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Microbiologic risk of invasive hemodynamic monitoring in patients undergoing open-heart operations
Abstract:
The microbiologic risk of invasive hemodynamic monitoring was studied prospectively in 574 patients undergoing open-heart surgery under cover of cephalothin prophylaxis. Of a total of 2277 catheters inserted in these patients, 1.5% yielded positive cultures. The rate of positive cultures was not significantly different between percutaneous and surgically placed catheters (1.7% vs. 0.8%, respectively). Specifically, the incidence of positive catheter tips for intravenous, central venous, arterial, and pulmonary artery catheters was 1.1%, 3.9%, 1.5%, and 2.1%, respectively; while the corresponding rates for surgically inserted right atrial and left atrial catheters were 0.8% and 0, respectively. Pulmonary artery catheters had a significantly (p less than .01) higher incidence of positive catheter tips after 72 h in situ. However, there was no relationship between the in situ time and the incidence of positive tips for arterial and intravenous catheters. Although the rate of positive catheter tip cultures was low, it affected 4.9% of the patients. Nevertheless, no patient developed catheter-related septicemia or endocarditis, and the data generally supported the microbiologic safety of invasive hemodynamic monitoring in patients undergoing open-heart surgery.
Insights
Invasive hemodynamic monitoring in open-heart surgery patients showed a low microbiologic risk, with less than 2% of catheters yielding positive cultures. No patients developed serious infections, supporting the safety of these procedures.
Area of Science:
- Cardiovascular Surgery
- Infectious Diseases
- Medical Devices
Background:
- Invasive hemodynamic monitoring is crucial for managing patients undergoing open-heart surgery.
- Understanding the microbiologic risks associated with these monitoring devices is essential for patient safety.
Purpose of the Study:
- To prospectively evaluate the microbiologic risk of invasive hemodynamic monitoring in patients undergoing open-heart surgery.
- To determine the incidence of positive catheter tip cultures and identify associated risk factors.
Main Methods:
- Prospective study of 574 patients undergoing open-heart surgery.
- Analysis of 2277 inserted catheters (intravenous, central venous, arterial, pulmonary artery, right atrial, left atrial).
- Assessment of catheter tip cultures and correlation with insertion method and in situ time.
Main Results:
- Overall, 1.5% of catheters yielded positive cultures.
- Pulmonary artery catheters showed a higher incidence of positive tips after 72 hours.
- No significant difference in positive culture rates between percutaneous and surgically placed catheters.
- Despite positive cultures in 4.9% of patients, no cases of catheter-related septicemia or endocarditis occurred.
Conclusions:
- Invasive hemodynamic monitoring in open-heart surgery patients, with cephalothin prophylaxis, demonstrates a low microbiologic risk.
- The incidence of catheter-related infections is low, supporting the safety of these monitoring techniques.
- Pulmonary artery catheters may require closer monitoring for potential longer-term colonization.