Ultrastructural analysis of indwelling vascular catheters: a quantitative relationship between luminal colonization and duration of placement.
To assess the degree of luminal and extraluminal colonization of long-term central venous catheters (CVC), 359 indwelling silicone CVC from 340 consecutive cancer patients were examined. All CVC were cultured by the roll-plate and sonication quantitative culture techniques. Semiquantitative electron microscopy was done on 39 CVC associated with catheter infections and on 26 culture-negative controls. An additional 10 culture-negative CVC obtained after death were also studied by electron microscopy. Ultrastructural colonization and biofilm formation was universal and quantitatively independent of clinical catheter-related infections. Ultrastructural colonization and biofilm formation was predominantly luminal in long-term CVC (> 30 days). Based on a composite definition, the sensitivity of the roll-plate catheter tip culture was 42%-45% compared with 65%-72% for the sonication of the tip. Colonization of indwelling catheters is universal regardless of culture results. For long-term CVC, colonization becomes predominantly luminal and extraluminal quantitative catheter cultures are of limited diagnostic sensitivity.
Raad
I
I
Department of Medical Specialties, University of Texas M. D. Anderson Cancer Center, Houston 77030.
Costerton
W
W
Sabharwal
U
U
Sacilowski
M
M
Anaissie
E
E
Bodey
G P
GP
D001419:Bacteria / Q000302:isolation & purification / Q000648:ultrastructure; D001424:Bacterial Infections / Q000473:pathology*; D002405:Catheterization, Central Venous; D006801:Humans; D008854:Microscopy, Electron; D008855:Microscopy, Electron, Scanning; D013997:Time Factors