ABSTRACT
OBJECTIVE: To assess the incidence and etiology of colonization and infection of pulmonary artery catheters inserted in cardiac surgery patients. To determine the influence of some variables on the risk of developing pulmonary artery catheter colonization and infection. DESIGN: Prospective observational study of pulmonary artery catheters inserted into the internal jugular vein that were in place for >48 hrs over a 13-month period. Data collected included age, gender, nature of the cardiac surgery intervention, duration of extracorporeal circulation, date of insertion and removal, subsequent infection, and curative antimicrobial therapy. End points were pulmonary artery catheter colonization with >or=10(3) colonies on quantitative cultures and pulmonary artery catheter-related bacteremia. Risk factors for colonization were determined by multiple logistic regression. SETTING: A 17-bed cardiac surgery intensive care unit in a 480-bed teaching hospital in Paris. PATIENTS: Patients undergoing cardiac surgery procedures between May 1, 1997, and May 31, 1998. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Of 164 pulmonary artery catheters inserted in 157 patients, 19 (11.6%) and 1 (0.6%) were associated with colonization (mean duration of catheterization, 7.5 +/- 2.8 days) and bacteremia, respectively. These data represent an incidence of 17.7 and 0.93 episodes per 1000 catheterization-days, respectively. Pulmonary artery catheter colonization was caused by Gram-positive cocci in 48% (67% were coagulase-negative staphylococci), Gram-negative rods in 48%, and Candida albicans in 4%. From multivariate analysis, >4 days of catheterization was the single variable associated with a significantly increased risk of pulmonary artery catheter colonization (odds ratio, 9.81; 95% confidence interval, 1.24-77.5, p = .03). CONCLUSIONS: Our data show that the risk of pulmonary artery catheter-related colonization and bacteremia is quite low despite the use of a high-risk insertion site. In cardiac surgery patient populations, a trial evaluating the impact of a systematic pulmonary artery catheter removal after 4 days is warranted.
Subject(s)
Bacteremia/epidemiology , Bacteria/isolation & purification , Catheterization, Peripheral/adverse effects , Intensive Care Units , Bacteremia/etiology , Equipment Contamination , Female , Heart Diseases/surgery , Humans , Incidence , Logistic Models , Male , Middle Aged , Paris/epidemiology , Postoperative Complications/etiology , Prospective Studies , Pulmonary Artery , Risk FactorsABSTRACT
OBJECTIVE: To assess methicillin-resistant Staphylococcus aureus (MRSA) nosocomial acquisition and carrier state in a wound care center. DESIGN AND SETTING: The results of an intervention to control MRSA were compared with those of historical controls at the wound care center of university-based Hôpital Broussais, Paris, France. PATIENTS: Patients admitted for specific care of chronic ulcers and surgical wounds. MAIN OUTCOME MEASURES: Incidence rates of MRSA carriers and acquisition in wounds. RESULTS: Of 88 patients admitted during a 3-month preintervention period in 1993, 18 (21%) were MRSA carriers. Of 334 patients admitted in 1994 and 395 in 1996, 65 (19.5%) and 81 (20.5%) were MRSA carriers, respectively (P=.80). In 1993, 6 (9%) of 70 patients without MRSA acquired MRSA wound infections; the corresponding numbers were 6 (2.2%) of 269 in 1994 and 3 (0.9%) of 314 in 1996. Despite that the number of MRSA carriers remained stable at admission to the wound care center, the rate of MRSA infections in wounds per 100 noncarriers decreased significantly between the preintervention period and subsequent years: 1994 (P=.02) and 1996 (P=.002). CONCLUSIONS: Although our results are limited by the use of historical controls, they showed that simple infection control measures, such as the use of soap and water and barrier precautions associated with staff education, seemed to significantly reduce MRSA infection rates in patients with chronic skin breaks.
