Peripheral Venous Blood Culture Research Articles

Umbilical cord blood culture for early onset sepsis in preterm infants.

Umbilical cord blood culture (UCBC) may have a diagnostic utility for early onset sepsis (EOS) detection in preterm infants. It may prevent sampling the newborn and collect a higher volume of blood for pathogenic identification. Retrospective analysis at a tertiary care center in Canada of preterm infants ≤ 34 0/7 weeks' gestation with UCBC taken at birth. Of 505 admitted infants, 195 had UCBC. 170 UCBCs were negative; 44 of these had also negative neonatal blood culture (NBC). No infants with negative UCBC showed EOS symptoms in the first week of life. 25 UCBCs were positive: 18 were contaminants (all with negative NBC) and 7 were confirmed as EOS. 18 infants with UCBC contaminants remained asymptomatic. 7 EOS cases were identified, with varying bacteriological profiles; 5 displayed sepsis symptoms while 2 were asymptomatic. Risk of EOS increased with prolonged rupture of membranes. UCBC effectively detected EOS establishing it as a method with possibly better diagnostic performance than NBC in high-risk neonates. Further studies are needed to improve UCBC technique and lower contamination rates. Umbilical cord blood culture has a higher bacterial identification rate than peripheral venous blood culture for the early identification of early-onset sepsis in preterm infants. Umbilical cord blood cultures that showed no growth were reliable predictors of not developing early onset sepsis. Umbilical cord blood culture should be considered as part of the evaluation for early onset sepsis in the preterm infants.

Umbilical Cord Blood Culture as an Aid to the Diagnosis of Early Onset Neonatal Sepsis: A Cross-sectional Study

Introduction: Neonatal sepsis is one of the leading causes of neonatal morbidity and mortality globally, accounting for an estimated neonatal mortality rate of 23.9 per 1000 live births. Due to overlapping signs and symptoms, a specific diagnosis of sepsis poses a diagnostic challenge. Blood collected from a peripheral vein for sepsis screening and blood culture remains the gold standard for diagnosing neonatal sepsis. The umbilical cord is still not routinely used as a site for collecting blood for sepsis screening and blood culture. Aim: To determine the diagnostic efficacy of Umbilical Cord Blood Culture (UCBC) compared to Peripheral Venous Blood Culture (PVBC) in Early Onset Neonatal Sepsis (EONS). Materials and Methods: This cross-sectional observational study was conducted at the Neonatology Unit, Department of Paediatrics, Assam Medical College and Hospital (AMCH), Dibrugarh, Assam, India, involving 110 neonates with two or more risk factors for EONS over a one-year period (August 2021-July 2022). Umbilical cord blood and peripheral venous blood were collected and cultured, and the neonates were monitored throughout their hospital stay. Statistical significance was determined using the Chi-square test for categorical variables and the t-test for continuous variables (with a p-value <0.05 considered statistically significant). The validity of UCBC for diagnosing early neonatal sepsis was assessed based on sensitivity, specificity, Positive Predictive Value (PPV), and Negative Predictive Value (NPV). Results: The mean gestational age was 34.95±3.314 weeks and mean birth weight was 2.08±0.790 grams. Of the 110 high- risk neonates, sepsis screening was positive in 67 (61%), while UCBC and PVBC were positive in 19 (17.3%) and 10 (9.09%), respectively. Acinetobacter was the most common organism found in both cultures. The sensitivity and specificity of sepsis screening were 100% and 47.25% compared to UCBC and 90% and 42% compared to PVBC. In comparison to PVBC, UCBC demonstrated a sensitivity and specificity of 70% and 88%, with a diagnostic accuracy of 86.36%. Conclusion: The UCBC exhibits good diagnostic accuracy for diagnosing EONS and can be utilised due to it being a painless and technically less challenging method of blood sampling, with high sensitivity and specificity.

