on longer incubation periods with the consideration of all morphotypes and molecular typing by pulsed-field gel electrophoresis techniques. We prospectively selected 61 episodes of suspected CR-BSI by CNS occurring during 1 year, based on the presence of a compatible clinical setting and the isolation of one or more CNS from blood and catheter tip. Of these episodes, 47 (77%) were identified as true episodes of CR-BSI based on the presence of microorganisms of the same genotype in the blood and on the catheter tip. The sensitivity, specificity, positive predictive, negative predictive, accuracy, positive likelihood ratio, and negative likelihood ratio values obtained by different phenotypic microbiological approaches to establish the diagnosis of CR-BSI were as follows: identity at species level (78. Catheter-related bloodstream infections (CR-BSI) are the main cause of documented sepsis (4, 5) in modern hospitals (2,20,27) and are mainly produced by coagulase-negative staphylococci (CNS) (6,26,32). The confirmed definition of a CR-BSI requires the isolation of one or more identical microorganism/s from blood and the catheter tip (19). However, present definitions are far from clear regarding the demonstration of such identity, particularly in the case of CNS. Most CNS colonies look alike after 24-h incubation, and laboratory routine involves taking a single colony for identification and antimicrobial susceptibility tests from those CNS growing in blood and on catheter tip cultures. The identity of both isolates is usually established on a phenotypic basis when the same genus, species, and antibiotype of the isolates in both samples are present. It is well known, however, that CNS growing on catheter tips may be frequently polyclonal (6, 12), especially when colonies are observed after longer periods of incubation. Moreover, biotype and antibiotype may have a weak correlation with genotype in CNS (22,30,34).7%We compare here the yields of two procedures for the characterization of CNS CR-BSI: "phenotypic" characterization, carried out in microbiology laboratories on a daily basis, and a procedure by which the different morphotypes are obtained after prolonged incubation and the application of genotyping with molecular techniques. MATERIALS AND METHODS Selection of Patients with CR-BSI.During a one-year period, we prospectively selected all consecutive patients fulfilling the following criteria: (i) age of Ն18 years; (ii) clinical signs of nosocomial sepsis (patients who had been in the hospital for more than 48 h when the first episode of fever was recorded and with one or more of the following signs or symptoms: tempera...

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The challenge of anticipating catheter tip colonization in major heart surgery patients in the intensive care unit: Are surface cultures useful?

Cited by 43 publications

References 43 publications

Cultures of Needleless Connectors Are Useful for Ruling Out Central Venous Catheter Colonization

Cultures of Needleless Connectors Are Useful for Ruling Out Central Venous Catheter Colonization

A Randomized and Prospective Study of 3 Procedures for the Diagnosis of Catheter-Related Bloodstream Infection without Catheter Withdrawal

Comparison of Phenotypic with Genotypic Procedures for Confirmation of Coagulase-Negative Staphylococcus Catheter-Related Bloodstream Infections

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