Context: Central venous catheter-related bloodstream infection (CRBSI) is associated with high rates of morbidity and mortality in critically ill patients. Aims: This study was conducted to determine the incidence of central venous catheter-related infections (CRIs) and to identify the factors influencing it. So far, there are very few studies that have been conducted on CRBSI in the intensive care unit in India. Settings and Design: This was a prospective, observational study carried out in the medical intensive care unit (MICU) over a period of 1 year from January to December 2004. Materials and Methods: A total of 54 patients with indwelling central venous catheters of age group between 20 and 75 years were included. The catheters were cultured using the standard semiquantitative culture (SQC) method. Statistical analysis used SPSS-10 version statistical software. Results: A total of 54 CVC catheters with 319 catheter days were included in this study. Of 54 patients with CVCs studied for bacteriology, 39 (72.22%) catheters showed negative SQCs and also negative blood cultures. A total of 15 (27.77%) catheters were positive on SQC, of which 10 (18.52%) were with catheter-associated infection and four (7.41%) were with catheter-associated bacteremia; the remaining one was a probable catheter-associated bacteremia. CRIs were high among catheters that were kept in situ for more than 3 days and emergency procedures where two or more attempts were required for catheterization (P < 0.05). In multivariate analysis of covariance duration of catheter in situ for >3 days, inexperienced venupucturist, more number of attempts and emergency CVC were associated with more incidence of CVCBSIs, with P <0.02. The duration of catheter in situ was negatively correlated (-0.53) and number of attempts required to put CVC was positively correlated (+0.39) with incidence of CVCBSIs. Sixty-five percent of the isolates belonged to the CONS group (13/20). Staphylococcus epidermidis showed maximum susceptibility to amikacin, doxycycline and amoxycillin with clavulanic acid and was susceptible to vancomycin (100%). Klebsiella pneumoniae was 100% susceptible to amikacin and ciprofloxacin. Escherichia coli was susceptible to amikacin and cefotaxime. Conclusions: The overall incidence of CRI was 27.77% (15/54). Catheter-associated BSIs were 47.31 per 1000 catheter-days. CRI was low in the catheters inserted by the experienced venipuncturists, elective procedure and CVC kept in situ for ≤3 days. S. epidermidis was the most common isolate.
Raad I, Hanna H, Maki D. Intravascular catheter-related infections: advances in diagnosis, prevention, and management. Lancet Infect Dis 2007;7:645-57.
Frasca D, Dahyot-Fizelier C, Mimoz O. Prevention of central venous catheter-related infection in the intensive care unit. Crit Care 2010;14:212.
Mermel LA, Allon M, Bouza E, Craven DE, Flynn P, O′Grady NP, et al. Clinical practice guidelines for the diagnosis and management of intravascular catheter-related infection: 2009 Update by the Infectious Diseases Society of America. Clin Infect Dis 2009;49:1.
Pronovost P, Needham D, Berenholtz S, Sinopoli D, Chu H, Cosgrove S, et al. An intervention to decrease catheter-related bloodstream infections in the ICU. N Engl J Med 2006;355:2725-32.
Richet H, Hubert B, Nitemberg G, Andremont A, Buu-Hoi A, Ourbak P, et al. Prospective multicenter study of vascular-catheter-related complications and risk factors for positive central catheter cultures in intensive care unit patients. J Clin Microbial 1990;28:2520-5.
Maki DG, Weise CE, Saratin HW. A semiquantitative culture method for identifying intravenous catheter related infection. N Eng J Med 1977;296:1305-9.
O′Grady NP, Alexander M, Dellinger EP, Gerberding JL, Heard SO, Maki DG, et al. Guidelines for the prevention of intravascular catheter-related infections. Clin Infect Dis 2002;35:1281-307.
