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Catheter materials affect the incidence of late blood-borne catheter infection
J R Mehall1, D A Saltzman, R J Jackson
1Department of Pediatric Surgery, Arkansas Children's Hospital, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA.
Insights
Catheter material impacts infection rates, especially when a fibrin sheath forms. Silastic catheters showed higher infection rates than polyurethane ones with a fibrin sheath, suggesting material influences catheter-related infections.
Area of Science:
- Biomaterials science
- Infectious diseases
- Medical device research
Background:
- Fibrin sheath formation on indwelling catheters significantly enhances bacterial adherence and catheter-related infections (CRI).
- Previous understanding suggested catheter material does not influence late CRI incidence due to the dominant role of the fibrin sheath.
Purpose of the Study:
- To investigate whether catheter material influences the incidence of catheter-related infections in the presence of a fibrin sheath.
- To compare infection rates between silastic catheters (SC) and polyurethane catheters (PC) in a rat model.
Main Methods:
- 276 rats received jugular vein catheters (SC or PC) and were injected with Staphylococcus epidermidis on day 0 or day 10.
- Control groups received sterile saline. Catheters were cultured post-sacrifice to determine CRI.
- Fibrin sheath presence was confirmed via microscopy.
Main Results:
- No significant difference in CRI was observed between SC and PC without a fibrin sheath (day 0).
- With a fibrin sheath (day 10), SC had a significantly higher CRI incidence (31/50) compared to PC (20/62).
- All control catheters remained culture-negative; fibrin sheaths were present on all day 10 catheters.
Conclusions:
- Catheter material significantly affects CRI incidence, even when a fibrin sheath is present.
- Differences in CRI rates may be attributed to variations in fibrin sheath formation or properties on different catheter materials.
Background:
Adherence of bacteria and subsequent catheter-related infections (CRI) are greatly enhanced by the fibrin sheath that develops on indwelling catheters. Since the infection rate of catheters without fibrin sheaths is low and the fibrin sheath mediates bacterial adherence, catheter material is not thought to affect the incidence of late catheter-related infection.
Methods:
A total of 276 rats had catheters placed in the right jugular vein with the proximal end buried subcutaneously to eliminate exit site infection. Rats were divided into two groups: silastic catheters (SC; n = 133) and polyurethane catheters (PC; n = 143). Injections of 1 x 10(8) CFU/mL of Staphylococcus epidermidis were given via the tail vein on either the day of surgery, day 0 (n = 53 SC, n = 51 PC), or on postoperative day 10 (n = 50 SC, n = 62 PC). Thirty animals from each group (SC, PC) received sterile saline injections on day 10 and served as controls. Animals were sacrificed on postinjection day 3. Catheters were removed via the chest and placed into trypticase soy broth. Broth was incubated at 37 degrees C for 48 h. Microscopy for the fibrin sheath was done on 20 randomly selected catheters (10/group). Data were compared using Fisher's exact test, with p < 0.05 considered significant.
Results:
Incidence of CRI was equal prior to the formation of the fibrin sheath, while CRI was significantly higher in silastic catheters in the presence of a fibrin sheath. Without a fibrin sheath (day 0), 8/53 silastic catheters and 3/51 polyurethane catheters were infected (p = NS). With a fibrin sheath (day 10), 31/50 silastic catheters were infected versus 20/62 polyurethane catheters (p < 0.05). Control catheters were all culture negative (30/group). With light microscopy, 20/20 catheters had fibrin sheaths at day 10 with no visible difference between silastic and polyurethane catheters.
Conclusion:
Catheter material does affect the incidence of catheter-related infection even when catheters are coated with a fibrin sheath. This difference may relate to a difference in the fibrin sheath itself as it forms on different catheter materials.
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