Annals of Surgical Treatment and Research

The Korean Surgical Society (대한외과학회)
권호 표지

Clinical Manifestations and Microbiological Features Correlating with Central Venous Catheter Related Infection

중심정맥 카테터를 통한 감염의 임상적 특성 및 세균학적 양상

Mun, Sung-Uk;Jeon, Hyeong-Jin;Ha, Dong-Yeop;Chung, Byung-Ook;Jung, Ho-Geun;Ahn, Woo-Sup;Ha, Gyoung-Yim;Bae, Jong-Dae;Kang, Seon-Hui;Jung, Ki-Hoon
문성욱;전형진;하동엽;정병욱;정호근;안우섭;하경임;배종대;강선희;정기훈

  • Published : 20070500
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Abstract

Purpose: Central venous catheterization is widely used to supply substantial amounts of fluids, total parenteral nutrition and hemodialysis in renal failure patients, as well as for measuring the central venous pressure. The most common complications encountered during central venous catheterization include catheter-related infections and subsequent sepsis. Therefore, when fever exists in patients with a central venous catheter, an immediate blood culture should be performed, and if the fever persists, an infection must be suspected and the catheter immediately removed; a culture of the catheter tip should also be performed. To date, no definite clinical details relating to this matter have been reported. Methods: Between December 2002 and March 2005, a retrospective study was undertaken using the medical records of 85 patients. In those patients where a fever lasted for more than 8 hours, or when catheterization was no longer needed, the catheter tip cultures were sent to the microbiology laboratory. Blood cultures were also performed on 49 patients with a fever. The Chi-square method using the PC SPSS program, with P value less than 0.05 as statically significant. Results: Of the 85 patients where the catheters were removed, significant microorganisms were detected 20 of the 49 with a fever. Only 5 of the remaining 36 patients had their catheters spontaneously removed. Moreover, 14 of the 20 patients with significant microorganisms were found to have kept their catheter in place for more than 14 days. Of the 49 patients with a fever, in who blood cultures were undertaken, 13 showed specific microorganisms, with 6 of these showing the same results for both their blood and catheter tip cultures, which enabled the definite diagnosis of the catheter-related infection and underlying sepsis. Various microorganisms were detected from the catheter tip cultures, including Staphylococcus species the CNS, with S. aureus being the most common, at 61.6%. Conclusion: A central venous catheter should be removed immediately when an infection is suspected, but early broad-spectrum antibiotics therapy should be commenced due to the time required to obtain the culture results. Moreover, even if a fever does not exist in patients with a catheter inserted for more than 14 days, infection and sepsis from the catheter should be of concern, with a more cautious approach being mandatory. (J Korean Surg Soc 2007;72: 403-408)

