title: [Microbiological findings in children with an indwelling central venous catheter].
abstract: BACKGROUND
  Besides their obvious advantages for the patient, central venous catheters (CVC) also carry the risk of possible infectious complications. The purpose of our investigation was to carry out a microbiological evaluation of a 5-year set of paediatric patients with indwelling CVCs.
  
  
  METHODS
  In the group were 218 CVCs inserted to 165 children over a period of 5 years. There were 26 multi-lumen catheters (11.927 %) and 192 single-lumen catheters (88.073 %). The mean indwelling period was 10.1 days per 1 CVC. Blood for microbiology was removed by a physician from the CVC after disinfecting its opening under standard sterile conditions into a commercial sampling vessel HEMOD (Imuna, Sarisske Michalany, Slovak Republic) or into a vessel of an automated haemoculture system BactecPeds PLUS/F (Becton Dickinson and Comp., Spark,MA, USA). When removing the tip of the CVC we disinfected, before removing the CVC, the area around the insertion with isopropyl or ethyl alcohol. We released the fixed CVC and 1 minute after disinfection we pulled out the CVC and cut off the end or rather the tip of the catheter (approx. 1-3 cm of the tip) into a sterile test tube. To establish the diagnosis of infectious complications we used the 1995 Sirges-Serra classification and the CDC criteria.
  
  
  RESULTS
  In 5 years (1995-1999) we had 71 infectious complications. There were 31 contaminated catheters, 27 cases of catheter sepsis and 11 cases of catheter bacteraemia. With 147 catheters (67.43%) there were no infectious complications. Dominant microbes were Staphylococcus epidermidis (32 cases - 11 from haemocultures and 21 from CVCs) and Candida spp. (30 cases, 17 from haemocultures and 13 from CVCs). Among the microbiological agents of catheter sepsis predominated Gram-negative bacteria. Out of the whole analysed group 41 children (24.8 %) died. CVC as the cause of death was demonstrated in 6 children (3.636 % of patients with CVC).
  
  
  CONCLUSIONS
  Microbiological findings in our group are in line with literary data. To reduce the incidence of infectious complications it is important to limit sampling from CVC to a minimum. Insertion of CVCs under strict sterile conditions and aseptic handling of all entries into the central bloodstream reduces to a minimum the risk of infectious complications.
authors.affiliation: Department of Pediatrics, St. Cyril and Method's Hospital, Bratislava, Slovak Republic. uhermar@hotmail.com
authors.forename: Martin
authors.initials: M
authors.lastname: Uher
authors.forename: Mária
authors.initials: M
authors.lastname: Pisarcíková
authors.forename: Milan
authors.initials: M
authors.lastname: Kurák
authors.forename: Anetta
authors.initials: A
authors.lastname: Cernáková
authors.forename: Viktória
authors.initials: V
authors.lastname: Takácová
authors.forename: Mária
authors.initials: M
authors.lastname: Molokácová
mesh_terms: D016470:Bacteremia / Q000209:etiology; D001419:Bacteria / Q000302:isolation & purification*; D001424:Bacterial Infections / Q000209:etiology* / Q000382:microbiology; D002175:Candida / Q000302:isolation & purification; D002405:Catheterization, Central Venous / Q000009:adverse effects*; D002648:Child; D005260:Female; D006801:Humans; D008297:Male