Infection associated with central venous catheters: a prospective survey

To assess the incidence of local and systemic infection caused by central venous catheters in a general hospital population.

Concord Repatriation General Hospital, Sydney, April to August 1991 inclusive.

A prospective survey of all patients with in situ central venous catheters. Systemic catheter-related infection was detected by blood and routine catheter tip culture, and local infection by clinical observation of the catheter exit site.

Local and systemic infection and complications.

479 central venous catheters were surveyed in 311 patients. Local infection developed in association with 54 catheters (11%) and systemic infection with 32 (6.7%). Local infection was predictive of systemic infection, but its absence did not exclude systemic infection. Haemodialysis catheters were responsible for a higher systemic infection rate than other catheter types, the most common organism responsible being methicillin-resistant Staphylococcus aureus. Twenty per cent of all bacteraemias (33/160) detected in the hospital occurred in patients with a central venous catheter and 24 of these (73%) were definitely or probably due to the catheter. Staphylococci were the predominant isolates and 40% of the methicillin-resistant S. aureus bacteraemias detected were due to catheter-related infection. Infection complications were few: three patients developed local abscesses; one endocarditis; and two died.

Central venous catheter-related infection is common in general hospital populations. Staphylococcal bacteraemia and local infection in a patient with a central venous catheter are strongly suggestive of catheter-related systemic infection. Empirical antibiotic treatment should include at least antistaphylococcal cover.