Central venous catheter-related infections in intensive care units

ABSTRACT

Objective: To determine the rates of colonization and infection related to central venous catheter (CVC), the causative microorganisms, and the influence of various factors. Methods: From June to August 1993, all CVC in 4 Intensive Care Units were evaluated from their insertion to removal. Data were collected, by 3 nurses. Blood and catheter tips were cultured. Results: Of 84 catheters, 29.8 percent were colonized, 9.5 percent of patients showed evidence of local infection, and 4.8 percent had primary bloodstream infections. The internal jugular vein was the most commun site for catheter insertion (81 percent). Causes of removal were end of need (48.3 percent), suspected infection (23.3 percent), malfunction (20 percent), routine change (8.3 percent). Among removals because of suspected infection 50 percent presented evidence of local infection, 43 percent were colonized (>15cfu), but there were no bloodstream infections. The average time of catheter use for those which became colonized was longer than for catheters that did not become colonized (p=0.008). The average time of catheter use associated with removal for infection (local and bloodstream) was longer than for removal for other reasons (p=0.042). Among colonized catheters, 16 percents developed bloodstream infection and 20 percent local infection. Immunosupressive drugs, cancer, diabets mellitus, HIV-infection, and neutropenia were not associated with infection or colonization. The most common microorganisms were gram-negative rods and S.aureus. Conclusions: The duration of venous catheter use increased the risk of colonization and infection. The observation suggests that physicians must strive for the shortest time of use of venous catheters, but it does not indicate a need for routine central venous catheter removal.