Koneman EW, Allen SD, Janda WM, Schreckenberger PC, Winn WC Jr. The gram-positive cocci. I. Staphylococci and related organisms. In Color atlas and textbook of diagnostic microbiology. 5 th ed. Philadelphia, PA: Lippincott/ The Williams and Wilkins Co; 1997. p. 539-76.
National committee for clinical laboratory standards. Performance standards for antimicrobial susceptibility testing. Twelfth informational supplement. Wayne PA: M100-S12 NCCLS; 2002.
Miles RS, Amyes SG. Laboratory control of antimicrobial therapy. In: Collee JG, Fraser AG, Marmion BP, Simmons A, editors. Mackie and McCartney Practical Medical Microbiology. 14 th ed. Vol. 2. London: Churchill Livingstone; 1996. p. 151-78.
Widmer AF, Nettleman M, Flint K, Wenzel RP. The clinical impact of culturing central venous catheters. Arch Intern Med 1992;152:1299-302.
Haslett TM, Isenberg HD, Hilton E, Tucci V, Kay BG, Vellozzi EM. Microbiology of indwelling central intravascular catheters. J Clin Microbiol 1988;26:696-701.
Groeger JS, Lucas AB, Thaler HT, Friedlander-Klar H, Brown AE, Kiehn TE, et al. Infectious morbidity associated with long term use of venous access devices in patients with cancer. Ann Intern Med 1993;119:1168-74.
Pemberton LB, Ross V, Cuddy P, Kremer H, Fessler T, McGurk E. No difference in catheter sepsis between standard and antiseptic central venous catheters. Arch Surg 1996;131:986-9.
Safdar N, Maki DG. The pathogenesis of catheter-related bloodstream infection with noncuffed short-term central venous catheters. Intensive Care Med 2004;30:62-7.
Trick WE, Miranda J, Evans AT, Charles-Damte M, Reilly BM, Clarke P. Prospective cohort study of central venous catheters among internal medicine ward patients. Am J Infect Control 2006;34:636-41.
LeMaster CH, Schuur JD, Pandya D, Pallin DJ, Silvia J, Yokoe D, et al. Infection and natural history of emergency department-placed central venous catheters. Ann Emerg Med 2010;56:492-7.
Lemaster CH, Agrawal AT, Hou P, Schuur JD. Systematic review of emergency department central venous and arterial catheter infection. Int J Emerg Med 2010;3:409-23.
Koh DB, Gowardman JR, Rickard CM, Robertson IK, Brown A. Prospective study of peripheral arterial catheter infection and comparison with concurrently sited central venous catheters. Crit Care Med 2008;36:397-402.
Lucet JC, Bouadma L, Zahar JR, Schwebel C, Geffroy A, Pease S, et al. Infectious risk associated with arterial catheters compared with central venous catheters. Crit Care Med 2010;38:1030-5.
Fortún J, Perez-Molina JA, Asensio A, Calderón C, Casado JL, Mir N, et al. Semiquantitative culture of subcutaneous segment for conservative diagnosis of intravascular catheter related infection. JPEN J Parenter Enteral Nutr 2000;24:210-4.
Deshpande KS, Hatem C, Ulrich HL, Currie BP, Aldrich TK, Bryan-Brown CW, et al. The incidence of infectious complications of central venous catheters at the subclavian, internal jugular and femoral sites in an intensive care unit population. Crit Care Med 2005;33:13-20; discussion 234-5.
Cobb DK, High KP, Sawyer RG, Sable CA, Adams RB, Lindley DA, et al. A controlled trial of scheduled replacement of central venous and pulmonary-artery catheters. N Engl J Med 1992;327:1062-8.
Charalambous C, Swoboda SM, Dick J, Perl T, Lipsett PA. Risk factors and clinical impact of central line infections in the surgical intensive care unit. Arch Surg 1998;133:1241-6.
Juste RN, Hannan M, Glendenning A, Azadin B, Soni N. Central venous blood culture: a useful test for catheter colonisation? Intensive Care Med 2000:26:1373-5.