Influencing factors of central venous catheter-associated bloodstream infection in patients with emergency hemorrhagic shock

Objective: To investigate and analyze the influencing factors of central venous catheter-associated bloodstream infection in patients with emergency hemorrhagic shock. Methods: According to the inclusion criteria, 249 patients with hemorrhagic shock and central venous catheterization admitted to the emergency department of Shanghai First People's Hospital from June 2016 to June 2022 were retrospectively analyzed, and divided into the infection group (54 cases) and the non-infection group (195 cases) according to whether catheter-related bloodstream infection occurred.Multivariate Logistic regression was used to analyze the relationship between central venous catheter-related bloodstream infection and various influencing factors. The etiological and drug susceptibility test data of peripheral venous blood culture, puncture site samples and catheter tip samples from patients with central venous catheter-associated bloodstream infection were statistically analyzed. Results: There were significant differences in age, catheterization location, ultrasound-guided puncture, APACHE ⅱ score, catheter indwelling time and application of broad-spectrum antibiotics between the infected group and the non-infected group (P<0.05). Staphylococcus epidermidis accounted for 44.4%, Escherichia coli 24.1%, and fungi 11.1% in 54 infected patients. The lowest resistance rate of Gram-positive cocci was to vancomycin (3.4%), followed by tetracycline 34.5%, and the highest resistance rate was to amoxicillin 100.0%. Conclusion: The risk factors of central venous catheter-related bloodstream infection in patients with emergency hemorrhagic shock include advanced age, femoral vein catheterization, non-ultrasound-guided puncture, high APACHE ⅱ score, catheter retention time, and application of broad-spectrum antibiotics. Staphylococcus epidermidis the common pathogen of central venous catheterization related infection in emergency hemorrhagic shock patients.

Comparative microbial analysis and assessment of paired umbilical cord blood culture and peripheral venous blood culture in neonates with high risk factors to detect early onset neonatal sepsis: A study from tertiary care hospital of central India

Background: Neonatal sepsis is a prime cause of neonatal morbidity and mortality. Peripheral venous blood (PVB) culture is a gold standard for the diagnosis of neonatal sepsis. Low sensitivity of blood culture in newborn is due to small volume of blood sample and antibiotics given before sampling. Aims and Objectives: The study aims to compare and analyze the microbial spectrum in the Umbilical cord blood (UCB) culture with PVB culture and evaluation of both for detection of early onset neonatal sepsis (EONS) in high risk neonates and to use appropriate microorganism specific antibiotic for treating the sepsis. Materials and Methods: About 100 inborn neonates with two or more risk factors for EONS, chosen by sequential sampling method were included in this prospective analytical study. Blood samples were collected from umbilical cord and peripheral vein for culture. Sepsis screen was done to substantiate the diagnosis of neonatal sepsis. Results: Out of 100 neonates, 21 belongs to sepsis; 14 to probable sepsis; 65 to no sepsis. Among these 27 had UCB culture & 24 had PVB culture +ve. Organisms grown on culture were Klebsiella(m/c isolate), Staphylococcus aureus, Escherichia coli, Acinetobacter, Coagulase-ve Staphylococcus (blood culture contaminant), Pseudomonas and Enterococcus. Conclusion: UCB culture is simple and convenient method for the diagnosis of neonatal sepsis as compared to PVB culture with Sensitivity of 66% and specificity of 93%. Organisms grown are comparable to PVB culture sample (Klebsiella - most common isolate).

Use of umbilical cord blood culture in the diagnosis of early onset neonatal sepsis among high risk mothers

