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Bacteraemia related to indwelling central venous catheters: prevention, diagnosis and treatment
N C Weightman1, E M Simpson, D C Speller
1Department of Microbiology, Bristol Royal Infirmary, UK.
Insights
Implementing improved catheter care protocols significantly reduced catheter-related bloodstream infections in immunocompromised children. This study highlights simple diagnostic methods and successful non-removal treatment strategies for these infections.
Area of Science:
- Pediatric Infectious Diseases
- Medical Microbiology
- Hospital Epidemiology
Background:
- Indwelling central venous catheters (CVCs) are crucial for immunocompromised children but pose a risk for infections.
- Catheter colonization and subsequent bloodstream infections are significant complications in this vulnerable population.
Purpose of the Study:
- To prospectively investigate infective episodes in immunocompromised children with CVCs.
- To evaluate the impact of protocol modifications on catheter-related bloodstream infections (CRBSIs).
- To assess the efficacy of a quantitative blood culture technique for diagnosing CRBSI and the success of non-removal eradication strategies.
Main Methods:
- Prospective one-year study of immunocompromised children with CVCs.
- Microbial surveillance of catheter hubs and skin entry sites.
- Implementation of revised catheter care protocols.
- Diagnosis of CRBSI using a pour-plate quantitative blood culture technique.
Main Results:
- Catheter hub contamination was identified as a key factor in catheter colonization.
- A 56.5% reduction in CRBSI incidence was observed after protocol changes (from 5.82 to 2.53 per 1000 catheter days).
- The pour-plate method provided a simple and economical diagnosis of CRBSI.
- All attempts to eradicate CRBSI without catheter removal were successful.
Conclusions:
- Altered protocols for catheter care significantly decrease the incidence of CRBSI in immunocompromised children.
- Quantitative blood cultures offer an effective diagnostic tool for CRBSI.
- Catheter-related bloodstream infections can be successfully treated without catheter removal.
Abstract:
Infective episodes in immunocompromised children with indwelling central venous catheters were studied prospectively for one year. Culture of catheter hubs and skin at catheter entry sites during the first six months suggested that hub contamination was important in the pathogenesis of catheter colonization. The incidence of catheter-related bacteraemia, and possible catheter-related bacteraemia, fell by 56.5% following alterations in the protocol for manipulative care of catheters, from 5.82 per 1000 catheter days in the first six months to 2.53 per 1000 catheter days in the subsequent six months. A firm diagnosis of catheter-related bacteraemia was made simply and economically by a pour-plate quantitative blood culture technique. Attempts at eradication of catheter-related bacteraemia without removal of the catheter were successful in all cases.