Aufwerber E, Ringertz S, Ransjo U. Routine semiquantitative cultures and central venous catheter related bacteremia. APMIS 1991;99:627- 30.
Mermel LA, Farr BM, Sherertz RJ, Raad II, O′Grady N, Harris JS, et al. Guidelines for the management of intravascular catheter - related infections. Clin Infect Dis 2001;32:1249-72.
Maki DG, Ringer M, Alvarado CJ. Prospective randomized trial of povidone-iodine, alcohol, and chlorhexidine for prevention of infection associated with central venous and arterial catheters. Lancet 1991;338:339-43.
Mimoz O, Pieroni L, Lawrence C, Edouard A, Costa Y, Samii K, et al. Prospective, randomized trial of two antiseptic solutions for prevention of central venous or arterial catheter colonization and infection in intensive care unit patients. Crit Care Med 1996;24:1818-23.
Moonens F, el Alami S, Van Gossum A, Struelens MJ, Serruys E. Usefulness of gram staining of blood collected from total parenteral nutrition catheter for rapid diagnosis of catheter related sepsis. J Clin Microbiol 1994;32:1578-9.
Velasco E, Thuler LC, Martins CA, Nucci M, Dias LM, Gonçalves VM, et al. Epidemiology of bloodstream infections at a cancer center. Sao Paulo Med J 2000;118:131-8.
Snydman DR, Gorbea HF, Pober BR, Majka JA, Murray SA, Perry LK. Predictive value of surveillance skin cultures in total parenteral nutrition-related infection. Lancet 1982;18:1385-8.
Schwaber MJ, Krasner CN, Gold HS, Venkataraman L, Avigan DE, Karchmer AW, et al. Detection of Staphylococcus aureus in peripheral blood stem cell cultures after sterilization of standard blood cultures. J Clin Apher 2003;1:37-9.
Bozzetti F, Terno G, Camerini E, Baticci F, Scarpo D, Pupa A. Pathogenesis and predictability of central venous catheter related sepsis. Surgery 1982;91:383-9.
Winston DJ, Dudnick DV, Chapin M, Ho WG, Gale RP, Martin WJ. Coagulase-negative staphylococcal bacteremia in patients receiving immunosuppressive therapy. Arch Intern Med 1983;143:32-6.
Kloos WE, Bannerman TL. Update of clinical significance of coagulase negative staphylococci. Clin Microbiol Rev 1994;7:117-40.
Lorente L, Henry C, Martín MM, Jiménez A, Mora ML. Central venous catheter-related infection in a prospective and observational study of 2,595 catheters. Crit Care 2005;9:R631-5.
Kemp L, Burge J, Choban P, Harden J, Mirtallo J, Flancbaum L. The effect of catheter type and site on infection rates in total parenteral nutrition patients. JPEN J Parenter Enteral Nutr 1994;18:71-4.
Eyer S, Brummitt C, Crossley K, Siegel R, Cerra F. Catheter related sepsis: prospective randomized trial of three methods of longterm catheter maintenance. Crit Care Med 1990;18:1073-9.
Maki DG, Kluger DM, Crnich CJ. The risk of bloodstream infection in adults with different intravascular devices: a systematic review of 200 published prospective studies. Mayo Clin Proc 2006;81:1159-71.
McGee WT, Ackerman BL, Rouben LR, Prasad VM, Bandi V, Mallory DL. Accurate placement of central venous catheters: a prospective randomized, multicentre trial. Crit care Med 1993;21;1118-23.
Safdar N, Kluger DM, Maki DG. A review of risk factors for catheter-related bloodstream infection caused by percutaneously inserted, noncuffed central venous catheters: implications for preventive strategies. Medicine (Baltimore) 2002;81:466-79.
Zhang L, Sriprakash KS, McMillan D, Gowardman JR, Patel B, Rickard CM. Microbiological pattern of arterial catheters in the intensive care unit. BMC Microbiol 2010;19;10:266.