Hostname: page-component-8448b6f56d-wq2xx Total loading time: 0 Render date: 2024-04-19T01:53:41.657Z Has data issue: false hasContentIssue false
  • English
  • Français

Quantitative Skin Cultures at Potential Catheter Sites in Neonates

Published online by Cambridge University Press:  02 January 2015

Susan A. Bertone ,
Margaret C. Fisher  and
Joel E. Mortensen
Susan A. Bertone
Affiliation:
Thomas Jefferson University, Temple University School of Medicine, St. Christopher's Hospital for Children, Philadelphia, Pennsylvania
Margaret C. Fisher*
Affiliation:
Thomas Jefferson University, Temple University School of Medicine, St. Christopher's Hospital for Children, Philadelphia, Pennsylvania
Joel E. Mortensen
Affiliation:
Thomas Jefferson University, Temple University School of Medicine, St. Christopher's Hospital for Children, Philadelphia, Pennsylvania
*
Section of infectious Diseases, St. Christopher's Hospital for Children, Erie Ave. at Front St., Philadelphia, PA 19134
Get access Rights & Permissions [Opens in a new window]

Abstract

Objective:

To identify and quantify the bacterial and fungal flora present at body sites used for vascular catheterization of infants in a neonatal intensive care unit.

Design:

Quantitative skin cultures were obtained from a group of neonatal patients to determine the bacterial flora found on the skin at four sites. Quantitative cultures of the jugular, subclavian, umbilical, and femoral sites were obtained on 50 infants, ranging in age from 2 days to 3 months old.

Setting:

The neonatal intensive care unit of St. Christopher's Hospital for Children, a university-affiliated tertiary care children's hospital.

Results:

Colony counts ranged from 0 to 106 colony-forming units/ 10 cm2. Types of organisms found were consistent with other published studies and included coagulase-negative staphylococci, Staphylococcus aureus, yeast, aerobic gram-negative rods, Enterococcus species, Corynebacterium species, and alpha-hemolytic streptococci. There was a significantly higher mean colony count at the combined jugular/femoral sites versus the subclavian site (P<0.01) and umbilical site (P<0.05). Mean colony counts did not differ significantly between the jugular and femoral site, or between the subclavian and umbilical site. The umbilical site was more likely to be colonized with aerobic gram-negative rods, Enterococcus species, and yeast, while the subclavian had coagulase-negative staphylococci as the predominant organism. The jugular and femoral sites demonstrated a higher colony count of aerobic gram-negative rods, Enterococcus species and yeast than the other sites.

If central venous catheters need to be in place for extended periods of time, placement at a site with lower bacterial densities on the skin may help minimize catheter-associated infections. This study supports the subclavian as the preferred site.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 15 , Issue 5 , May 1994 , pp. 315 - 318
Copyright
Copyright © The Society for Healthcare Epidemiology of America 1994

