Hostname: page-component-848d4c4894-tn8tq Total loading time: 0 Render date: 2024-07-07T20:01:43.007Z Has data issue: false hasContentIssue false
  • English
  • Français

Microbiology and Risk Factors for Catheter Exit-Site and -Hub Colonization in Neonatal Intensive Care Unit Patients

Published online by Cambridge University Press:  02 January 2015

Ludo M. Mahieu ,
Jozef J. De Dooy ,
Aimé O. De Muynck ,
Guillaume Van Melckebeke ,
Margareta M. Ieven  and
Patrick J. Van Reempts
Ludo M. Mahieu*
Affiliation:
Departments of Pediatrics, Institute of Tropical Medicine, Antwerp, Belgium
Jozef J. De Dooy
Affiliation:
Departments of Pediatrics, Institute of Tropical Medicine, Antwerp, Belgium
Aimé O. De Muynck
Affiliation:
Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
Guillaume Van Melckebeke
Affiliation:
Departments of Pediatrics, Institute of Tropical Medicine, Antwerp, Belgium
Margareta M. Ieven
Affiliation:
Division of Neonatology, and Clinical Microbiology, University Hospital of Antwerp, Institute of Tropical Medicine, Antwerp, Belgium
Patrick J. Van Reempts
Affiliation:
Departments of Pediatrics, Institute of Tropical Medicine, Antwerp, Belgium
*
Department of Pediatrics, Division of Neonatology, University Hospital of Antwerp, Wilrijkstraat 10, B-2650 Antwerp, Belgium
Get access Rights & Permissions [Opens in a new window]

Abstract

Objective:

To identify risk factors and describe the microbiology of catheter exit-site and hub colonization in neonates.

Design:

During a period of 2 years, we prospectively investigated 14 risk factors for catheter exit-site and hub colonization in 862 central venous catheters in a cohort of 441 neonates. Cultures of the catheter exit-site and hub were obtained using semiquantitative techniques at time of catheter removal.

Setting:

A neonatal intensive care unit at a university hospital.

Results:

Catheter exit-site colonization was found in 7.2% and hub colonization in 5.3%. Coagulase-negative staphylococci were predominant at both sites. Pathogenic flora were found more frequently at the catheter hub (36% vs 14%; P<.05). Through logistic regression, factors associated with exit-site colonization were identified as umbilical insertion (odds ratio [OR], 8.1; 95% confidence interval [CI95], 2.35-27.6; P<.001), subclavian insertion (OR, 54.6; CI95, 12.2-244; P<.001), and colonization of the catheter hub (OR, 8.9; CI95,3.5-22.8; P<.001). Catheter-hub colonization was associated with total parenteral nutrition ([TPN] OR for each day of TPN, 1.056; CI95,1.029-1.083; P<.001) and catheter exit-site colonization (OR, 6.11; CI95, 2.603-14.34; P<.001). No association was found between colonization at these sites and duration of catheterzation and venue of insertion, physician's experience, postnatal age and patient's weight, ventilation, steroids or antibiotics, and catheter repositioning.

Conclusion:

These data support that colonization of the catheter exit-site is associated with the site of insertion and colonization of the catheter hub with the use of TPN. There is a very strong association between colonization at both catheter sites.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 22 , Issue 6 , June 2001 , pp. 357 - 362
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2001