Background: Early onset neonatal sepsis (EONS) is one of the important causes of morbidity and mortality in neonates. Its early diagnosis and prompt treatment is essential and any delay in the diagnosis can have serious consequences including neonatal death. Blood culture is the gold standard test for diagnosis of neonatal sepsis. Umbilical cord blood culture (UCBC) is a painless procedure and technically less challenging. We conducted this study to evaluate use of UCBC for the diagnosis of EONS and compared it with the results of peripheral venous blood culture (PVBC) reports. Aims and Objectives: The aim of the study was to evaluate UCBC for the diagnosis of EONS and compared it with the results of PVBC reports. Materials and Methods: This was a hospital-based prospective cohort study consisting of 100 neonates who were at risk of EONS. The study was conducted in the Department of Pediatrics Sikkim Manipal Institute of Medical Sciences Gangtok between January 2018 and December 2019. Neonates found to be at risk of development of EONS were included in this study on the basis of a predefined inclusion and exclusion criteria. Immediately after birth blood samples were collected from both umbilical cord and peripheral vein and were sent to bacteriology lab. Sensitivity, specificity, positive predictive value, and negative predictive value of both the samples were analyzed. Results: Out of 100 neonates in 32 (32%) EONS could be confirmed with positive sepsis screening results and/or demonstration of organisms on blood culture. Among the 32 neonates with EONS, 17 were found to be premature. The mean gestational age of newborns with EONS was found to be 35.2 weeks. The umbilical blood culture was found to have sensitivity and specificity of 100% and 74.4%, respectively, whereas peripheral vein blood culture was found to have sensitivity and specificity of 77.7% and 72.5%, respectively. The most common organism grown in our study was Escherichia coli. Conclusion: UCBC is painless and technically less challenging method of blood sampling. It has been found to have a higher sensitivity as well specificity for the diagnosis of EONS as compared to peripheral venous blood sample.

EVALUATION OF CORD BLOOD CULTURE AS AN EARLY PREDICTOR FOR THE DETECTION OF EARLY ONSET NEONATAL SEPSIS IN TERTIARY CENTRE OF CENTRAL INDIA.

BACKGROUND : Neonatal sepsis is one of the major causes of neonatal morbidity and mortality. Peripheral venous blood culture and sensitivity is gold standard for the diagnosis of neonatal sepsis. Low sensitivity of blood culture in newborn is due to small volume of blood sample collected from neonates & antibiotics given before sampling. AIM : To evaluate the utility & compare the Umblical cord blood culture(UCBC) with Peripheral venous blood culture(PVBC) for detection of Early Onset Neonatal Sepsis(EONS) METHOD : 100 inborn neonates with two or more risk factors for EONS, chosen by sequential sampling method were included in this prospective analytical study. Blood samples were collected from umbilical cord and peripheral vein for culture. Sepsis screen was done to corroborate the diagnosis of neonatal sepsis. RESULT : Out of 100 neonates, 21 belongs to sepsis; 14 to probable sepsis; 65 to no sepsis. UCBC had Sensitivity-65.71% , Specicity-93.84%, PPV-85.18% , NPV-83.56% & PVBC had Sensitivity-60% , Specicity-95.38% , PPV-87.5% , NPV-81.57%. CONCLUSION : UCBC is simple and convenient method for the diagnosis of EONS compared to PVBC. Organisms grown are comparable to PVBC sample.

A PROSPECTIVE COMPARATIVE STUDY OF UMBILICAL CORD BLOOD CULTURE VERSUS PERIPHERAL VENOUS BLOOD CULTURE IN DIAGNOSIS OF EARLY ONSET NEONATAL SEPSIS IN PRETERM NEONATES IN NEONATAL INTENSIVE CARE UNIT OF TERTIARY CARE HOSPITAL

