Abstract
BackgroundCulture of catheter hubs and skin surrounding the catheter entry site has a negative predictive value for catheter tip colonization. However, manipulation of the hub for culture requires the hubs to be swabbed, introducing potential dislodging of biofilm and subsequent migration of microorganisms. Hubs are usually closed with needleless connectors (NCs), which are replaced regularly. Our objective was to evaluate whether culture of flushed withdrawn NCs is an alternative to hub culture when investigating central venous catheter colonization.MethodsThe study population comprised 49 intensive care unit patients whose central venous catheters had been in place for at least 7 days. Cultures of NCs and skin were obtained weekly.ResultsWe included 82 catheters with more than 7 days’ indwelling time. The catheter tip colonization rate was 18.3 % (15/82). Analysis of skin and NC cultures revealed a 92.5 % negative predictive value for catheter colonization. Three episodes of catheter-related bloodstream infection (C-RBSI) occurred in patients with colonized catheters.ConclusionSurveillance of NC and skin cultures could help to identify patients at risk for C-RBSI.
Highlights
Culture of catheter hubs and skin surrounding the catheter entry site has a negative predictive value for catheter tip colonization
Diagnosis of catheter tip colonization is confirmed by culturing the catheter tip after withdrawal but may be anticipated by conservative methods based on superficial cultures of hubs and the skin surrounding the catheter entry site [5]
Several authors, including our group, have demonstrated that negative superficial cultures of the skin surrounding the catheter insertion site and catheter hubs ruled out catheter tip colonization in MHS-Intensive care unit (ICU), oncology, and hemodialysis patients, avoiding unnecessary withdrawals of the catheter [3, 6, 7]
Summary
Culture of catheter hubs and skin surrounding the catheter entry site has a negative predictive value for catheter tip colonization. Our objective was to evaluate whether culture of flushed withdrawn NCs is an alternative to hub culture when investigating central venous catheter colonization. Catheter-related bloodstream infection (C-RBSI) is a severe condition with high rates of associated morbidity and mortality [1, 2]. It occurs after catheter tip colonization by microorganisms progressing along both the inner and outer surface of the catheter [3, 4]. The aim of our study was to evaluate whether culture of flushed withdrawn connectors is an alternative to hub culture when investigating catheter colonization
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