Predictive value of surveillance skin and hub cultures in central venous catheters sepsis

doi:10.1016/0195-6701(88)90006-0

Journal of Hospital Infection

Volume 12, Issue 3, October 1988, Pages 191-198

https://doi.org/10.1016/0195-6701(88)90006-0 Get rights and content

Abstract

In a prospective study of septic complications of central venous catheters used for total parenteral nutrition, daily surveillance catheter hub cultures and twice weekly skin cultures at the catheter entry site were evaluated for their predictive value for catheter sepsis i.e. bacteraemia with an identical species as that recovered from the catheter tip, or catheters which grew ⩾ 15 cfus by a semiquantitative method and/or ⩾ 10³ cfus by a quantitative method. Of 142 catheters studied, 29 were identified to have catheter sepsis. For these the sensitivity of the surveillance hub culture was 34·5% and the sensitivity of the skin culture was 37·9%. When either the hub or the skin culture result was considered as an indication of catheter sepsis, the sensitivity increased to 79·3%. The positive and negative predictive value of the combined result was 44·2% and 93·3% respectively. This study suggests that simultaneous hub and skin cultures are required for a satisfactory surveillance.

References (13)

A. Sitges-Serra et al.
Bacteria in total parenteral nutrition catheters: where do they come from?
Lancet
(1983)
D.R. Snydman et al.
Predictive value of surveillance skin cultures in total-parenteral-nutrition-related infection
Lancet
(1982)
H.S. Bjornson et al.
Association between microorganism growth at the catheter insertion site and colonization of the catheter in patients receiving total parenteral nutrition
Surgery
(1982)
D.J. Cleri et al.
Quantitative culture of intravenous catheters and other intravascular inserts
Journal of Infectious Diseases
(1980)
M. Deitel et al.
An outbreak of Staphylococcus epidermidis septicaemia
Journal of Parenteral and Enteral Nutrition
(1983)
P.J. Collignon et al.
Is semiquantitative culture of central vein catheter tips useful in the diagnosis of catheter-related bacteraemia?
Journal of Clinical Microbiology
(1986)

There are more references available in the full text version of this article.

Cited by (64)

