The routine microbiological screening of central venous catheters in home parenteral nutrition patients.
OBJECTIVE
Catheter-related bloodstream infection (CRBSI) is a major complication for patients receiving home parenteral nutrition (HTPN). Endoluminal sampling techniques allow the diagnosis of CRBSI without catheter removal and may allow the screening of asymptomatic patients.


METHODS
Over a 5-year period, patients receiving HTPN were offered screening on a 3 monthly basis. All patients had tunnelled cuffed Hickman lines. All were asymptomatic at the time of screening, which took the form of either endoluminal brushing or quantitative cultures on through-line blood.


RESULTS
Thirty-two patients were suitable for inclusion within the study period (10 male, median age 51 (iqr 46-61)) years with 30 of these having a least one screening performed. Four had positive screening results and underwent appropriate treatment. Of the remainder, 12 presented with at least one clinical episode of CRBSI and 14 had neither clinical CRBSI nor a positive screening result. The combined clinical and screening CRBSI rate was 0.39 episodes per catheter year.


CONCLUSIONS
Although routine microbiological catheter screening can detect subclinical infections in HTPN patients the positive rate is low with the majority of patients still presenting clinical. Identification of higher risk patients and appropriate alterations to screening frequency may improve its value further.
Catton
James A
JA
Academic Unit of Surgery, The General Infirmary at Leeds, Great George Street, Leeds LS1 3EX, UK.
Dobbins
Brian M
BM
Wood
Jonathan M
JM
Kite
Peter
P
Burke
Dermot
D
McMahon
Michael J
MJ
D002177:Candidiasis / Q000175:diagnosis; D002405:Catheterization, Central Venous / Q000009:adverse effects* / Q000295:instrumentation; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D016562:Parenteral Nutrition, Home Total / Q000009:adverse effects*; D018805:Sepsis / Q000175:diagnosis* / Q000209:etiology / Q000382:microbiology*; D013203:Staphylococcal Infections / Q000175:diagnosis / Q000188:drug therapy; D014640:Vancomycin / Q000627:therapeutic use
D014640:Vancomycin