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Sonicating multi-lumen sliced catheter tips after the roll-plate technique improves the detection of catheter
María Guembe1, Pablo Martín-Rabadán2, Raquel Cruces1
1Department of Clinical Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Marañón, Madrid, Spain.
Abstract:
The Maki technique is the standard method for detecting catheter tip (CT) colonization. However, some "multi-lumen" catheters finish in a vaulted fornix and end at different distances from the CT. Therefore, we compared the traditional Maki technique with the sonication method using several cross-cut fragments of the CT. Our objective was to assess the yield of the Maki technique followed by sonication in the detection of adult CT colonization and catheter-related bloodstream infection (C-RBSI). For 3 months, we prospectively performed CT cultures of polyurethane catheters from adult patients admitted to our institution. First, we performed CT culture using the Maki technique on blood agar plates and then sonicated small fragments of CTs in 5 ml of BHI followed by culture of 100 μl of the sonicate. We included a total of 252 CVCs, with overall colonization and C-RBSI rates of 14.3% (36/252) and 5.9% (15/252). Of the 36 colonized CVCs, 21 (58.3%) were detected both by Maki and sonication, 6 (16.7%) were detected only by Maki technique, and 9 (25.0%) only by sonication method. Among 15 episodes with concomitant bacteremia, both techniques were positive and concordant in 9 cases (60.0%), the result of the Maki was positive in only 1 (6.7%), and sonication in 5 (33.3%). Our study shows that both techniques are complementary. We recommend sonicating fragments of the CT from patients with bacteremia of unknown origin and a negative CT culture by the Maki technique.
Insights
The sonication method enhances the detection of catheter tip colonization and catheter-related bloodstream infections (C-RBSI) when compared to the traditional Maki technique alone. Combining both methods improves diagnostic yield, especially for complex catheter types.
Area of Science:
- Infectious Diseases
- Clinical Microbiology
- Medical Device Infections
Background:
- The Maki technique is standard for detecting catheter tip colonization.
- Multi-lumen catheters pose challenges due to varied tip placement.
- Limitations exist in accurately identifying catheter colonization with standard methods.
Purpose of the Study:
- To compare the Maki technique with sonication for detecting adult catheter tip colonization.
- To assess the combined yield of Maki technique and sonication for catheter-related bloodstream infection (C-RBSI) detection.
- To evaluate diagnostic accuracy for C-RBSI in patients with unknown bacteremia.
Main Methods:
- Prospective study of 252 central venous catheters (CVCs) over 3 months.
- Catheter tips cultured using the traditional Maki technique.
- Catheter tip fragments were sonicated, and the resulting fluid was cultured.
Main Results:
- Overall colonization and C-RBSI rates were 14.3% and 5.9%, respectively.
- Sonication detected 25.0% of colonized catheters missed by the Maki technique alone.
- Sonication identified 33.3% of C-RBSI cases not detected by the Maki technique.
Conclusions:
- The Maki technique and sonication are complementary methods for diagnosing CVC colonization and C-RBSI.
- Sonication significantly increases the detection rate of catheter colonization and infection.
- Recommend sonication for catheter tips in patients with unexplained bacteremia and negative Maki cultures.