Background Neonatal sepsis is major cause of neonatal morbidity and mortality. Blood culture and sensitivity is gold standard for the diagnosis of neonatal sepsis. Low sensitivity of blood culture especially in newborn is due to small volume of blood sample collected from neonates and antibiotics given before sampling. Study Methodology A prospective, analytical, cross sectional study where comparison of umbilical cord blood culture and peripheral venous blood culture was done in 100 inborn neonates . Sensitivity and specificity, positive and negative predictive values were calculated. P value was calculated, Chi Square test was applied and association was quantified. Results Higher sensitivity(81.0%) and accuracy(87%) for predicting disease outcome of patients by UCBC method against PVBC method conclude that UCBC can be used as reliable and alternate tool to predict final outcome. Conclusion UCBC can be useful diagnostic test for EONS. Adequate amount of blood is obtained by umbilical cord method which can be difficult to obtain in a low birth weight new born. Inadequate samples of PVBC can lead to a false negative report. Umbilical cord blood is obtained from placental end of umbilical cord, there are less chances of introducing iatrogenic infection unlike routine culture technique where chances of false positive and risk of introducing iatrogenic infection is high. If umbilical cord blood is taken at birth, normal appearing newborn could be followed up in postnatal wards and discharged if reports are normal. If umbilical cord blood is collected at birth and culture report comes positive,we can prevent sequelae of sepsis by providing antibiotics for fixed duration and for units practising empirical antibiotics , antibiotics can be discontinued if report is negative.

Umbilical Cord Blood Culture in General in the Diagnosis of Sageis Newborns

Worldwide neonatal sepsis is among the most frequent causes of neonatal death. Various studies have tried to establish the relationship between prevalence of neonatal septicemia risk factors and bacteriological profiling, low birth weight, prematurity, etc. Current study was aimed to compare early onset of neonatal sepsis (EONS) among primigravida and multigravida mothers using umbilical cord blood (UCB) and peripheral venous blood (PVB) samples. It was also aimed to establish the utilization of umbilical cord blood culture (UCBC) in comparison to peripheral venous blood culture (PVBC) in identifying EONS. In present study the blood samples were collected from high risk neonates for the clinical blood culture and screening. Among the 75 neonates in the study, 24 (32.0%) were observed to have sepsis screen positive. Study of high risk neonates umbilical cord blood culture (UCBC) positivity was 17.3% while Peripheral Venous blood culture positivity was 5.3%. Moreover, in this study all risk factors like Prematurity, Low birth weights, Premature rupture of membrane, and birth asphyxia were significantly (p<0.05) associated with UCBC growth/positivity. Low birth weight (86%) was mostly reported in the high risk neonates with other associated sepsis factors. Similarly maternal fever and prolonged rupture of membrane was highly significantly (p<0.01) associated with UCBC positivity. Gram negative bacterias were more commonly found, such as Pseudomonas (5.3%), followed by E. coli (4%), and Klebsiella (2.7%) and gram positive Streptococcus sp. (2.7%), etc. From our analysis it can be said that the UCBC has strong diagnostic outcomes as compared to the PVBC for etiological evaluation of bacterial sepsis in neonates at high risk.

Umbilical cord blood culture versus peripheral venous blood culture in early onset neonatal sepsis

Background: Neonatal sepsis is a major cause of neonatal morbidity and mortality. Blood culture and sensitivity is gold standard for the diagnosis of neonatal sepsis. Low sensitivity of blood culture especially in newborn is due to small volume of blood sample collected from neonates and antibiotics given before sampling. The aim was to evaluate the use of umbilical cord blood culture in the diagnosis of early onset neonatal sepsis as compared to Peripheral vein blood culture. Methods: Eighty neonates with two or more risk factors for early onset neonatal sepsis were included in the study. Blood samples were collected from umbilical cord and peripheral vein for culture. Sepsis screen was done to corroborate the diagnosis of neonatal sepsis. Results: Sepsis screen was positive in twenty three babies. Among these four had grown organism on Umbilical cord blood culture only. While two babies had both positive, Umbilical cord bloods culture and peripheral vein blood culture. Organisms grown on culture were E.Coli, Pseudomonas, Klebsiella and Acinetobacter.Conclusions: Umbilical cord blood culture is simple and convenient method for the diagnosis of early onset neonatal sepsis compared to peripheral venous blood culture. Organisms grown are comparable to peripheral venous blood culture sample.

Utility of cord blood culture in early onset neonatal sepsis.