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.Gladstone, IM, Ehrenkranz, RA, Edberg, SC, Baltimore, RS. A ten-year review of neonatal sepsis and comparison with the previous fifty-year experience. Pediatr Infect Dis J 1990;9:819–825.CrossRefGoogle ScholarPubMed
2.Leroyer, A, Bedu, A, Lombrail, P, Desplanques, L, Diakite, B, Bingen, E, et al. Prolongation of hospital stay and extra costs due to hospital-acquired infection in a neonatal unit. J Hosp Infect 1997;35:37–45.Google Scholar
3.Gaynes, RP, Edwards, JR, Jarvis, WR, Culver, DH, Tolson, JS, Martone, WJ. Nosocomial infections among neonates in high-risk nurseries in the United States. Pediatrics 1996;98:357–361.Google Scholar
4.Fan, ST, Teoh-Chan, CH, Lau, KF, Chu, KW, Kwan, AK, Won, KK. Predictive value of surveillance skin and hub cultures in central venous catheter sepsis. J Hosp Infect 1988;12:191–198.Google Scholar
5.Mahieu, LM, De Muynck, AO, De Dooy, JJ, Laroche, SM, Van Acker, KJ. Prediction of nosocomial sepsis in neonates by means of a computer-weighted bedside scoring system (NOSEP score). Crit Care Med 2000;28:2026–2033.CrossRefGoogle ScholarPubMed
6.Mueller-Premru, M, Gubina, M, Kaufmann, ME, Primozic, J, Cookson, BD. Use of semi-quantitative and quantitative culture methods and typing for studying the epidemiology of central venous catheter-related infections in neonates on parenteral nutrition. J Med Microbiol 1999;48:451–60.Google Scholar
7.Ieven, M, Verhoeven, J, Pattyn, SR, Goossens, H. Rapid and economical method for species identification of clinically significant coagulase-negative staphylococci. J Clin Microbiol 1995;33:1060–1063.Google Scholar
8.Salzman, MB, Isenberg, HD, Shapiro, JF, Lipsitz, PJ, Rubin, LG. A prospective study of the catheter hub as the portal for entry of microorganisms causing catheter-related sepsis in neonates. J Infect Dis 1993;167:487–490.CrossRefGoogle ScholarPubMed
9.Freeman, J. Goldmann, A, Smith, NE, Sidebottom, DG, Epstein, MF, Platt, R. Association of intravenous lipid emulsion and coagulase-negative staphylococcal bacteremia in neonatal intensive care units. N Engl J Med 1989;323:301–308.CrossRefGoogle Scholar
10.Snydman, DR, Murray, SA, Kornfeld, SJ, Majka, JA. Ellis, CA. Total parenteral nutrition-related infections. Am J Med 1982;73:695–699.CrossRefGoogle ScholarPubMed
11.Sitges Serra, A, Linares, J, Pérez, JL, Jaurrieta, E, Lorente, L. A randomized trial on the effect of tubing changes on hub contamination and catheter sepsis during parenteral nutrition. JPEN J Parenter Enteral Nutr 1985;9:322–325.CrossRefGoogle ScholarPubMed
12.Maas, A, Flament, P, Pardou, A, Deplano, A, Dramaix, M, Struelens, MJ. Central venous catheter-related bacteraemia in critically ill neonates: risk factors and impact of a prevention programme. J Hosp Infect 1998;40:211–24.CrossRefGoogle ScholarPubMed
13.Kacica, MA, Horgan, MJ, Ochoa, L, Sandler, R, Lepow, ML, Venezia, RA. Prevention of gram-positive sepsis in neonates weighing less than 1500 grams. J Pediatr 1994;125:253–258.CrossRefGoogle ScholarPubMed
14.Mahieu, LM, De Muynck, AO, Ieven, MM, De Dooy, JJ, Goossens, H, Van Acker, K, et al. Risk factors for central vascular-related bloodstream infections among neonates in a high-risk nursery. J Hosp Infect 2001;48:20–26.CrossRefGoogle Scholar
15.Atela, I, Coll, P, Rello, J, Quintana, E, Barrio, J, March, F, et al. Serial surveillance cultures of skin and catheter hub specimens from critically ill patients with central venous catheters: molecular epidemiology and implications for management and research. J Clin Microbiol 1997;35:1784–1790.Google Scholar
16.Raad, II. The pathogenesis of central venous catheter-related infections. Middle East J Anesthesiol 1994;12:381–403.Google ScholarPubMed
17.Goldmann, DA. The bacterial flora of neonates in intensive care-monitoring and manipulation. J Hosp Infect 1988;11(suppl A):340–351.Google Scholar
18.Bertone, SA, Fisher, MC, Mortensen, JE. Quantitative skin cultures at potential catheter sites in neonates. Infect Control Hosp Epidemiol 1994;15:315–318.Google Scholar
19.Chathas, MK, Paton, JB, Fisher, DE. Percutaneous central venous catheterization. Three years' experience in a neonatal intensive care unit. Am J Dis Child 1990;144:1246–1250.Google Scholar
20.Valvano, MA, Hartstein, AI, Morthland, VH, Dragoon, ME, Potter, SA, Reynolds, JW, et al. Plasmid DNA analysis of Staphylococcus epidermidis isolated from blood and colonization cultures in very low birth weight neonates. Pediatr Infect Dis J 1988;7:116–120.CrossRefGoogle ScholarPubMed
21.Gladstone, IM, Clapper, L, Thorp, JW, Wright, DI. Randomized study of six umbilical cord care regimens. Comparing length of attachment, microbial control, and satisfaction. Clin Pediatr (Phila) 1988;27:127–129.Google Scholar
22.Douard, MC, Clementi, E, Arlet, G, Marie, O, Schremmer, B, Rouveau, M, et al. Negative catheter-tip culture and diagnosis of catheter-related bacteremia. Nutrition 1994;10:397–404.Google Scholar