Hostname: page-component-848d4c4894-pjpqr Total loading time: 0 Render date: 2024-07-04T12:07:22.945Z Has data issue: false hasContentIssue false
  • English
  • Français

Impact of Central Venous Catheter Removal on the Recurrence of Catheter-Related Coagulase-Negative Stahylococcal Bacteremia

Published online by Cambridge University Press:  21 June 2016

Issam Raad ,
Steve Davis ,
Asma Khan ,
Jeffrey Tarrand ,
Linda Elting  and
Gerald P. Bodey
Issam Raad*
Affiliation:
Section of Infectious Diseases, Department of Medical Specialties, The University of Texas MD Anderson Cancer Center, Houston, Texas
Steve Davis
Affiliation:
Section of Infectious Diseases, Department of Medical Specialties, The University of Texas MD Anderson Cancer Center, Houston, Texas
Asma Khan
Affiliation:
Section of Infectious Diseases, Department of Medical Specialties, The University of Texas MD Anderson Cancer Center, Houston, Texas
Jeffrey Tarrand
Affiliation:
Section of Infectious Diseases, Department of Medical Specialties, The University of Texas MD Anderson Cancer Center, Houston, Texas
Linda Elting
Affiliation:
Section of Infectious Diseases, Department of Medical Specialties, The University of Texas MD Anderson Cancer Center, Houston, Texas
Gerald P. Bodey
Affiliation:
Section of Infectious Diseases, Department of Medical Specialties, The University of Texas MD Anderson Cancer Center, Houston, Texas
*
Section of Infectious Diseases (Box 47), UT MD Anderson Cancer Center, 1515 Holcombe Blvd., Houston, TX 77030
Get access Rights & Permissions [Opens in a new window]

Abstract

Objective:

To determine the impact of catheter management on the acute and long-term outcome of catheter-related coagulase-negative staphylococcal bacteremia.

Design:

Retrospective surveillance of catheter-related sepsis using quantitative blood and catheter cultures.

Setting:

University-affiliated tertiary cancer center.

Patients and Methods:

seventy patients with catheter-related coagulase-negative staphylococcal bacteremia were studied by retrospective chart review. The clinical characteristics of the patients and the management of the bacteremias were determined. The impact of immuno-suppressive risk factors, antibiotic therapy, and catheter management on the recurrence of the bacteremia was investigated.

Results:

Acute sepsis-related morbidity and mortality were not related to catheter management. However, during a 12-week followup period, the bacteremia recurred in 20% of the patients whose catheters remained in place, compared with only 3% of those whose catheters were removed (p<.05). By multivariate analysis, patients whose catheters remained in place were 2.9 times more likely to experience a recurrence than those whose catheters were removed (odds ratio = 2.9, 95% confidence interval = 1.2-8.8, p= .03). All other potential risk factors were equally distributed between patients, with and without a recurrence.

Conclusions:

Although patients with catheter-related coagulase-negative staphylococcal bacteremia could be treated successfully while the catheter remains in place with the majority remaining free of recurrence, catheter retention results in a significantly higher risk for the recurrence of the bacteremia.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 13 , Issue 4 , April 1992 , pp. 215 - 221
Copyright
Copyright © The Society for Healthcare Epidemiology of America 1992

