Abstract
BackgroundSuperficial culture has a high negative predictive value in the assessment of catheter tip colonization (CC) and catheter-related bloodstream infection (C-RBSI). However, the process of hub culture requires the hubs to be swabbed, and this carries a risk of dislodging the biofilm. At present, most catheter hubs are closed by needleless connectors (NCs) that are periodically replaced. Our objective was to compare the yield of SC (skin + hub culture) with that of skin + NC culture in the assessment of CC and C-RBSI.MethodsDuring 5 months, we included the patients on the Major Heart Surgery ICU when a central venous catheter (CVC) remained in place ≥7 days after insertion. SCs were taken simultaneously when the NC was withdrawn and processed by the semi-quantitative method, even when the catheter was not removed. All catheter tips were cultured. All NCs belonging to a single catheter lumen were individually flushed with 100 μl of brain-heart infusion (BHI) broth. We considered the lumen to be colonized when ≥1 NC culture from the lumen flush was positive. We collected a total of 60 catheters.ResultsThe overall CC rate was 15.0 %, and we confirmed two episodes of C-RBSI. The validity values after the comparison of SCs with skin + NC culture for prediction of CC were the following: sensitivity 66.7 % vs. 77.8 %, and negative predictive value 93.6 % vs. 93.1 %. The sensitivity and negative predictive value for prediction of C-RBSI was 100 % for both SC and skin + NC culture.ConclusionThe combination of skin and flushed NC culture can be an alternative to conventional SC for ruling out CC and C-RBSI.
Highlights
Superficial culture has a high negative predictive value in the assessment of catheter tip colonization (CC) and catheter-related bloodstream infection (C-RBSI)
A recent study by our group showed that culture of the needleless connectors (NCs) used to close the catheter hubs combined with skin culture, can be an alternative and safer procedure for prediction of catheter colonization and ruling out C-RBSI [10]
The new procedure we describe for ruling out catheter colonization and C-RBSI based on the combination of skin and NC cultures showed, at least, no inferiority to the conventional superficial culture
Summary
Superficial culture has a high negative predictive value in the assessment of catheter tip colonization (CC) and catheter-related bloodstream infection (C-RBSI). The conventional conservative diagnostic method based on superficial culture requires a surface culture of the skin surrounding the catheter insertion site and a surface culture of the inside of each catheter hub [1]. This procedure has been used in several populations to select patients at risk of catheter-related bloodstream infection (C-RBSI) and to rule out the catheter as the source of the bloodstream infection [2,3,4,5,6]. The aim of the present study was to compare the validity values of conventional superficial culture (skin + hubs) with those of skin + NC cultures for catheter tip colonization and C-RBSI.
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