The microbiological and clinical outcome of guide wire exchanged versus newly inserted antimicrobial surface treated central venous catheters

Critical Care

Michael Bailey³  Paul DR Johnson¹  Neil J Glassford³  Antoine G Schneider²  Rinaldo Bellomo³  Norelle Sherry¹  Nisha Parbat² 

[1] Departments of Microbiology and Infectious Diseases, Austin Hospital, Heidelberg, Melbourne, VIC, Australia;Department of Intensive Care, Austin Hospital, Heidelberg, Melbourne, VIC, Australia;ANZIC Research Centre, School of Public Health & Preventive Medicine, Monash University and Department of Medicine, The University of Melbourne, Melbourne, VIC, Australia

关键词: Gram negative bacteria;    intensive care;    bacteraemia;    sepsis;    catheter related blood stream infection;    central venous catheters;   

Others  :  817885
DOI  :  10.1186/cc12867

 received in 2013-03-15, accepted in 2013-09-03,  发布年份 2013

【 摘 要 】

Introduction

The management of suspected central venous catheter (CVC)-related sepsis by guide wire exchange (GWX) is not recommended. However, GWX for new antimicrobial surface treated (AST) triple lumen CVCs has never been studied. We aimed to compare the microbiological outcome of triple lumen AST CVCs inserted by GWX (GWX-CVCs) with newly inserted triple lumen AST CVCs (NI-CVCs).

Methods

We studied a cohort of 145 consecutive patients with GWX-CVCs and contemporaneous site-matched control cohort of 163 patients with NI-CVCs in a tertiary intensive care unit (ICU).

Results

GWX-CVC and NI-CVC patients were similar for mean age (58.7 vs. 62.2 years), gender (88 (60.7%) vs. 98 (60.5%) male) and illness severity on admission (mean Acute Physiology and Chronic Health Evaluation (APACHE) III: 71.3 vs. 72.2). However, GWX patients had longer median ICU lengths of stay (12.2 vs. 4.4 days; P < 0.001) and median hospital lengths of stay (30.7 vs. 18.0 days; P < 0.001). There was no significant difference with regard to the number of CVC tips with bacterial or fungal pathogen colonization among GWX-CVCs vs. NI-CVCs (5 (2.5%) vs. 6 (7.4%); P = 0.90). Catheter-associated blood stream infection (CA-BSI) occurred in 2 (1.4%) GWX patients compared with 3 (1.8%) NI-CVC patients (P = 0.75). There was no significant difference in hospital mortality (35 (24.1%) vs. 48 (29.4%); P = 0.29).

Conclusions

GWX-CVCs and NI-CVCs had similar rates of tip colonization at removal, CA-BSI and mortality. If the CVC removed by GWX is colonized, a new CVC must then be inserted at another site. In selected ICU patients at higher central vein puncture risk receiving AST CVCs GWX may be an acceptable initial approach to line insertion.

【 授权许可】

   
2013 Parbat et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

Figure 2.

