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Crit Care. 2016 May 28;20(1):166. doi: 10.1186/s13054-016-1334-1.

Vascular catheter colonization: surveillance based on culture of needleless connectors.

Pérez-Granda MJ1,2,3, Guembe M4,5,6, Cruces R7,8, Bouza E7,9,10.

Author information

1
Cardiac Surgery Postoperative Care Unit, Hospital General Universitario Gregorio Marañón, Madrid, Spain. massus@hotmail.es.
2
CIBER de Enfermedades Respiratorias-CIBERES (CB06/06/0058), Madrid, Spain. massus@hotmail.es.
3
Hospital General Universitario "Gregorio Marañón", C/Dr. Esquerdo, 46, 28007, Madrid, Spain. massus@hotmail.es.
4
Department of Clinical Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Marañón, Madrid, Spain. mariaguembe@hotmail.com.
5
Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Madrid, Spain. mariaguembe@hotmail.com.
6
Hospital General Universitario "Gregorio Marañón", C/Dr. Esquerdo, 46, 28007, Madrid, Spain. mariaguembe@hotmail.com.
7
Department of Clinical Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Marañón, Madrid, Spain.
8
Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Madrid, Spain.
9
Medicine Department, School of Medicine, Universidad Complutense de Madrid, Madrid, Spain.
10
CIBER de Enfermedades Respiratorias-CIBERES (CB06/06/0058), Madrid, Spain.

Abstract

BACKGROUND:

Superficial culture has a high negative predictive value in the assessment of catheter tip colonization (CC) and catheter-related bloodstream infection (C-RBSI). However, the process of hub culture requires the hubs to be swabbed, and this carries a risk of dislodging the biofilm. At present, most catheter hubs are closed by needleless connectors (NCs) that are periodically replaced. Our objective was to compare the yield of SC (skin + hub culture) with that of skin + NC culture in the assessment of CC and C-RBSI.

METHODS:

During 5 months, we included the patients on the Major Heart Surgery ICU when a central venous catheter (CVC) remained in place ≥7 days after insertion. SCs were taken simultaneously when the NC was withdrawn and processed by the semi-quantitative method, even when the catheter was not removed. All catheter tips were cultured. All NCs belonging to a single catheter lumen were individually flushed with 100 μl of brain-heart infusion (BHI) broth. We considered the lumen to be colonized when ≥1 NC culture from the lumen flush was positive. We collected a total of 60 catheters.

RESULTS:

The overall CC rate was 15.0 %, and we confirmed two episodes of C-RBSI. The validity values after the comparison of SCs with skin + NC culture for prediction of CC were the following: sensitivity 66.7 % vs. 77.8 %, and negative predictive value 93.6 % vs. 93.1 %. The sensitivity and negative predictive value for prediction of C-RBSI was 100 % for both SC and skin + NC culture.

CONCLUSION:

The combination of skin and flushed NC culture can be an alternative to conventional SC for ruling out CC and C-RBSI.

KEYWORDS:

Catheter colonization; Catheter-related bloodstream infection; Flushing; Hub culture; Needleless connectors; Superficial culture

PMID:
27234944
PMCID:
PMC4884389
DOI:
10.1186/s13054-016-1334-1
[Indexed for MEDLINE]
Free PMC Article

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