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.Garland, JS, Nelson, DB, Cheah, T, Hennes, HH, Johnson, TM. Infectious complications during peripherial intravenous therapy with teflon catheters; a prospective study. Pediatr Infect Dis J 1987;6:918–921.Google Scholar
2.Maki, DG. Infection caused by intravascular devices: pathogenesis, strategies for prevention. Improving catheter site care 1991. Royal Society of Medicine Services International Congress and Symposium Series no. 179:3–27.Google Scholar
3.Doering, RB, Stemmer, EA, Connolly, JE. Complications of indwelling venous catheters. Am J Surg 1967;114:259–266.Google Scholar
4.Bently, DW, Lepper, MH. Septicemia related to indwelling venous catheter. JAMA 1968;206:1749–1752.Google Scholar
5.Maki, DG, Ringer, M. Evaluation of dressing regimens for prevention of infection with peripheral intravenous cathethers. JAMA 1987;258:2396–2402.Google Scholar
6.Ducharme, FM, Gauthier, M, LaCroix, J, Lafleur, L. Incidence of infection related to arterial catheterization in children: a prospective study. Crit Care Med 1988;16:272–276.Google Scholar
7.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;92:720–727.Google Scholar
8.Haslett, TM, Isenberg, HD, Hilton, E, Tucci, V, Kay, BG, Vellozzi, EM. Microbiology of indwelling central intravascular catheters. J Clin Microbial 1988;26:696–701.Google Scholar
9.Linares, J, Sitges-Serra, A, Garau, J, Perez, JL, Martin, R. Pathogenesis of catheter sepsis: a prospective study with quantitive and semiquantitive cultures of catheter hub and segments. J Clin Microbiol 1985;21:357–360.Google Scholar
10.Maki, DG. Infections due to infusion therapy. In: Bennett, JV, Brachman, PS, eds. Hospital Infections. 3rd ed. Boston, MA: Little Brown and Company Inc; 1992;849–898.Google Scholar
11.Cronin, WA, Germanson, TP, Donowitz, LG. Intravascular catheter colonization and related bloodstream infection in critically ill neonates. Infect Control Hosp Epidemiol 1990;11:301–308.Google Scholar
12.Hartman, GE, Shochat, SJ. Management of septic complications associated with silastic catheters in childhood malignancy. Pediatr Infect Dis J 1987;6:1042–1047.Google Scholar
13.Marcoux, C, Fisher, S, Wong, D. Central venous access devices in children. Pediatr Nursing 1990;16:123–133.Google Scholar
14.Wenzel, RI? Infection control priorities in critical care medicine: deviceassociated intravascular infection. In: Lennette, EH, Balows, A, Hausler, WJ, Shadomy, HJ, eds. A Manual of Clinical Microbiology. 4th ed. Washington, DC: American Society for Microbiology; 1985:123–128.Google Scholar
15.Tipple, MA, Jarvis, WR. Martone, WI. Bacteremia and fungemia. In: Donowitz, LG, ed. hospital-Acquired Infection in the Pediatric Patient. Baltimore, MD: Williams&Wilkins; 1988:3–16.Google Scholar
16.Maki, DG. Marked differences in skin colonization of insertion sites for central venous, arterial and peripheral intravenous catheters. The major reason for differing risks of catheter-related infection. Presented at the 30th Interscience Conference on Antimicrobial Agents and Chemotherapy; October 21-24 1990; Atlanta, GA. Abstract 712.Google Scholar
17.Balow, A, Hausler, W, Hermann, KL, Isenberg, HD, Shadony, HJ, eds. A Manual of Clinical Microbiology. 5th ed. Washington, DC. American Society for Microbiology; 1991.Google Scholar
18.National Committee for Clinical Laboratory Standards. Methods for Dilution Antimicrobial Susceptibility Tests for Bacteria That Grow Aerobically. 2nd ed. Villanova, PA: NCCLS, Document M7-A2; 1990.Google Scholar
19.Price, PB. The bacteriology of normal skin, a new quantitative test applied to study of the bacterial flora and the disinfectant action of mechanical cleansing. J Infect Dis 1983;63:301–318.Google Scholar
20.LaRocco, M, Dorenbaum, A, Robinson, A, Pickering, L. Recovery of Mulussezia pachydemzatis from eight infants in a neonatal intensive care nursing: clinical and laboratory features. Pediatr Infect Dis J 1988;7:398–401.Google Scholar
21.Powell, DA, Hayes, J, Durrell, DE, Miller, M, Marcon, MJ. Malassezia furfur skin colonization of infants hospitalized in intensive care inits. J Pediatr 1987;111:217–220.Google Scholar
22.Teglia, O, Schoch, PE. Cunha, BA. Malassezia furfur infections. Infect Control Hosp Epidemol 1991;12:676–681.Google Scholar
23.Maki, DG. Nosocomial bacteremia, an epidemiologic overview. In: Dixon, RE, ed. Nosocomial Infections. 2nd ed. New York, NY: York Medical Books; 1981:183–200.Google Scholar
24.Maki, DG. Infections associated with intravascular lines. In: Remington, JS, Swartz, MN eds. Current Clinical Topics in Infectious Diseases. Vol. 3. New York, NY: McGraw-Hill Book Company; 1982:309–362.Google Scholar
25.Wenzel, RP. Bloodstream and IV-related infections. Prevention and Control of Nosocomia1 Infections. Baltimore, MD: Williams & Wilkins; 1987.Google Scholar