Infections Associated with Intravascular Lines and Grafts
2017, Infectious Diseases, 2-Volume Set
Utility of routine surveillance blood cultures in asymptomatic allogeneic hematopoietic stem cell transplant recipients with indwelling central venous catheters at a comprehensive cancer center
2014, American Journal of Infection Control
Citation Excerpt :
Currently, no reliable methods to identify colonized patients who are likely to develop a subsequent infection are available.7 Additionally, other studies have demonstrated that routine surveillance blood cultures (SBCs) are not cost effective and add very little to the management of critically ill patients.8-11 BSIs are a frequent complication of, and a significant cause of, morbidity and mortality in patients undergoing allo-HCT.1,12-16
Many transplant centers obtain surveillance blood cultures (SBCs) from asymptomatic allogeneic hematopoietic stem cell transplant (allo-HCT) recipients with central venous catheters for early detection of potential blood stream infections. The aim of this study was to determine the utility of this practice.
We conducted a retrospective study of all patients who underwent allo-HCT to determine the frequency, clinical significance, and costs associated with SBCs.
From 776 patients, 6,801 SBCs were obtained (median, 9 per patient). Most (96.89%) were negative. Of the 211 positive SBCs, 171 (81%) had minimal clinical significance. The remaining 40 positive cultures (19%) were considered potentially significant. The frequency of potentially significant SBCs was 5.1% for the entire cohort and 0.59% of all SBCs drawn.
All potentially significant cultures and some that were deemed to have minimal significance led to medical intervention, some of which were probably unnecessary. No adverse outcomes occurred in patients with positive SBCs for the first 30 days following the positive result, regardless of the pathogen isolated or the quantitative colony count. The frequency of clinically significant positive SBCs in asymptomatic adult allo-HCT recipients is very low. Routine use of this practice leads to some unnecessary medical interventions and added costs.
Differential time to positivity is not predictive for central line-related Staphylococcus aureus bloodstream infection in routine clinical care
2014, Journal of Infection
Infections associated with intravascular lines, grafts and devices
2010, Infectious Diseases: Third Edition
Intravascular catheter-related infections: advances in diagnosis, prevention, and management
2007, Lancet Infectious Diseases
Citation Excerpt :
Several older qualitative culture methods involving the catheter segment or blood drawn through the catheter have been studied, but have been found to be associated with limited sensitivity and specificity.14–16 Similarly, other quantitative culture methods of the insertion site or catheter hub have been associated with a limited specificity and positive predictive value.17–21 The methods outlined below have been studied the most during the past decade and most of them have shown promising results (table).
Indwelling vascular catheters are a leading source of bloodstream infections in critically ill patients and cancer patients. Because clinical diagnostic criteria are either insensitive or non-specific, such infections are often overdiagnosed, resulting in unnecessary and wasteful removal of the catheter. Catheter-sparing diagnostic methods, such as differential quantitative blood cultures and time to positivity have emerged as reliable diagnostic techniques. Novel preventive strategies include cutaneous antisepsis, maximum sterile barrier, use of antimicrobial catheters, and antimicrobial catheter lock solution. Management of catheter-related bloodstream infections involves deciding on catheter removal, antimicrobial catheter lock solution, and the type and duration of systemic antimicrobial therapy. Such decisions depend on the identity of the organism causing the bloodstream infection, the clinical and radiographical manifestations suggesting a complicated course, the underlying condition of the host (neutropenia, thrombocytopenia), and the availability of other vascular access sites.
The risk of bloodstream infection in adults with different intravascular devices: A systematic review of 200 published prospective studies
2006, Mayo Clinic Proceedings
Citation Excerpt :
Because the pooled rate is identical to the weighted mean, the data are reported in terms of the pooled rate for all studies of each device and expressed per 100 devices and per 1000 device-days, with 95% confidence intervals calculated using Microsoft Excel v.X for Macintosh (Microsoft Inc, Redmond, Wash) and SAS 8.2 (SAS Institute Inc, Cary, NC). Two hundred studies that prospectively examined the risk of IVD-related BSI with peripheral intravenous (IV) catheters and steel needles,22–32 midline catheters,33–35 arterial catheters for hemodynamic monitoring,36–49 PA catheters,37,50–61 PICCs,35,62–75 nonmedicated CVCs,33,37,44–46,49,54,63,76–148 medicated CVCs,44,105–107,111–114,116,117,121–123,130,133,136,139–141,144,145,147–150 short-term noncuffed and nontunneled hemodialysis CVCs,126,151–165 long-term cuffed and tunneled hemodialysis catheters,165–180 cuffed and tunneled all-purpose Hickman-likeCVCs,35,128,181–207 central venous ports,35,191,197,199,201,207–215 peripheral subcutaneous central venous ports,207,216,217 left ventricular assist devices,218–220 and intra-aortic balloon pumps221 fulfilled criteria for inclusion in this systematic review. The patient populations in the studies included in the analysis are shown in Tables 1 and 2.
To better understand the absolute and relative risks of bloodstream infection (BSI) associated with the various types of intravascular devices (IVDs), we analyzed 200 published studies of adults in which every device in the study population was prospectively evaluated for evidence of associated infection and microbiologically based criteria were used to define IVD-related BSI.
English-language reports of prospective studies of adults published between January 1, 1966, and July 1, 2005, were identified by MEDLINE search using the following general search strategy: bacteremia [Medical Subject Heading, MeSH] OR septicemia [MeSH] OR bloodstream infection AND the specific type of intravascular device (eg, central venous port). Mean rates of IVD-related BSI were calculated from pooled data for each type of device and expressed as BSIs per 100 IVDs (%) and per 1000 IVD days.
Point incidence rates of IVD-related BSI were lowest with peripheral intravenous catheters (0.1%, 0.5 per 1000 IVD-days) and midline catheters (0.4%, 0.2 per 1000 catheter-days). Far higher rates were seen with short-term noncuffed and nonmedicated central venous catheters (CVCs) (4.4%, 2.7 per 1000 catheter-days). Arterial catheters used for hemodynamic monitoring (0.8%, 1.7 per 1000 catheter-days) and peripherally inserted central catheters used in hospitalized patients (2.4%, 2.1 per 1000 catheter-days) posed risks approaching those seen with short-term conventional CVCs used in the intensive care unit. Surgically implanted long-term central venous devices—cuffed and tunneled catheters (22.5%, 1.6 per 1000 IVD-days) and central venous ports (3.6%, 0.1 per 1000 IVD-days)—appear to have high rates of infection when risk is expressed as BSIs per 100 IVDs but actually pose much lower risk when rates are expressed per 1000 IVD-days. The use of cuffed and tunneled dual lumen CVCs rather than noncuffed, nontunneled catheters for temporary hemodialysis and novel preventive technologies, such as CVCs with anti-infective surfaces, was associated with considerably lower rates of catheter-related BSI.
Expressing risk of IVD-related BSI per 1000 IVD-days rather than BSIs per 100 IVDs allows for more meaningful estimates of risk. These data, based on prospective studies in which every IVD in the study cohort was analyzed for evidence of infection by microbiologically based criteria, show that all types of IVDs pose a risk of IVD-related BSI and can be used for benchmarking rates of infection caused by the various types of IVDs in use at the present time. Since almost all the national effort and progress to date to reduce the risk of IVD-related infection have focused on short-term noncuffed CVCs used in intensive care units, infection control programs must now strive to consistently apply essential control measures and preventive technologies with all types of IVDs.

