A New Approach to the Diagnosis of Central Venous Catheter Sepsis

Abstract

One hundred forty-four cancer patients harboring a central venous catheter (CVC) were prospectively investigated to assess the relationship between hub culture, clinical assessment of sepsis before removal, and CVC sepsis. In 22 patients, the CVC was removed because of clinical assessment of catheter sepsis expressed by the staff prior to the removal. For each CVC removal, peripheral blood (qualitative method), hub, and CVC tip (quantitative method) cultures were performed. Clinical sepsis (disappearance of fever after CVC removal) was observed in 13 patients, microbiologic "sepsis" (identification of the same microorganisms on the CVC tip and in the peripheral blood) in seven patients, and clinical and/or microbiologic sepsis in 16 patients. Staphylococcus epidermidis was the microorganism most frequently identified. Hub culture was negative in 48% and positive for a low number and a high number of colonies in 35% and 17%, respectively. The predictive value of hub culture was 96% when testing negative and 8% and 37% (p = 3 x 10^-3) when testing positive for a low and a high number of colonies, respectively. Predictive values of clinical assessment were 55% if positive and 97% if negative. Combining hub cultures and clinical assessment, the risk of sepsis varied from 2% with both evaluations negative to 89% in the case of positive clinical assessment associated with positive high-count hub. Inasmuch as the CVCs used have a disposable hub, it is possible to have an accurate diagnosis of CVC sepsis without removing the CVC. (Journal of Parenteral and Enteral Nutrition 15:412-416, 1991)

Get full access to this article

View all access options for this article.

References

Padberg FT Jr , Ruggiero J. , Blackburn GL , et al: Central venous catheterization for parenteral nutrition. Ann Surg 193:264-270, 1983

Ryan JA , Abel RM , Abbott WM , et al: Catheter complications in parenteral nutrition. N Engl J Med 290:757-761, 1974

Bjornson HS , Colley RN , Bower RH , et al: Association between micro-organism growth of catheter insertion site and colonization of the catheters in patients receiving total parenteral nutrition. Surgery 92:720-727. 1982

Snydman D. , Pober B. Murray S. , et al: Predictive value of surveillance skin cultures in total parenteral nutrition-related infection. Lancet 2:1385-1388, 1982

Bozzetti F. , Terno G. Bonfanti G. et al: Blood culture as a guide for the diagnosis of central venous catheter sepsis. JPEN 8:396-398, 1983

Bozzetti F. Terno G. Camerini E. et al: Pathogenesis and predictabiliy of central venous catheter sepsis . Surgery 91:383-389, 1982

Maki DG , Weise CE , Sarafin HW : A semiquantitative culture method for identifying intravenous-catheter-related infection. N Engl J Med 298:1305-1308, 1977

Cleri DJ , Corrado ML , Seligman SJ : Quantitative culture of intravenous catheters and other intravascular inserts . J Infect Dis 141:781-786, 1980

Belani AK , Sherertz RJ , Koo LC , et al: Sonification as a method of quantitative catheter culture (abstract L2). Abstracts of the Annual Meeting of the American Society for Microbiology, 1985, p 379

10.

Cooper GL , Hopkins CC : Rapid diagnosis of intravascular catheter-associated infection by direct Gram staining of catheter segments. N Engl J Med 312:1142-1147, 1985

11.

Mosca R. , Curtas S. , Forbes B. , et al: The benefits of Isolator cultures in the management of suspected catheter sepsis. Surgery 102:718-723, 1985

12.

Sitges-Serra A. , Puig P. , Linares J. , et al: Hub colonization as the initial step in an outbreak of catheter-related sepsis due to coagulase negative staphylococci during parenteral nutrition. JPEN 8:668-672, 1984

13.

Body JJ , Lemaire A. , Pascual-Lopez A. , et al: Bacteriological monitoring during parenteral nutrition in cancer patients: Usefulness of weekly blood cultures performed through the catheter (abstr). 7th ESPEN Congress, Munich, 1985. Clin Nutr 4:65, 1985

14.

Ponting GA , Stotter AT , Waterfield AH , et al: The diagnosis of catheter sepsis using drawback and peripheral cultures (abstr). 7th ESPEN Congress, Munich, 1985. Clin Nutr 4:66, 1985

15.

Bozzetti F. : Central venous catheter sepsis. Surg Gynecol Obstet 161:293-301, 1985