A prospective study of central venous catheter colonization and catheter-related bloodstream infection in an intensive care unit including ecocardiographic follow-up after catheter removal

Natalia Hagău¹, M.Flonta², Adriana Slavcovici², Daniela Studnicska¹, Simona Cocu¹, Monica Mleşniţe¹, Rodica Găvruş¹, Carmen Laslo¹
1) Secţia Anestezie Terapie Intensivă nr.1, Spitalul Clinic Judeţean de Urgenţă Cluj; 2 )Spitalul Clinic de Boli Infecţioase Cluj

Abstract

Aim. We wanted to assess the incidence of central venous catheter (CVC) colonization and infection in our intensive care unit (ICU) population and to perform the echocardiographic follow-up of the patients with positive catheter tip culture results.

Material and methods. This is an epidemiologic prospective study. Data were collected over a period of 10 months from an adult 20 beds surgical-medical ICU, at the university teaching hospital. All ICU patients who required CVC placement for 48 hours were included in the study. Double and triple lumen catheters in the subclavian (SC) and internal jugular (IJ) sites, were used. After their removal, the tips of the catheters were cultured by two methods: semiquantitative and quantitative techniques. Peripheral blood cultures were also obtained at the time of catheter removal. The catheter infection and colonization rate were expressed in terms of cumulative incidences and incidence densities. The Kaplan-Meier test was used to compare the risk of positive quantitative culture (PQC) over time between SC and IJ catheters. The catheter infections were treated; catheter colonizations were not treated. All the patients with PQC results were assigned to undergo echocardiography examination 28 days after catheter removal.

Results and discussions. A total of 85 CVC and 749 catheter days in 59 patients were studied. The cumulative incidence of catheter infection was 8.24% and the incidence density was 9.3. The cumulative incidence of catheter colonization was 25.88% and the incidence density was 29.3. There was no statistically significant difference in the incidence of infection and colonization during the time between the SC and IJ catheters (p = 0.24). All patients with PQC and echocardiographic follow-up were free of valvular infections.

Conclusions. In our ICU population the incidence of CVC infection was close to the top limit stated by the American National Nosocomial Infections Surveillance, with no difference between SC and JI sites. All patients with PQC, treated or not, were free of valvular infections.

Keywords: nosocomial infections, central venous catheter, catheter-related bloodstream infections

Studiu prospectiv al colonizării şi infecţiei de cateter venos central într-o unitate de terapie intensivă. Evaluare ecocardiografică a pacienţilor cu catetere pozitive

Jurnalul Român de Anestezie Terapie intensivă 2006 Vol.13 Nr.2, 85-88