Hostname: page-component-78c5997874-8bhkd Total loading time: 0 Render date: 2024-11-18T17:23:02.177Z Has data issue: false hasContentIssue false
  • English
  • Français

Clinical Predictors of Infection of Central Venous Catheters Used for Total Parenteral Nutrition

Published online by Cambridge University Press:  21 June 2016

Carl W. Armstrong ,
C. Glen Mayhall ,
Kathy B. Miller ,
Heber H. Newsome Jr. ,
Harvey J. Sugerman ,
Harry P. Dalton ,
Gaye O. Hall  and
Sally Hunsberger
Carl W. Armstrong
Affiliation:
Hospital Epidemiology Unit, Division of Infectious Diseases, Department of Medicine, Medical College of Virginia, Virginia Commonwealth University, Richmond, Krginia
C. Glen Mayhall*
Affiliation:
Hospital Epidemiology Unit, Division of Infectious Diseases, Department of Medicine, Medical College of Virginia, Virginia Commonwealth University, Richmond, Krginia
Kathy B. Miller
Affiliation:
Departments of Nursing, Medical College of Virginia, Virginia Commonwealth University, Richmond, Krginia
Heber H. Newsome Jr.
Affiliation:
Surgery, Medical College of Virginia, Virginia Commonwealth University, Richmond, Krginia
Harvey J. Sugerman
Affiliation:
Surgery, Medical College of Virginia, Virginia Commonwealth University, Richmond, Krginia
Harry P. Dalton
Affiliation:
Pathology, Medical College of Virginia, Virginia Commonwealth University, Richmond, Krginia
Gaye O. Hall
Affiliation:
Hospital Epidemiology Unit, Division of Infectious Diseases, Department of Medicine, Medical College of Virginia, Virginia Commonwealth University, Richmond, Krginia
Sally Hunsberger
Affiliation:
Biostatistics, Medical College of Virginia, Virginia Commonwealth University, Richmond, Krginia
*
Division of Infectious Diseases, Box 49 MCV Station, Richmond, VA 23298
Get access Rights & Permissions [Opens in a new window]

Abstract

To identify predictors of infection in catheters used for total parenteral nutrition (TPN), clinical and microbiological data were prospectively collected on 169 catheter systems (88 patients). Based on semiquantitative catheter cultures, infection was associated with a positive insertion site skin culture taken close to the time of catheter removal (relative risk [RR] = 4.50), especially one yielding 250 colonies of an organism other than coagulase-negative staphylococci. Infection was also associated with erythema at the insertion site greater than 4 mm in diameter (RR = 2.93). In a subset of 67 catheters for which blood cultures were obtained, infection was also associated with a positive peripheral venous blood culture (RR = 5.90) and a positive central venous blood culture obtained through the catheter (RR = 5.44). Based on a logistic regression model, periodic cultures of the insertion site should be useful in evaluating subsequent fever in stable patients with indwelling central venous catheters. Another source of fever is likely if inflammation is absent and there is either no colonization or there is colonization by less than 50 colonies of coagulase-negative staphylococci at the insertion site. Conversely, the catheter should be removed and cultured semi-quantitatively if the site is colonized by an organism other than coagulase-negative staphylococci. We suggest that blood culture results add little to the risk estimate in these situations.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 11 , Issue 2 , February 1990 , pp. 71 - 78
Copyright
Copyright © The Society for Healthcare Epidemiology of America 1990