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. Maki, DG, Weise, CE, Sarafin, HW. A semiquantitative culture method for identifying intravenous catheter-related infection. N Engl J Med. 1977;296:1305–1309.CrossRefGoogle ScholarPubMed
2. Collignon, PG, Soni, N, Pearson, IY, Woods, WP, Munro, R, Sorrell, TC. Is semiquantitative culture of central vein catheter tips useful in the diagnosis of catheter-associated bacteremia? J Clin Microbiol. 1986;24:532–535.CrossRefGoogle ScholarPubMed
3. Bjornson, HS, Colley, R, Bower, RH, Duty, VP, Schwartz-Fulton, JT, Fisher, JE. Association between microorganism growth at the catheter insertion site and colonization of the catheter in patients receiving total parenteral nutrition. Surgery. 1982;92:720–726.Google ScholarPubMed
4. Sherertz, RJ, Raad, II, Balani, A, et al. Three-year experience with sonicated vascular catheter cultures in a clinical microbiology laboratory. J Clin Microbiol. 1990;28:76–82.CrossRefGoogle Scholar
5. Cleri, DJ, Corrado, ML, Seligman, SJ. Quantitative culture of intravenous catheters and other intravascular inserts. J Infect Dis. 1980;141:781–786.CrossRefGoogle ScholarPubMed
6. Andremont, A, Paulet, R, Nitenberg, G, Hill, C. Value of semiquantitative cultures of blood drawn through catheter hubs for estimating the risk of catheter tip colonization in cancer patients. J Clin Microbiol. 1988;26:2297–2299.CrossRefGoogle ScholarPubMed
7. Moyer, MA, Edwards, JD, Farley, L. Comparative culture methods on 101 intravenous catheters. Arch Intern Med. 1983;143:66–69.CrossRefGoogle ScholarPubMed
8. Jones, PG, Hopfer, RL, Elting, L, Jackson, JA, Fainstein, V, Bodey, GP. Semiquantitative cultures of intravascular catheters from cancer oatients. Diasn Microbiol Infect Dis. 1986;4:299–306.CrossRefGoogle Scholar
9. Linares, J, Sitges-Serra, A, Garau, J, Perez, JL, Martin, R. Pathogenesis of catheter sepsis: a prospective study with quantitative and semiquantitative cultures of catheter hub and segments. J Clin Microbiol. 1985;21:357–360.CrossRefGoogle ScholarPubMed
10. Collignon, P, Chan, R, Munro, R. Rapid diagnosis of intravascular catheter-related sepsis. Arch Intern Med. 1987;147:1609–1612.CrossRefGoogle ScholarPubMed
11. Maki, DG, Goldmann, DA, Rhame, FS. Infection control in intravenous therapy. Ann Intern Med. 1973;79:867–887.CrossRefGoogle ScholarPubMed
12. Ryan, JA, Abel, RM, Abbott, WM, et al. Catheter complications in total parenteral nutrition: a prospective study of 200 consecutive patients. N Engl JMed. 1974;290:757–761.CrossRefGoogle ScholarPubMed
13. Pollack, PF, Kadder, M, Byrne, WJ, et al. One hundred patient years’ experience with the Broviac silastic catheter for central venous nutrition. JPEN. 1981;5:32–36.CrossRefGoogle Scholar
14. Ladefoged, K, Efsen, F, Christoffersen, JK, et al. Long-term parenteral nutrition II catheter related complications. Scand J Gastroenterol. 1981;16:913–919.CrossRefGoogle ScholarPubMed
15. Riella, MC, Scribner, BH. Five years experience with a right atrial catheter for prolonged parenteral nutrition at home. Surg Gynecol Obstet. 1976;143:205–208.Google ScholarPubMed
16. Abrahm, JL, Mullen, JL. A prospective study of prolonged central venous access in leukemia. JAMA. 1982;248:2868–2873.CrossRefGoogle ScholarPubMed
17. Wang, EEL. Prober, CG, Ford-Jones, L, Gold, R. The management of central intravenous catheter infections. Adiatr Infect Dis. 1984;3:110–113.CrossRefGoogle ScholarPubMed
18. Hiemenz, J, Skelton, J, Pizzo, PA. Perspective on the management of catheter-related infections in cancer patients. Pediatr Infect Dis. 1986;5:6–11.CrossRefGoogle ScholarPubMed
19. Sadiq, HE, Devaskar, S, Keenan, WJ, Weber, TR. Broviac catheterization in low birth weight infants: incidence and treatment of associated complications. Crit Care Med. 1987;15:47–50.CrossRefGoogle ScholarPubMed