【 参考文献 】

• [1]Maki DG: Nosocomial bacteremia. An epidemiologic overview. Am J Med 1981, 70:719-732.
• [2]Craven DE, Kunches LM, Lichtenberg DA, Kollisch NR, Barry MA, Heeren TC, McCabe WR: Nosocomial infection and fatality in medical and surgical intensive care patients. Arch Intern Med 1988, 148:1161-1168.
• [3]Kaye CG, Smith DR: Complications of central venous cannulation. BMJ 1988, 297:572-573.
• [4]Safdar N, Makdi DG: The pathogenesis of catheter-related bloodstream infection with noncuffed short-term central venous catheters. Intensive Care Med 2004, 30:62-67.
• [5]Patil HV, Patil VC, Ramteerthkar MN, Kulkarni RD: Central venous catheter-related bloodstream infections in the intensive care unit. Indian J Crit Care Med 2011, 15:213-223.
• [6]Pittet D, Tarara D, Wenzel R: Nosocomial bloodstream infection in critically ill patients: excess length of stay, extra costs, and attributable mortality. JAMA 2004, 271:1598-1601.
• [7]Cobb D, High K, Sawyer R: A controlled trial of scheduled replacement of central venous and pulmonary artery catheters. N Engl J Med 1992, 327:1062-1068.
• [8]Cook D, Randolph A, Kernerman P, Cupido C, King D, Soukup C, Brun-Buisson C: Central venous catheter replacement strategies: a systematic review of the literature. Crit Care Med 1997, 25:1417-1424.
• [9]Timsit JF: Scheduled replacement of central venous catheters is not necessary. Infect Control Hosp Epidemiol 2000, 21:371-374.
• [10]Jeske C, Raedler C, von Goedecke A, Mayr A, Hinterberger G, Aspoeck Ch, Lass-Floerl C, Benzer A: Early identification of bacteria leading to central venous catheter contamination. Anesth Analg 2003, 97:940-943.
• [11]Casey J, Davies J, Balshaw-Greer A, Taylor N, Crowe AV, McClelland P: Inserting tunnelled hemodialysis catheters using elective guidewire exchange from nontunnelled catheters: is there a greater risk of infection when compared with new-site replacement? Haemodial Int 2008, 12:52-54.
• [12]Cahill SL, Benotti PN: Catheter infection control in parenteral nutrition. Nutr Clin Pract 1991, 6:65-67.
• [13]Mermel L, Farr B, Sherertz R, Raad II, O'Grady N, Harris JS, Craven DE, Infectious Diseases Society of America; American College of Critical Care Medicine; Society for Healthcare Epidemiology of America: Guidelines for management of intravascular catheter- related infections. Clin Infect Dis 2001, 32:1249-1272.
• [14]Pagani JL, Eggimann P: Management of catheter-related infection. Expert Rev Anti Infect Ther 2008, 6:31-37.
• [15]Castelli GP, Pognani C, Stuani A, Cita M, Paladini R: Central venous catheter replacement in the ICU: new site versus guidewire exchange. Minerva Anestesiol 2007, 73:267-273.
• [16]Newsome HH Jr, Armstrong CW, Mayhall GC, Sugerman HJ, Miller K, Rich A, Dalton H: Mechanical complications from insertion of subclavian venous feeding catheters: comparison of de novo percutaneous venepuncture to change of catheter over guidewire. JPEN J Parenter Enteral Nutr 1984, 8:560-562.
• [17]Milner P: Complications of pulmonary artery balloon flotation catheters. Lancet 1983, 1:37-38.
• [18]Mitchell SE, Clark RA: Complications of central venous catheterisation. Am J Roentgenol 1979, 133:467-476.
• [19]Borja AR: Current status of infraclavicular subclavian vein catheterisation. Ann Thorac Surg 1972, 13:615-624.
• [20]Pettigrew RA, Lang SD, Haydock DA, Parry BR, Bremner DA, Hill GL: Catheter-related sepsis in patients on intravenous nutrition: a prospective study of quantitative catheter cultures and guidewire changes for suspected sepsis. Br J Surg 1985, 72:52-55.
• [21]Robinson D, Suhocki P, Schwab S: Treatment of infected tunnelled venous access haemodialysis catheters with guidewire exchange. Kidney Int 1998, 53:1792-1794.
• [22]Snyder RH, Archer FJ, Endy T, Allen TW, Condon B, Kaiser J, Whatmore D, Harrington G, McDermott CJ: Catheter infection: a comparison of two catheter maintenance techniques. Ann Surg 1988, 208:651-653.