Keywords

References

  1. Bernard RW, Stahl WM. Subclavian vein catheterizations: a prospective study. Ann Surg 1971;173:184-200 https://doi.org/10.1097/00000658-197102000-00002
  2. Dillon JD, Schaffner W, Van Way III CW, Meng HC. Septicemia and total parenteral nutrition. JAMA 1973;223:1341-4 https://doi.org/10.1001/jama.223.12.1341
  3. Watnick P, Kolter R. Biofilm. City of microbes. J Bacteriol 2000;182:2675-9 https://doi.org/10.1128/JB.182.10.2675-2679.2000
  4. Habash M, Reid G. Microbial biofilms: their development and significance for medical device-related infection. J Clin Phamacol 1999;39:887-98
  5. Aubaniac R. L'injection intraveineuse sousclaviculaire. Advantages et techniques. Press Med 1952;60:1456
  6. Seldinger SL. Catheter replacement of the needle in percutaneous arteriography. Acta Radiol 1953;39:368-76 https://doi.org/10.3109/00016925309136722
  7. Keeri-Szanto M. The subclavian vein, a constant and convenient intravenous injection site. Arch Surg 1956;72:179-81 https://doi.org/10.1001/archsurg.1956.01270190181021
  8. Hernandez D, Diaz F, Suria S, Machado M, Lorenzo V, Losada M, et al. Subclavian catheter-related infection is a major risk factor for the late development of subclavian vein stenosis. Nephrol Dial Transplant 1993;8:227-30
  9. Rowley S, Downing R. Breast 'abscess': an unusual complication of catheterisation of the subclavian vein. Br J Radiol 1987;60:773-4 https://doi.org/10.1259/0007-1285-60-716-773
  10. Ratcliffe FM. Suppurative thrombosis of the superior vena cava: a lethal complication of central venous catheters. Intensive Care Med 1985;11:265-6
  11. Peters JL, Armstrong R. Air embolism occurring as a complication of central venous catheterization. Ann Surg 1987;187:375-8 https://doi.org/10.1097/00000658-197804000-00005
  12. Stuart RK, Shikora SA, Akerman P. Incidence of arrhythmia with central venous catheter insertion and exchange. J Parenter Enteral Nutr 1990;14:152-5 https://doi.org/10.1177/0148607190014002152
  13. Smith BE, Model TH. Complication of subclavian vein catheterization. Arch Surg 1965;90:228-9 https://doi.org/10.1001/archsurg.1965.01320080052011
  14. Estrada V, Gutierrez FM, Cortes M. Budd-Chiari syndrome as a complication of the catheterization of the subclavian vein (letter). Am J Gastroenterol 1991;86:250-1
  15. Krauss D, Schmidt GA. Cardiac tamponade and contralateral hemothorax after subclavian vein catheterization. Chest 1991;99:517-8 https://doi.org/10.1378/chest.99.2.517
  16. Oborin AN, Novak VL. Pneumomediastinum as a complication of subclavian vein puncture. Vrach Delo 1990;2:91
  17. Kang JS, Kim HJ. A clinical review of percutaneous catheterization of subclavian vein. J Korean Surg Soc 1979;21:35-9
  18. Benter T, Teichgraber UKM, Kluhs L, Dorken B. Percutaneous central venous catheterization with a lethal complication. Intensive Care Med 1999;25:1180-2 https://doi.org/10.1007/s001340051034
  19. Bently DW, Lepper MH. Septicemia related to indwelling venous catheter. JAMA 1968;206:1749-52 https://doi.org/10.1001/jama.206.8.1749
  20. Durskin MS, Siegel PD. Bacterial contamination of indwelling intravenous polyethylene catheters. JAMA 1963;185:966-8 https://doi.org/10.1001/jama.1963.03060120076031
  21. Yoon WH, Ha WS, Park ST, Choi SK, Hong SC, Han HS. A clinical review of central venous catheterization. J Korean Surg Soc 1992;43:725-31
  22. Moran JM, Atwood RP, Rowe NI. Clinical and bacteriologic study of infection associated with venous cutdowns. N Engl J Med 1965;272:554-60 https://doi.org/10.1056/NEJM196503182721103
  23. Collins RN, Braun PA. Risk of local and systemic infection with polyethylene intravenous catheters. A prospective study of 213 catheterization. N Engl J Med 1968;279:340-3 https://doi.org/10.1056/NEJM196808152790702
  24. Polderman KH, Girbes AR. Central venous catheter use. Part 2: infectious complications. Intensive Care Med 2002;28:18-28 https://doi.org/10.1007/s00134-001-1156-7
  25. Bernard RW, Stahl WM, Chase Jr RM. Subclavian vein catheterization: a prospective study. II. Infectious complications. Ann Surg 1971;173:191-200 https://doi.org/10.1097/00000658-197102000-00003
  26. Smits H, Freedman LR. Prolonged venous catheterization as a cause of sepsis. N Engl J Med 1967;276:1229-33 https://doi.org/10.1056/NEJM196706012762204
  27. David A, Risitano DC, Mazzeo G, Sinardi L, Venuti FS, Sinardi AU. Central venous catheters and infections. Minerva Anestesiol 2005;71:561-4
  28. Shawn JP, Traves DC, Thomas GG, Timothy LP, Robert GS. Bacteremia associated with central venous catheter. infection is not an independent predictor of outcomes. J Am Coll Surg 2000;190:671-80 https://doi.org/10.1016/S1072-7515(00)00266-0
  29. Ryan Jr JA, Abel RM. Catheter complications of total parenteral nutrition. N Engl J Med 1974;290:757-61 https://doi.org/10.1056/NEJM197404042901401
  30. Thoburn R, Fekety FR, Cluff LE, Melvin VB. Infections acquired by hospitalized patients. Arch Int Med 1968;121:1-10 https://doi.org/10.1001/archinte.121.1.1