Microbiological characteristics of catheter-related bacteremia in a Tunisian intensive care unit

ABSTRACT

Prevalence of catheter-related bacteremia in intensive care units is increasing as central venous catheters [CVC] are used more frequently. In the most of the published literature, Gram positive cocci are the leading cause of catheter-related bacteremia and the systemic empiric treatment recommended include the administration of glycopeptides. To search for the microbiological characteristics of catheterrelated bacteremia in a Tunisian ICU. Prospective observational cohort survey conducted in the ICU of the Habib Bourguiba university hospital, Tunisia [a 22 bed medical-surgical intensive care unit]. We had included all patients admitted to the unit over the study period [from August 1[st], 2001 to March 31[st], 2002], and who submitted to a central venous catheter for more than 24 hours. Catheter-tip specimens were cultured using a semiquantitative method. During the study period 218 central venous catheters [CVC] were assessed. The mean length of time the catheter was kept in place was 8 +/- 6.7 days [range; 2 and 46 days]. The CVC insertion site was the subclavian vein in 156 cases [71.6%], the jugular vein in 35 cases [16%], and the femoral vein in 27 cases [12.4%]. Seventy four catheters [33.9%] were removed because of suspicion of catheterrelated sepsis. The catheter-related bacteremia rate was 6.1 infections/1000 days-CVC. Unlike Gram-positive cocci which caused only one case of catheter-related bacteremia, Gram-negative rods, namely Klebsiella pneumoniae and Serratia marcescens were responsible for 91.7% of cases of catheter-related bacteremia. Our findings translate a specific microbiological flora in our Tunisian intensive care unit and highlight the importance of a treatment strategy based on local epidemiology in patients with catheter related bacteremia