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Infections caused by aterial catheters used for hemodynamic monitoring
Abstract:
Utilizing a semiquantitative technique for culturing vascular catheters, we prospectively studied the risk and profile of infection caused by arterial catheters used for hemodynamic monitoring in 95 patients with a high risk of nosocomial infection. Of 130 catheters, 23 (18 per cent) produced local infection (larger than or equal to 15 colonies on semi-quantitative culture) and five septicemia (4 per cent). Sixteen of the 23 local infections and all septicemias occurred with catheter placements exceeding four days (p less than 0.001). Other factors associated with an increased risk of infection included insertion by surgical cut-down rather than percutaneously (ninefold increased rate of bacteremia, p = 0.008) and the presence of local inflammation (12-fold increase, p = 0.009). Systemic antimicrobial therapy (given to 80 per cent of the entire group and to four of the five with septicemia) did not protect against catheter-related infection but may account for the predominance of enterococci, Candida and gram-negative bacilli in these infections. Twelve per cent of all nosocomial bacteremias occurring in this critical care unit population originated from an arterial catheter. Indwelling arterial catheters pose a significant risk of bacteremic infection to ctirically ill patients. The percutaneous mode of placement is preferred; when prolonged arterial cannulation is required, the site should be rotated every four days. Local pain or inflammation, or clinical signs of sepsis without an obvious source should prompt removal and culture of the catheter.
Insights
Arterial catheters in critically ill patients pose a significant risk of infection, especially after four days. Percutaneous insertion and frequent site rotation are recommended to reduce nosocomial infections.
Area of Science:
- Infectious Diseases
- Critical Care Medicine
- Medical Device Infections
Background:
- Nosocomial infections are a major concern in intensive care units.
- Vascular catheters, particularly arterial catheters, are essential for hemodynamic monitoring in critically ill patients.
- The risk of infection associated with indwelling arterial catheters requires careful evaluation.
Purpose of the Study:
- To prospectively investigate the risk and profile of infections associated with arterial catheters used for hemodynamic monitoring.
- To identify risk factors for catheter-related infections in high-risk patients.
- To determine the contribution of arterial catheters to overall nosocomial bacteremia.
Main Methods:
- Prospective study involving 95 high-risk patients requiring hemodynamic monitoring via arterial catheters.
- Semiquantitative culturing technique used to assess catheter tip colonization and infection.
- Analysis of patient data to identify factors associated with increased infection risk.
Main Results:
- 18% of catheters (23/130) resulted in local infection, and 4% (5/130) led to septicemia.
- Infections were significantly more common with catheter dwell times exceeding four days (p < 0.001).
- Factors increasing infection risk included surgical cut-down insertion (9-fold increase in bacteremia) and local inflammation (12-fold increase).
Conclusions:
- Indwelling arterial catheters present a significant bacteremic infection risk in critically ill patients.
- Percutaneous insertion and catheter site rotation every four days are recommended to minimize infection.
- Arterial catheters were the source of 12% of nosocomial bacteremias in this critical care unit population.