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1. Simmons, BP CDC guidelines for the prevention and control of nosocomial infections. Guideline for prevention of intravascular infections. Am J Infect Control. 1983;11:183–188.10.1016/0196-6553(83)90079-2CrossRefGoogle ScholarPubMed
2. Cunha, BA. Intravascular line infections. Infectious disease practice. 1985;8:1–7.Google Scholar
3. Pettigrew, RA, Lang, SDR, Haydock, DA, Parry, BR, Bremner, DA, Hill, GL. Catheter-related sepsis in patients on intravenous nutrition: a prospective study of quantitative catheter cultures and guidewire changes for suspected sepsis. Br J Surg. 1985;72:52–55.10.1002/bjs.1800720121Google Scholar
4. Wing, EJ, Norden, CW, Shadduck, RK, Winkelstein, K. Use of quantitative bacteriologic techniques to diagnose catheter-related sepsis. Arch intern Med. 1979;139:482–483.Google Scholar
5. Whimbey, E, Wang, B, Kiehn, TE, Armstrong, D. Clinical correlations of serial quantitative blood cultures determined by lysis-centrifugation in patients with persistent septicemia. J Clin Microbiol. 1984;19:766–771.CrossRefGoogle ScholarPubMed
6. Raucher, HS, Hyatt, AC, Barzilai, A, et al. Quantitative blood cultures in the evaluation of septicemia in children with Broviac catheters. J Pediatr. 1984;104:29–33.Google Scholar
7. Flynn, PM, Shenep, JL, Stokes, DC, Barrett, FF. In situ management of confirmed central venous catheter-related bacteremia. Pediatr Infect Dis J. 1987;6:729–734.10.1097/00006454-198708000-00007Google Scholar
8. Mosca, R, Curtas, S, Forbes, B, Meguid, MM. The benefits of isolator cultures in the management of suspected catheter sepsis. Surgery. 1987;102:718–723.Google ScholarPubMed
9. Armstrong, CW, Mayhall, CG, Miller, KB, et al. Prospective study of catheter replacement and other risk factors for infection of hyperalimentation catheters. J Infect Dis. 1986;154:808–816.Google Scholar
10. Maki, DG, Weise, CE, Sarafin, HW. A semiquantitative culture method for identifying intravenous-catheter-related infection. N Engl J Med. 1977;296:1305–1309.10.1056/NEJM197706092962301Google Scholar
11. National Committee for Clinical Laboratory Standards. Standard Methods for Dilution Antimicrobial Susceptibility Tests for Bacteria which Grow Aerobically. Approved standard, M7-A. Villanova, Pennsylvania: National Committee for Laboratory Standards; 1985.Google Scholar
12. Schlesselman, JJ. Case-Control Studies: Design, Conduct, Analysis. New York, Oxford: Oxford University Press; 1982:206.Google Scholar
13. Halperin, M, Blackwelder, WC, Verter, JI. Estimation of the multivariate logistic risk function: a comparison of the discriminant function and maximum log likelihood approaches. J Chronic Dis. 1971;24:125–158.10.1016/0021-9681(71)90106-8CrossRefGoogle Scholar
14. Sitges-Serra, A, Puig, P, Liñares, J, et al. Hub colonization as the initial step in an outbreak of catheter-related sepsis due to coagulase negative staphylococci during parenteral nutrition. JPEN. 1984;8:668–672.CrossRefGoogle Scholar
15. Liñares, J, Sitges-Serra, A, Garau, J, Perez, JL, Martin, R. Pathogenesis of catheter sepsis: a prospective study with quantitative and semi-quantitative cultures of catheter hub and segments. J Clin Microbiol. 1985;21:357–360.Google Scholar
16. Snydman, DR, Pober, BR, Murray, SA, Gorbea, HF, Majka, JA, Perry, LK. Predictive value of surveillance skin cultures in total-parenteral-nutrition-related infection. Lancet. 1982;2:1385–1388.CrossRefGoogle ScholarPubMed
17. Bjornson, HS, Colley, R, Bower, RH, Duty, VP, Schwartz-filton, JT, Fischer, JE. Association between microorganism growth at the catheter insertion site and colonization of the catheter in patients receiving total parenteral nutrition. Surgery. 1982;92:720–727.Google Scholar
18. Maki, DG, Jarrett, F, Sarafin, HW. A semiquantitative culture method for identification of catheter-related infection in the bum patient. J Surg Res. 1977;22:513–520.10.1016/0022-4804(77)90034-8Google Scholar
19. Pruitt, BA Jr McManus, WF, Kim, SH, et al. Diagnosis and treatment of cannula-related intravenous sepsis in burn patients. Ann Surg. 1980;191:546–554.10.1097/00000658-198005000-00005CrossRefGoogle ScholarPubMed
20. Plotkin, SA, Austrian, R. Bacteremia caused by Pseudomonas sp following the use of materials stored in solutions of a cationic surface-active agent. Am J Med Sci. 1958;235:621–627.Google Scholar
21. Dixon, RE, Kaslow, RA, Mackel, DC, et al. Aqueous quaternary ammonium antiseptics and disinfectants. Use and misuse. JAMA. 1976;236:2415–2417.Google Scholar
22. Frank, MJ, Schaffner, W. Contaminated aqueous benzalkonium chloride. An unnecessary hospital infection hazard. JAMA. 1976;236:2418–2419.Google Scholar
23. Cooper, GL, Hopkins, CC. Rapid diagnosis of intravascular catheter-associated infection by direct grain staining of catheter segments. N Engl J Med. 1985;312:1142–1147.Google Scholar
24. Maki, DG, Ringer, M. Evaluation of dressing regimens for prevention of infection with peripheral intravenous catheters. JAMA. 1987;258:2396–2403.10.1001/jama.1987.03400170082027Google Scholar
25. Prager, RL, Silva, J Jr. Colonization of central venous catheters. South Med J. 1984;77:458–461.10.1097/00007611-198404000-00012Google Scholar
26. Tonnesen, A, Peuler, M, Lockwood, WR. Cultures of blood drawn by catheters vs venipuncture. JAMA. 1976;235:1877.Google Scholar
27. Felices, FJ, Hernandez, JL, Ruiz, J, Mesegner, J, Gomez, JA, Molina, E. Use of the central venous pressure catheter to obtain blood cultures. Crit Care Med. 1979;7:78–79.CrossRefGoogle ScholarPubMed
28. Tafuro, P, Colbourn, D, Gurevich, I, et al. Comparison of blood cultures obtained simultaneously by venipuncture and from vascular lines. J Hosp infect. 1986;7:283–288.10.1016/0195-6701(86)90079-4Google Scholar
29. Bryant, J, Strand, CL. Reliability of blood cultures collected from intravascular catheter versus venipuncture. Am J Clin Pathol. 1987;88:113–116.Google Scholar
30. Snydman, DR, Murray, SA, Kornfeld, SJ, Majka, JA, Ellis, Ca. Total parenteral nutrition-related infections: prospective epidemiologic study using semiquantitative methods. Am J Med. 1982;73:695–699.Google Scholar