View all citing articles on Scopus

View full text

Article preview

Journal of Hospital Infection

Abstract

References (13)

Bacteria in total parenteral nutrition catheters: where do they come from?

Lancet

Predictive value of surveillance skin cultures in total-parenteral-nutrition-related infection

Lancet

Association between microorganism growth at the catheter insertion site and colonization of the catheter in patients receiving total parenteral nutrition

Surgery

Quantitative culture of intravenous catheters and other intravascular inserts

Journal of Infectious Diseases

An outbreak of Staphylococcus epidermidis septicaemia

Journal of Parenteral and Enteral Nutrition

Is semiquantitative culture of central vein catheter tips useful in the diagnosis of catheter-related bacteraemia?

Journal of Clinical Microbiology

Cited by (64)

Infections Associated with Intravascular Lines and Grafts

Utility of routine surveillance blood cultures in asymptomatic allogeneic hematopoietic stem cell transplant recipients with indwelling central venous catheters at a comprehensive cancer center

Differential time to positivity is not predictive for central line-related Staphylococcus aureus bloodstream infection in routine clinical care

Infections associated with intravascular lines, grafts and devices

Intravascular catheter-related infections: advances in diagnosis, prevention, and management

The risk of bloodstream infection in adults with different intravascular devices: A systematic review of 200 published prospective studies

Original articlePredictive value of surveillance skin and hub cultures in central venous catheters sepsis

Abstract

Lancet

Lancet

Association between microorganism growth at the catheter insertion site and colonization of the catheter in patients receiving total parenteral nutrition

Surgery

Quantitative culture of intravenous catheters and other intravascular inserts

Journal of Infectious Diseases

An outbreak of Staphylococcus epidermidis septicaemia

Journal of Parenteral and Enteral Nutrition

Is semiquantitative culture of central vein catheter tips useful in the diagnosis of catheter-related bacteraemia?

Journal of Clinical Microbiology

Original article
Predictive value of surveillance skin and hub cultures in central venous catheters sepsis