2101. Catheter-related Infections Complicating Central Venous Catheter Access Device Insertion: A Retrospective Audit and Comparison of Two Cohorts

Abstract

BackgroundCentral venous access devices (CVAD) are essential for long-term intra-venous treatment of malignancies and other conditions. Catheter-related infections (CRI) complicate long-term CVAD use at rates between 1.5 and 5%, resulting in significant morbidity and mortality. Current evidence does not support a role for antibiotic prophylaxis pre-insertion. We aim to determine rates of CRIs complicating CVAD insertions by vascular surgery and interventional radiology in a single institution and examine the role of antibiotic prophylaxis in prevention.MethodsA retrospective audit was carried out on CVAD insertions (tunnelled central venous catheter (CVC) or subcutaneous port) by the Vascular Surgery and Radiology Departments at a tertiary teaching hospital in Sydney, Australia from January 2014 to December 2016. Data were collected on patient demographics, antibiotic prophylaxis, skin preparation and CRIs. Rates of CRIs were compared by chi-square test (α 0.05).ResultsNinety-five (11 tunnelled CVC; 84 subcutaneous ports) and 222 (21 tunnelled CVC; 201 subcutaneous ports) CVAD insertions were performed by vascular surgery and radiology, respectively. Median age was 56 years (IQR 48–66) in the vascular cohort and 64 years (IQR 55–72) in the radiology cohort. Females were predominant in both vascular (70; 73.7%) and radiology (119, 53.6%) cohorts and the most common indication was chemotherapy (vascular 84; 88.4% and radiology 205; 92.8%, n = 1 missing). Antibiotic prophylaxis was used in 88 (92.6%) vascular insertions but only 2 (0.95%, n = 12 missing) insertions by radiology. Iodine skin preparation was preferred for vascular insertions (92; 98.9%, n = 2 missing) compared with chlorhexidine for radiology insertions (214; 97.7%, n = 3 missing). CRIs occurred in 4 (4.2%) of the vascular cohort and 8 (3.6%) of radiology cohort (P = 0.80).ConclusionRates of CRIs complicating CVAD procedures were similar in a vascular cohort where most received antibiotic prophylaxis, and in a radiology cohort where antibiotic prophylaxis was rarely used. There was no evidence to support antibiotic prophylaxis in prevention of CRIs, although choice of skin preparation and other factors may have confounded findings.Disclosures All authors: No reported disclosures.