• [23]Graeve Ah, Carpenter CM, Schiller WR: Management of central venous catheters using a wire introducer. Am J Surg 1981, 142:752-755.
• [24]Chatzinikolau I, Raad II: Intravascular catheter-related infections: a preventable challenge in the critically ill. Semin Respir Infect 2000, 15:264-271.
• [25]Rupp ME, Lisco SJ, Lipsett PA, Perl TM, Keating K, Civetta JM, Mermel LA, Lee D, Dellinger EP, Donahoe M, Giles D, Pfaller MA, Maki DG, Sherertz R: Effect of a second generation venous catheter impregnated with chlorhexidine and silver sulfadiazine on central catheter-related infections: a randomized, controlled trial. Ann Intern Med 2005, 143:570-580.
• [26]Brun-Buisson C, Doyon F, Sollett JP, Cochard JF, Cohen Y, Nitenberg G: Prevention of intravascular catheter-related infection with newer chlorhexidine-silver sulfadiazine-coated catheters: a randomized controlled trial. Intensive Care Med 2004, 30:837-843.
• [27]Heard SO, Wagle M, Vijayakumar E, McLean S, Brueggemann A, Napolitano LM, Edwards LP, O'Connell FM, Puyana JC, Doern GV: Influence of triple-lumen central venous catheters coated with chlorhexidine and silver sulfadiazine on the incidence of catheter-related bacteremia. Arch Intern Med 1998, 158:81-87.
• [28]Stow PJ, Hart GK, Higlett T, George C, Herkes R, McWilliam D, Bellomo R, ANZICS Database Management Committee: Development and implementation of a high-quality clinical database: the Australian and New Zealand Intensive Care Society Adult Patient Database. J Crit Care 2006, 21:133-141.
• [29]Pronovost P, Needham D, Berenholtz S, Sinopoli D, Chu H, Cosgrove S, Sexton B, Hyzy R, Welsh R, Roth G, Bander J, Kepros J, Goeschel C: An intervention to decrease catheter-related bloodstream infections in the ICU. N Engl J Med 2006, 355:2725-2732. Erratum in N Engl J Med 2007, 356:2660
• [30]Michel LA, Bradpiece HA, Randour P, Pouthier F: Safety of central venous catheter change over a guidewire for suspected catheter related sepsis. A prospective randomised trial. Int Surg 1988, 73:180-186.
• [31]Hilton E, Haslett TM, Borenstein MT, Tucci V, Isenberg HD, Singer C: Central catheter infections: single versus triple lumen catheters. Influence of guidewires on infection rates when used for replacement of catheters. Am J Med 1988, 84:667-672.
• [32]Almuneef MA, Memish ZA, Blakhy HH, Hijazi O, Cunningham G, Francis C: Rate, risk factors and outcomes of catheter-related bloodstream infection in a paediatric intensive care unit in Saudi Arabia. J Hosp Infect 2006, 62:207-213.
• [33]O'Grady NP, Alexander M, Burns LA, Dellinger EP, Garland J, Heard SO, Lipsett PA, Masur H, Mermel LA, Pearson ML, Raad II, Randolph AG, Rupp ME, Saint S, Healthcare Infection Control Practices Advisory Committee (HICPAC):: Summary of recommendations: guidelines for the prevention of intravascular catheter-related infections. Clin Infect Dis 2011, 52:1087-1099.
• [34]Erbay A, Ergonul O, Stoddard GJ, Samore MH: Recurrent catheter-related bloodstream infections: risk factors and outcome. Int J Infect Dis 2006, 10:396-400.
• [35]Garnacho-Montero J, Aldabó-Pallás T, Palomar-Martínez M, Vallés J, Almirante B, Garcés R, Grill F, Pujol M, Arenas-Giménez C, Mesalles E, Escoresca-Ortega A, de Cueto M, Ortiz-Leyba C: Risk factors and prognosis of catheter-related bloodstream infection in critically ill patients: a multicenter study. Intensive Care Med 2008, 34:2185-2193.
• [36]Conrick-Martin I, O'Gorman J, Lenehan D, Oshodi D, Scanlon N, O'Brien S, Hannan M, Lynch M, Carton E: Nosocomial infections in a cohort of extracorporeal life support patients. Crit Care Resusc 2012, 14:198-201.
• [37]Mullany DV, Bull TN, Hunt W, Shekar K, Thomson B, Fraser JF, Ziegenfuss M: Outcomes of the first 30 cases of an adult extracorporeal membrane oxygenation program: strategies to manage the "learning curve" and implications for intensive care unit risk adjustment models. Crit Care Resusc 2012, 14:119-129.