Colonization and infection of pulmonary artery catheter in cardiac surgery patients: epidemiology and multivariate analysis of risk factors.
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.


METHODS
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.


METHODS
A 17-bed cardiac surgery intensive care unit in a 480-bed teaching hospital in Paris.


METHODS
Patients undergoing cardiac surgery procedures between May 1, 1997, and May 31, 1998.


METHODS
None.


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.
Kac
G
G
Unité d'Hygiène Hospitalière, Hôpital Broussais, Paris, France.
Durain
E
E
Amrein
C
C
Hérisson
E
E
Fiemeyer
A
A
Buu-Hoï
A
A
D016470:Bacteremia / Q000453:epidemiology* / Q000209:etiology; D001419:Bacteria / Q000302:isolation & purification*; D002406:Catheterization, Peripheral / Q000009:adverse effects*; D004866:Equipment Contamination; D005260:Female; D006331:Heart Diseases / Q000601:surgery; D006801:Humans; D015994:Incidence; D007362:Intensive Care Units; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D010297:Paris / Q000453:epidemiology; D011183:Postoperative Complications / Q000209:etiology; D011446:Prospective Studies; D011651:Pulmonary Artery; D012307:Risk Factors