The microbiological and clinical outcome of guide wire exchanged versus newly inserted antimicrobial surface treated central venous catheters

Abstract

IntroductionThe management of suspected central venous catheter (CVC)-related sepsis by guide wire exchange (GWX) is not recommended. However, GWX for new antimicrobial surface treated (AST) triple lumen CVCs has never been studied. We aimed to compare the microbiological outcome of triple lumen AST CVCs inserted by GWX (GWX-CVCs) with newly inserted triple lumen AST CVCs (NI-CVCs).MethodsWe studied a cohort of 145 consecutive patients with GWX-CVCs and contemporaneous site-matched control cohort of 163 patients with NI-CVCs in a tertiary intensive care unit (ICU).ResultsGWX-CVC and NI-CVC patients were similar for mean age (58.7 vs. 62.2 years), gender (88 (60.7%) vs. 98 (60.5%) male) and illness severity on admission (mean Acute Physiology and Chronic Health Evaluation (APACHE) III: 71.3 vs. 72.2). However, GWX patients had longer median ICU lengths of stay (12.2 vs. 4.4 days; P < 0.001) and median hospital lengths of stay (30.7 vs. 18.0 days; P < 0.001). There was no significant difference with regard to the number of CVC tips with bacterial or fungal pathogen colonization among GWX-CVCs vs. NI-CVCs (5 (2.5%) vs. 6 (7.4%); P = 0.90). Catheter-associated blood stream infection (CA-BSI) occurred in 2 (1.4%) GWX patients compared with 3 (1.8%) NI-CVC patients (P = 0.75). There was no significant difference in hospital mortality (35 (24.1%) vs. 48 (29.4%); P = 0.29).ConclusionsGWX-CVCs and NI-CVCs had similar rates of tip colonization at removal, CA-BSI and mortality. If the CVC removed by GWX is colonized, a new CVC must then be inserted at another site. In selected ICU patients at higher central vein puncture risk receiving AST CVCs GWX may be an acceptable initial approach to line insertion.

Prevention of Transmission of Multidrug-Resistant Organisms during Catheter Exchange using Antimicrobial Catheters

“…In a recent retrospective study, patients with guide-wire-exchanged CVCs stayed in the ICU and in the hospital longer than controls (26). The catheter tips of the guide-wire-exchanged CVCs were found to have been colonized with Gram-negative bacteria, Staphylococcus, and Candida, whereas CVCs inserted at a new site were not contaminated (26), which is consistent with the cross-contamination of pathogens upon exchange in our study.…”

Guidewire exchange vs new site placement for temporary dialysis catheter insertion in ICU patients: is there a greater risk of colonization or dysfunction?

“…Three recent observational studies of critically ill adult patients, designed to assess the impact of catheter replacement by GWE on the risk of infections, yielded conflicting results [ 20 – 22 ]. In a prospective multicentre survey of 1598 central venous catheters, including 67 inserted by GWE, GWE was identified as an independent risk factor of catheter-related bacteraemia; however, more than 20 % of the catheters were inserted outside of the ICU [ 23 ].…”

“…In a prospective multicentre survey of 1598 central venous catheters, including 67 inserted by GWE, GWE was identified as an independent risk factor of catheter-related bacteraemia; however, more than 20 % of the catheters were inserted outside of the ICU [ 23 ]. Conversely, two single-centre observational studies, including one that examined triple-lumen antimicrobial surface-treated catheters [ 22 ], reported that the rate of catheter colonization in serial catheter insertions was not influenced by GWE [ 20 , 22 ]. However, whether the results of these studies can be applied to DC placement by GWE is questionable because central venous catheters and DCs are inserted for different purposes and their extent and manner of use are not the same, and critically ill patients with AKI requiring RRT have a higher mortality rate than the general ICU population.…”

Aspergillus Sphenoiditis Associated with an Artificial Bone Graft Used for Transsphenoidal Surgery

“…Fungi can colonize implanted foreign bodies such as central venous catheters, pacemaker leads, and prosthetic joints, resulting in systemic complications. [8][9][10][11] Feely and Steinberg described two cases of Aspergillus infection caused by a transsphenoidal 90 Y pituitary implant mounted on stainless steel screws to destroy the pituitary by interstitial irradiation. 12) To the best of our knowledge, this is the first report of Aspergillus infection in an artificial bone graft.…”