title: Development of bacteraemia or fungaemia after removal of colonized central venous catheters in patients with negative concomitant blood cultures.
abstract: There are limited data on the clinical significance of positive central venous catheter (CVC) tip cultures associated with concomitant negative blood cultures performed at the time of CVC removal. A retrospective cohort study of all patients who yielded isolated positive CVC tip cultures was conducted in a tertiary-care hospital with 2200 beds during a 10-year period. All patients with isolated positive CVC tip cultures were observed for the development of subsequent bacteraemia or fungaemia between 2 and 28 days after CVC removal. An isolated positive CVC tip culture was defined as a case in which (i) a CVC tip culture yielded > or = 15 colonies using a semiquantitative culture method and (ii) at least two sets of blood samples revealed no organism at, or close to, the time of CVC removal (48 h before to 48 h after CVC removal). During the study period, 312 patients with isolated positive CVC cultures were enrolled. Eight (2.6%; 95% CI 1.2-5.1) of the 312 patients yielding isolated bacterial or fungal CVC tip cultures developed subsequent bloodstream infection (BSI) caused by the same species as that isolated from the tip culture (Staphylococcus aureus, 1: Enterococcus spp.; 2: Pseudomonas aeruginosa; and 3: Candida spp.). Among 125 patients from whose CVC tips the above four organisms were grown, seven (12.3%) of 57 patients who did not receive appropriate antibiotic therapy within 48 h after CVC removal subsequently developed BSI, but only one (1.5%) of 68 patients who did receive appropriate therapy developed BSI (OR 0.11, p 0.02).
authors.affiliation: Department of Infectious Diseases, Asan Medical Centre, University of Ulsan College of Medicine, University of Ulsan, Seoul, Korea.
authors.forename: K-H
authors.initials: KH
authors.lastname: Park
authors.forename: S-H
authors.initials: SH
authors.lastname: Kim
authors.forename: E H
authors.initials: EH
authors.lastname: Song
authors.forename: E-Y
authors.initials: EY
authors.lastname: Jang
authors.forename: E J
authors.initials: EJ
authors.lastname: Lee
authors.forename: Y P
authors.initials: YP
authors.lastname: Chong
authors.forename: S-H
authors.initials: SH
authors.lastname: Choi
authors.forename: S-O
authors.initials: SO
authors.lastname: Lee
authors.forename: J H
authors.initials: JH
authors.lastname: Woo
authors.forename: Y S
authors.initials: YS
authors.lastname: Kim
mesh_terms: D000368:Aged; D016470:Bacteremia / Q000453:epidemiology*; D001769:Blood / Q000382:microbiology*; D002175:Candida / Q000302:isolation & purification; D055499:Catheter-Related Infections / Q000453:epidemiology*; D002405:Catheterization, Central Venous / Q000009:adverse effects*; D057785:Catheters / Q000382:microbiology; D015331:Cohort Studies; D016983:Enterococcus / Q000302:isolation & purification; D005260:Female; D016469:Fungemia / Q000453:epidemiology*; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D011550:Pseudomonas aeruginosa / Q000302:isolation & purification; D012189:Retrospective Studies; D013211:Staphylococcus aureus / Q000302:isolation & purification