Neonatal sepsis is a major cause of neonatal mortality. The clinical outcome mainly depends on the early diagnosis and peripheral venous blood culture (PVBC) is the most widely practiced diagnostic method. This study aimed to evaluate the utility of umbilical cord blood culture (UCBC) in neonates at high risk of early onset neonatal sepsis (EONS) in comparison to peripheral venous blood culture. A total of 40 neonates with two or more risk factors for EONS were included in the study. Umbilical cord blood was collected aseptically during delivery for blood culture and C-reactive protein (CRP). Peripheral venous blood was collected within 24 hours of birth for sepsis screen and PVBC. Although 11 babies were sepsis screen positive, cord blood CRP was negative in all cases. In comparison to PVBC, UCBC had 100 per cent sensitivity and 94.9 per cent specificity. The results of UCBC were consistent with PVBC. One neonate who was both UCBC and PVBC positive also had isolation of the same pathogen in both the cultures and 33 per cent PPV for UCBC. UCBC is a simple convenient method, which ensures culture of adequate volume of blood from newborns allowing effective early isolation of bacterial pathogens, especially in EONS.

Uncommon aetiological agents of catheter-related bloodstream infections.

The clinical and microbiological characteristics of catheter-related bloodstream infection (CR-BSI) due to uncommon microorganisms was assessed in a retrospective case-control study over a 9-year period in a tertiary teaching hospital. Uncommon microorganisms were defined as those representing <0·5% of all CR-BSI. Diagnosis of CR-BSI required that the same microorganism was grown from at least one peripheral venous blood culture and a catheter tip culture. Thirty-one episodes of CR-BSI were identified due to 13 different genera and these accounted for 2·3% of all CR-BSI in the hospital. Although these infections were not associated with increased mortality, they occurred in patients with more severe underlying conditions who were receiving prolonged antibiotic therapy.

Comparison of hematologic indices and markers of infection in umbilical cord and neonatal blood

Objective: Evaluation of a neonate for suspected early neonatal sepsis routinely includes blood tests such as complete blood count, C-reactive protein (CRP) and culture. In order to obviate the need for venepuncture, we prospectively compared these tests in paired samples from umbilical cord and peripheral venous blood drawn during the first hours after birth in both preterm and term infants.Methods: Paired blood samples were studied from asymptomatic neonates with risk factors for early sepsis. Data were collected on maternal and neonatal factors that may have influenced the correlation between the tests.Results: Three hundred fifty pairs of samples were studied. Significant correlation between umbilical cord and peripheral venous samples was found for white blood cell (WBC; r = 0.683) and platelets (PLT) (r = 0.54). Correlation for hemoglobin was lower (r = 0.36). No cases of early neonatal sepsis were detected. However, contamination rates were 12% in umbilical cord blood and 2.5% in peripheral venous blood cultures. WBC rose after birth and the 90th percentile rose from 22 500 in umbilical cord blood to 29 700 in peripheral blood.Conclusions: Screening for sepsis with umbilical cord CBC may be useful provided normal ranges are adjusted accordingly.

Study of umbilical cord blood culture in diagnosis of early-onset sepsis among newborns with high-risk factors

Context:Blood culture is gold standard for diagnosis of neonatal sepsis. Low sensitivity of blood culture is usually due to small volume of blood sample, intrapartum antibiotics, and antibiotics given to newborn before sampling.Aim:We evaluated use of Umbilical cord blood culture (UCBC) in diagnosis of neonatal sepsis as compared to peripheral venous blood culture.Settings and Design:This study was done in tertiary care teaching hospital during May-June 2012. A total of 45 newborns with presence of two or more risk factors of sepsis were included.Subjects and Methods:Blood sample from placental end of umbilical cord was collected and cultured. Primary outcome was diagnosis of neonatal sepsis by use of umbilical cord blood sample as compared with venous blood sample. Secondary outcome was to compare organisms identified by UCBC and venous blood culture.Statistical Analysis:Sensitivity, specificity, positive and negative predictive values of UCBC were calculated.Results:A total of 24.44% (11 out of 45) high-risk newborns had positive UCBC. A total of 17.8% (8 out of 45) newborns had positive blood culture report. Organisms grown in UCBC were Pseudomonas (45%, 5 out of 11), Acinetobacter (27.27%, 3 out of 11), Escherichia coli (18.18%, 2 out of 11), and Klebsiella (9%, 1 out of 11).Conclusion:UCBC is a good method for diagnosis of neonatal sepsis among high-risk newborns as compared to venous blood culture with a sensitivity of 80% and specificity of 91.43%. Organisms grown are comparable to blood culture samples.