20. Benezra, D, Kiehn, TE, Gold, JWM. Brown, AE, Turnbull, ADM. Armstrong, D. Prospective study of infections in indwelling central venous catheters using quantitative blood cultures. Am J Med. 1988;85:495–498.CrossRefGoogle ScholarPubMed
21. Flynn, PM, Shenep, JL, Barrett, FE. Differential quantitation with a commercial blood culture tube for diagnosis of catheter-related infection. J Clin Microbiol. 1988;26:1045–1046.CrossRefGoogle ScholarPubMed
22. Collins, RN, Braun, PA, Zinner, SH, et al. Risk of local and systemic infection with polyethylene intravenous catheters. N Engl J Med. 1968;279:340–343.CrossRefGoogle ScholarPubMed
23. McGowan, JE, Barnes, MW, Finland, M. Bacteremia at Boston City Hospital: occurrence and mortality during 12 selected years (1935-1972), with special reference to hospital acquired cases. J Infect Dis. 1975;132:316–335.CrossRefGoogle ScholarPubMed
24. Setia, U, Gross, PA. Bacteremia in a community hospital. Arch Intern Med. 1977;137:1698–1701.CrossRefGoogle Scholar
25. Wade, JC, Schimpff, SC, Newman, KA, Wiernik, PH. Staphylococcus epidermidis: an increasing cause of infection in patients with granulocytopenia. Ann Intern Med. 1982;97:503–508.CrossRefGoogle ScholarPubMed
26. 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.CrossRefGoogle ScholarPubMed
27. Flynn, PM, Shenep, JL, Stokes, DC, Barrett, FE. In situ management of confirmed central venous catheter-related bacteremia. Pediatr Infect Dis J. 1987;6:729–734.CrossRefGoogle ScholarPubMed
28. 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
29. Armstrong, CW, Mayhall, G, Miller, KB, et al. Clinical predictors of infection of central venous catheters used for total parenteral nutrition. Infect Control Hosp Epidemiol. 1990;11:71–78.CrossRefGoogle ScholarPubMed
30. Martin, MA, Pfaller, MA, Wenzel, RP. Coagulase-negative staphylococcal bacteremia: mortality and hospital stay. Ann Intern Med. 1989;110:9–16.CrossRefGoogle ScholarPubMed
31. Johnson, PR, Decker, MD, Edwards, KM, Schaffner, W, Wright, PE. Frequency of Broviac catheter infections in pediatric oncology patients. J Infect Dis. 1986;154:570–578.CrossRefGoogle ScholarPubMed
32. Davenport, DS, Massanari, RM, Pfaller, MA, et al. Usefulness of a test for slime production as a marker for clinically significant infections with coagulase-negative staphylococci. J Infect Dis. 1986;153:332–339.CrossRefGoogle ScholarPubMed
33. Sheth, NK, Franson, TR, Sohnle, PG. Influence of bacterial adherence to intravascular catheters on in vitro antibiotic susceptibility. Lancet. 1985;ii:1266—1268.Google Scholar
34. Farber, BE, Kaplan, MH, Clogston, AG. Staphylococcus epidermidis extracted slime inhibits the antimicrobial action of glycopeptide antibiotics. J Infect Dis. 1990;161:37–40.CrossRefGoogle ScholarPubMed
35. Davis, S, Raad, I, Umphrey, J, Getz, K, Khan, A, Tejani, N, Bodey, Gl? Low infection rate and high durability of central venous catheters (CVC) in cancer patients. Presented at the 91st Annual Meeting of the American Society for Microbiology May 5-9, 1991. Dallas, Texas.Google Scholar
36. Pettigrew, RA, Lang, SDR. Haydock, DA, Parry, BR, Bremner, DA, Efill, CL. 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.CrossRefGoogle ScholarPubMed
37. Powell, C, Kudsk, KA, Kulich, PA, Mandelbaum, JA, Fabri, PJ. Effect of frequent guidewire changes on triple-lumen catheter sepsis. JPEN. 1988;12:462–464.CrossRefGoogle ScholarPubMed
38. High, KP, Cobb, DK, Sable, CA, et al. A randomized controlled trial of scheduled central venous catheter (CVC) replacement. Presented at the 30th Interscience Conference on Antimicrobial Agents and Chemotherapy. October 21-24, 1990. Atlanta, Ga.Google Scholar