Catheter Related Bloodstream Infection (CR-BSI) in ICU Patients: Making the Decision to Remove or Not to Remove the Central Venous Catheter

Rodrigo Octávio Deliberato,Oscar Fernando Pavão Dos Santos,Michael B Edmond,Alexandre R Marra,Marinês Dalla Vale Martino,Luci Correa,Thiago Domingos Corrêa

doi:10.1371/journal.pone.0032687

Rodrigo Octávio Deliberato, Oscar Fernando Pavão Dos Santos + Show 5 more

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https://doi.org/10.1371/journal.pone.0032687

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Abstract

BackgroundApproximately 150 million central venous catheters (CVC) are used each year in the United States. Catheter-related bloodstream infections (CR-BSI) are one of the most important complications of the central venous catheters (CVCs). Our objective was to compare the in-hospital mortality when the catheter is removed or not removed in patients with CR-BSI.MethodsWe reviewed all episodes of CR-BSI that occurred in our intensive care unit (ICU) from January 2000 to December 2008. The standard method was defined as a patient with a CVC and at least one positive blood culture obtained from a peripheral vein and a positive semi quantitative (>15 CFU) culture of a catheter segment from where the same organism was isolated. The conservative method was defined as a patient with a CVC and at least one positive blood culture obtained from a peripheral vein and one of the following: (1) differential time period of CVC culture versus peripheral culture positivity of more than 2 hours, or (2) simultaneous quantitative blood culture with 5∶1 ratio (CVC versus peripheral).Results53 CR-BSI (37 diagnosed by the standard method and 16 by the conservative method) were diagnosed during the study period. There was a no statistically significant difference in the in-hospital mortality for the standard versus the conservative method (57% vs. 75%, p = 0.208) in ICU patients.ConclusionIn our study there was a no statistically significant difference between the standard and conservative methods in-hospital mortality.

Highlights

150 million central venous catheters (CVC) are used each year in the United States
In an attempt to reduce the rate of these infections, the Institute for Health Care Improvement (IHI) and the Centers for Disease Control and Prevention (CDC) have issued guidelines for the prevention of Catheterrelated bloodstream infections (CR-bloodstream infection (BSI)), including: hand hygiene, maximum barrier precautions for insertion, skin antisepsis with chlorhexidine, careful choice of the insertion site and a proactive approach to CVC removal [3,5]
Definitions The use of the standard method for diagnosis of CR-BSI was defined as a patient with a CVC and at least one positive blood culture obtained from a peripheral vein and a positive semi-quantitative culture of a catheter segment

Summary

Introduction

150 million central venous catheters (CVC) are used each year in the United States These catheters have unquestionable benefits in current medical practice, but their potential complications are well known [1]. One of the main complications is catheter-related bloodstream infection (CR-BSI). In the United States 150,000 new cases are estimated to occur each year, of which approximately 80,000 occur in intensive care units (ICUs). Catheterrelated bloodstream infections (CR-BSI) are one of the most important complications of the central venous catheters (CVCs).

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