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Infection of pulmonary artery catheters. Epidemiologic characteristics and multivariate analysis of risk factors
1Intensive Care Department, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Spain.
Abstract:
Sixty-nine consecutive pulmonary artery catheters (PACs) were prospectively studied in a medical-surgical intensive care unit. Fifteen (21.7 percent) and two (2.9 percent) of the PACs were associated with colonization and bacteremia, respectively. These data represent an incidence of 4.98 and 0.66 episodes per 100 catheterization-days, respectively. Coagulase-negative staphylococci were the most common isolates. The source of the colonizing microorganism was the skin in 56 percent of cases, hubs in 28 percent, and unknown in 16 percent. From multivariate analysis, only more than 5 days of catheterization was significantly associated with a greater risk of colonization. Antimicrobial use was associated with negative cultures. The most useful method to diagnose colonization was the examination of both tip and intradermal segments. In addition, we suggest associate hub cultures when catheter-related bacteremia is suspected. These data may be useful in improving efficacy in the diagnosis and prevention of PAC-related infection.
Insights
Pulmonary artery catheter (PAC) colonization occurred in 21.7% of cases, with longer catheterization (>5 days) increasing risk. Antimicrobial use was linked to negative cultures, aiding infection prevention.
Area of Science:
- Critical Care Medicine
- Infectious Diseases
- Medical Device Infections
Background:
- Pulmonary artery catheters (PACs) are crucial in intensive care but pose infection risks.
- Understanding PAC colonization and bacteremia is vital for patient safety and effective treatment strategies.
Purpose of the Study:
- To determine the incidence of PAC colonization and bacteremia.
- To identify risk factors associated with PAC-related infections.
- To evaluate diagnostic methods for PAC colonization and bacteremia.
Main Methods:
- Prospective study of 69 consecutive PACs in a medical-surgical ICU.
- Analysis of colonization and bacteremia rates per 100 catheterization-days.
- Multivariate analysis to identify significant risk factors for colonization.
Main Results:
- PAC colonization and bacteremia incidence were 21.7% and 2.9%, respectively.
- Coagulase-negative staphylococci were the most frequent isolates.
- Catheterization exceeding 5 days significantly increased colonization risk; antimicrobial use correlated with negative cultures.
Conclusions:
- Prolonged PAC use (>5 days) is a key risk factor for colonization.
- Examining catheter tip and intradermal segments is effective for diagnosing colonization.
- Hub cultures are recommended when catheter-related bacteremia is suspected to improve diagnosis and prevention.