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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dc.contributor.authorBouza Santiago, Emilio
dc.contributor.authorMuñoz García, Patricia Carmen
dc.contributor.authorBurillo Albizua, Almudena
dc.contributor.authorLópez Rodríguez, Javier
dc.contributor.authorFernández Pérez, Cristina
dc.contributor.authorPérez, María Jesús
dc.contributor.authorRincón, Cristina
dc.date.accessioned2025-11-18T08:07:32Z
dc.date.available2025-11-18T08:07:32Z
dc.date.issued2005-09-01
dc.descriptionObjective: 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.
dc.description.abstractEste 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.
dc.description.departmentDepto. de Medicina
dc.description.facultyFac. de Medicina
dc.description.refereedTRUE
dc.description.sponsorshipRed Española de Investigación en Patología Infecciosa (REIPI-C03/14); Proyecto PI-021049 (Fondo de Investigación Sanitaria, FIS, España)
dc.description.sponsorshipMinisterio de Economía, Comercio y Empresa (España)
dc.description.statuspub
dc.identifier.citationBouza, 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
dc.identifier.doi10.1097/01.CCM.0000171842.63887.C1
dc.identifier.essn1530-0293
dc.identifier.issn1530-0293
dc.identifier.officialurlhttps://doi.org/10.1097/01.CCM.0000171842.63887.C1
dc.identifier.relatedurlhttps://journals.lww.com/ccmjournal/abstract/2005/09000/the_challenge_of_anticipating_catheter_tip.9.aspx
dc.identifier.urihttps://hdl.handle.net/20.500.14352/126158
dc.issue.number9
dc.journal.titleCritical Care Medicine
dc.language.isoeng
dc.page.final1960
dc.page.initial1953
dc.publisherLippincott Williams and Wilkins
dc.relation.projectIDREIPI-C03/14
dc.relation.projectIDPI-021049
dc.rights.accessRightsrestricted access
dc.subject.cdu616.98
dc.subject.cdu616.1-089.843
dc.subject.cdu617.58-089.168
dc.subject.cdu614.2
dc.subject.ucmMedicina
dc.subject.unesco32 Ciencias Médicas
dc.titleThe challenge of anticipating catheter tip colonization in major heart surgery patients in the intensive care unit: Are surface cultures useful?
dc.typejournal article
dc.type.hasVersionVoR
dc.volume.number33
dspace.entity.typePublication
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relation.isAuthorOfPublication057f539e-41b0-4a1e-b97b-204a23ead398
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relation.isAuthorOfPublication.latestForDiscovery617e0427-008c-4911-8a51-5c307739f9cf

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