Bacteraemia following single-stage percutaneous dilatational tracheostomy

Surgical tracheostomy in critically ill adults has largely been replaced by physicians performing percutaneous dilatational tracheostomy (PDT) at the bedside. Complications associated with this technique include haemorrhage, wound infection, barotrauma, false passage, ruptured tracheal ring and bacteraemia. Prophylactic antibiotics are not generally used with this procedure, however the incidence of bacteraemia following PDT has not been extensively studied. Prospective observational study. Adult intensive care unit of a university medical centre. Peripheral venous blood cultures were obtained immediately before and after PDT in 118 consecutive patients. Surveillance cultures of potential respiratory pathogens were also recorded using routine non-directed broncholalveolar lavage. Forty-three female and 75 male patients underwent PDT. Fifty-seven patients (48.3%) were not receiving antibiotics on the day of PDT, whilst the remaining 61 individuals (51.7%) were on antibiotic therapy at the time of the procedure. Bacteraemia following PDT occurred in six out of 113 patients (5.3%), five of which occurred in patients not receiving antibiotics (9.2%). Unexpected bacteraemia (positive pre-and post PDT blood cultures) was identified in five patients, two of whom were on antibiotic therapy. The incidence of bacteraemia following a single stage PDT was similar to other manipulations of the aerodigestive tract such as intubation, insertion of an LMA or tooth brushing. We suggest that routine antibiotic prophylaxis is unnecessary for this procedure.

Diagnosis of catheter-related bacteraemia: a prospective comparison of the time to positivity of hub-blood versus peripheral-blood cultures

A method of diagnosing catheter-related infection (CRI) without removing the catheter would be useful. An earlier positivity of central compared with peripheral venous-blood cultures may be associated with catheter-related bacteraemia. We evaluated prospectively the differential time to positivity (DTP) of paired blood cultures drawn simultaneously via the catheter hub and from a peripheral venous site. Over a 14-month period in an intensive-care unit of a cancer referral centre, simultaneous hub-blood and peripheral-blood cultures (a mean of two per patient) were obtained from patients with a suspected CRI. According to clinical criteria and quantitative culture of the catheter tip, cases were classified as CRI or sepsis of other origin. At least one pair of hub-blood and peripheral-blood cultures was obtained within 48 h before catheter removal, and we recorded the DTP between hub-blood and peripheral-blood cultures with an automatic device for detection of blood culture positivity. We analysed 93 catheters removed because of suspicion of CRI. In 28 episodes, the same micro-organisms were found in both hub-blood and peripheral-blood cultures. A diagnosis of definite bacteraemic CRI was made in 16 of the 17 patients in whom a positive hub-blood culture was detected at least 2 hours earlier than peripheral-blood culture. About half (9/17) of these episodes occurred in long-term (>30 days) devices. CRI was excluded in ten of the 11 patients with a DTP lower than 2 h. The DTP of paired blood cultures was significantly greater in patients with CRI than in others (p<10(-4)). A cut-off DTP value of 120 min had 91% specificity and 94% sensitivity for the diagnosis of CRI. Three of 17 episodes with only hub-blood culture positive were associated with CRI. This prospective study suggests that measurement of the differential time to positivity between hub-blood and peripheral-blood cultures is a simple and reliable tool for in-situ diagnosis of catheter-related sepsis in cancer patients. Further studies are needed to confirm these data for short-term catheters.

