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Published on: January 7, 2019
Density of microbial colonization on external and internal surfaces of concurrently placed intravascular devices
David Boon Chai Koh1, Iain Kilpatrick Robertson, Marianne Watts
1Launceston General Hospital, School of Human Life Sciences, University of Tasmania, Australia. dkoh@utas.edu.au
Background:
Intravascular devices provide essential vascular access for management of critically ill patients but can be associated with bloodstream infections.
Objectives:
To determine colonization rates in segments of concurrently placed peripheral arterial, nontunnelled short-term central venous catheters and peripherally inserted central catheters and the pattern of heaviest colonization when the catheters are removed.
Methods:
A prospective study was conducted on inpatients with intravascular devices in place for 9 days or more. At removal, each catheter was cut into 3 segments, and each segment was cultured separately. The density of colonization on external and internal surfaces of each segment was compared by estimating odds ratios by repeated-measures ordinal logistic regression.
Results:
A total of 48 peripheral arterial, 135 central venous, and 106 peripherally inserted central catheters were obtained from 289 patients. Colonization was greatest at the proximal external segment of all catheters. On the external surface, colonization was lower on the middle (odds ratio, 0.70; P < .001) and distal (odds ratio, 0.56; P < .001) segments than on the proximal segments. On the internal surface, colonization was lower on the proximal (odds ratio, 0.39; P < .001), middle (odds ratio, 0.30; P < .001), and distal (odds ratio, 0.31; P < .001) segments than on the external proximal segments. This trend was similar for all catheter types.
Conclusion:
Colonization of intravascular devices was heaviest on proximal segments.
Insights
Intravascular device colonization, including central venous catheters and peripherally inserted central catheters, is heaviest on proximal segments. This finding is crucial for understanding and preventing bloodstream infections in critically ill patients.
Area of Science:
- Medical Devices
- Infectious Diseases
- Clinical Microbiology
Background:
- Intravascular devices are vital for critically ill patients but pose a risk of bloodstream infections.
- Understanding catheter colonization patterns is key to infection prevention.
Purpose of the Study:
- To assess colonization rates in different segments of peripheral arterial, central venous, and peripherally inserted central catheters.
- To identify the pattern of heaviest colonization upon catheter removal.
Main Methods:
- Prospective study of inpatients with intravascular devices for ≥9 days.
- Catheters were divided into three segments upon removal and cultured separately.
- Colonization density on internal and external surfaces was compared using logistic regression.
Main Results:
- Colonization was most significant on the proximal external segment across all catheter types.
- External surface colonization decreased from proximal to middle and distal segments.
- Internal surface colonization was lower across all segments compared to the external proximal segment.
Conclusions:
- The proximal segment of intravascular devices exhibits the heaviest colonization.
- This highlights the importance of focusing on proximal catheter segments for infection control strategies.
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