The challenge of anticipating catheter tip colonization in major heart surgery patients in the intensive care unit: Are surface cultures useful?
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2005
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Lippincott Williams and Wilkins
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Bouza, Emilio MD, PhD; Muñoz, Patricia MD, PhD; Burillo, Almudena MD, PhD; López-Rodríguez, Javier MD; Fernández-Pérez, Cristina MD, PhD; Pérez, María Jesús RN; Rincón, Cristina RN the Cardiovascular Infection Study Group. The challenge of anticipating catheter tip colonization in major heart surgery patients in the intensive care unit: Are surface cultures useful?. Critical Care Medicine 33(9):p 1953-1960, September 2005. | DOI: 10.1097/01.CCM.0000171842.63887.C1
Abstract
Este estudio prospectivo evalúa si los cultivos de vigilancia obtenidos de la piel en el punto de inserción del catéter y de los hubs (“surface cultures”) pueden predecir la colonización del catéter y el origen de las bacteriemias en pacientes sometidos a cirugía cardíaca mayor y monitorizados en una UCI especializada. Se analizaron 561 catéteres en 130 pacientes durante 11 meses, realizando más de 3.700 cultivos superficiales seriados. La colonización del catéter ocurrió en 23,7% de los casos y se registraron 15 episodios de bacteriemia relacionada con el catéter. Los cultivos superficiales mostraron alta sensibilidad y excelente valor predictivo negativo para descartar colonización y bacteriemia relacionada con el catéter, especialmente los cultivos de piel. Además, permitieron anticipar la aparición de bacteriemias y contribuir a determinar si el catéter era el origen de la infección. La vigilancia microbiológica sistemática de la piel y los hubs podría ayudar a implementar medidas de prevención y mejorar el manejo clínico de los pacientes de cirugía cardiaca en UCI.
Description
Objective:
Patients undergoing heart surgery show a high risk of catheter colonization and catheter-related bloodstream infections. We evaluated whether skin insertion site and catheter hub surveillance cultures (“surface cultures”) could predict catheter colonization and help establish the origin of bloodstream infections.
Design:
Prospective cohort study.
Setting:
An 11-bed heart surgery intensive care unit in a tertiary university hospital.
Patients:
Heart surgery patients spending >4 days in intensive care over an 11-month period.
Interventions:
All catheters were surveyed. Cultures were obtained from the skin insertion site and all hubs on day 5 after surgery, every 72 hrs thereafter, and on catheter removal. Swabs were processed semiquantitatively by streaking the surface of a Columbia agar plate. Catheters were processed using Maki’s method. The observation of ≥15 colonies/plate was taken to indicate a positive skin or catheter colonization culture result.
Measurements and Main Results:
Over the study period, 561 catheters were inserted in 130 patients. The median time a catheter was in place was 6 days (interquartile range 3–11), and 3,712 surface cultures were obtained (median four per patient). Catheter colonization occurred in 133 catheters, and there were 15 episodes of catheter-related bloodstream infection (incidence density of colonization 29.3 and of catheter-related bloodstream infection 8.8 per 1,000 catheter-days). Validity indexes for the capacity of surface cultures to predict catheter colonization and catheter-related bloodstream infection, respectively, were as follows: accuracy, 71.4, 65.6; sensitivity, 83.5%, 100%; specificity, 67.1%, 64.7%; positive predictive value, 47.6%, 7.2%; negative predictive value, 91.9%, 100%; positive likelihood ratio, 2.5, 2.83; and negative likelihood ratio, 0.2, 0. Surface cultures correctly predicted 77.4% of all bacteremia episodes (catheter-related and non-catheter-related).
Conclusions:
Systematic surveillance cultures of catheter hub and skin insertion sites in patients admitted to a heart surgery intensive care unit could help identify patients who would benefit from decontamination and preventive measures and establish whether catheters are the portal of entry of bloodstream infection.