Differential secretion of chemokines from peripheral blood in pregnant compared with non-pregnant women

The maintenance of a normal pregnancy is dependent on the delicate interaction between the endocrine and the immune systems. Cytokines are thought to play a key role in pregnancy by way of local modulation of the immune system at the level of peripheral leukocytes. This study examined the potential of peripheral venous blood cultures from pregnant women throughout gestation and from non-pregnant women to produce the chemokines monocyte chemotactic protein-1 (MCP-1), interleukin-8 (IL-8) and RANTES. Significantly ( P=<0.001), higher levels of MCP-1 were released from peripheral blood cultures from pregnant women at term than during the first trimester or from women who were not pregnant. This could not be accounted for by differences in differential blood counts. Significantly higher levels ( P=<0.05) of MCP-1 were released from PBMC preparations from pregnant compared with non-pregnant women. No `rebound' increase in MCP-1 was observed on withdrawing progesterone support to the PBMC preparations. MCP-1 was secreted predominately from CD14 + cells with those from pregnant women producing more than those from non-pregnant women. There was no statistical difference in release of IL-8 or RANTES from either peripheral blood or PBMC preparations from pregnant or non-pregnant women. IL-8 and RANTES were secreted from CD14 + and CD14 − cells, respectively. The hypothesis proposed is that the monocytes are fundamentally different in pregnancy and that measurement of MCP-1 has the potential to act as a marker of pregnancy status.

Clinical Predictors of Infection of Central Venous Catheters Used for Total Parenteral Nutrition

To identify predictors of infection in catheters used for total parenteral nutrition (TPN), clinical and microbiological data were prospectively collected on 169 catheter systems (88 patients). Based on semiquantitative catheter cultures, infection was associated with a positive insertion site skin culture taken close to the time of catheter removal (relative risk [RR] = 4.50), especially one yielding greater than or equal to 50 colonies of an organism other than coagulase-negative staphylococci. Infection was also associated with erythema at the insertion site greater than 4 mm in diameter (RR = 2.93). In a subset of 67 catheters for which blood cultures were obtained, infection was also associated with a positive peripheral venous blood culture (RR = 5.90) and a positive central venous blood culture obtained through the catheter (RR = 5.44). Based on a logistic regression model, periodic cultures of the insertion site should be useful in evaluating subsequent fever in stable patients with indwelling central venous catheters. Another source of fever is likely if inflammation is absent and there is either no colonization or there is colonization by less than 50 colonies of coagulase-negative staphylococci at the insertion site. Conversely, the catheter should be removed and cultured semiquantitatively if the site is colonized by an organism other than coagulase-negative staphylococci. We suggest that blood culture results add little to the risk estimate in these situations.

Clinical Predictors of Infection of Central Venous Catheters Used for Total Parenteral Nutrition

To identify predictors of infection in catheters used for total parenteral nutrition (TPN), clinical and microbiological data were prospectively collected on 169 catheter systems (88 patients). Based on semiquantitative catheter cultures, infection was associated with a positive insertion site skin culture taken close to the time of catheter removal (relative risk [RR] = 4.50), especially one yielding greater than or equal to 50 colonies of an organism other than coagulase-negative staphylococci. Infection was also associated with erythema at the insertion site greater than 4 mm in diameter (RR = 2.93). In a subset of 67 catheters for which blood cultures were obtained, infection was also associated with a positive peripheral venous blood culture (RR = 5.90) and a positive central venous blood culture obtained through the catheter (RR = 5.44). Based on a logistic regression model, periodic cultures of the insertion site should be useful in evaluating subsequent fever in stable patients with indwelling central venous catheters. Another source of fever is likely if inflammation is absent and there is either no colonization or there is colonization by less than 50 colonies of coagulase-negative staphylococci at the insertion site. Conversely, the catheter should be removed and cultured semiquantitatively if the site is colonized by an organism other than coagulase-negative staphylococci. We suggest that blood culture results add little to the risk estimate in these situations.