title: Positive tip cultures and related risk factors associated with intravascular catheterization in pediatric cardiac patients.
abstract: The incidence and risk factors of positive catheter tip cultures were studied prospectively in 392 consecutive children undergoing cardiac surgery under cover of cephalothin prophylaxis. A total of 1649 catheter tips were cultured and 58 (3.5%) yielded positive cultures. Specifically, the incidence of positive catheter tip cultures for iv, central venous, arterial and pulmonary arterial (PA) catheters was 0.9%, 5.9%, 3.9% and 10.6%, respectively, whereas one of the six surgically placed venous and arterial catheters had a positive tip culture and none of the 279 transthoracic catheters. Staphylococcus epidermidis was isolated from 79% of the positive tip cultures. Ten percent of the children had one or more positive tip cultures but none developed catheter-related septicemia or endocarditis. Stepwise logistic regression analysis revealed that longer in situ time (p less than .001), younger age (p less than .001), and inotropic support (p = .003) were significant independent predictors of risk for children developing positive catheter tip cultures. The safe in situ period for arterial, central venous, and PA catheters is 3 days in infants under 1 yr and 4 and 6 days for arterial and central venous catheters, respectively, in older children, if 0.95 cumulative probability of remaining free of a positive tip culture is accepted. The data generally support the bacteriologic safety of invasive hemodynamic monitoring in infants and children undergoing cardiac surgery.
authors.affiliation: Department of Cardiac Anesthesiology, University Hospital Utrecht, The Netherlands.
authors.forename: J
authors.initials: J
authors.lastname: Damen
authors.forename: I
authors.initials: I
authors.lastname: Van der Tweel
mesh_terms: D000293:Adolescent; D000367:Age Factors; D006328:Cardiac Catheterization / Q000009:adverse effects; D006348:Cardiac Surgical Procedures; D002404:Catheterization / Q000009:adverse effects*; D002408:Catheters, Indwelling / Q000009:adverse effects*; D002648:Child; D002675:Child, Preschool; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007239:Infections / Q000209:etiology*; D011183:Postoperative Complications / Q000209:etiology; D011446:Prospective Studies; D012307:Risk Factors; D013212:Staphylococcus epidermidis / Q000302:isolation & purification