title: Prospective, randomised study of selective versus routine culture of vascular catheter tips: patient outcome, antibiotic use and laboratory workload.
abstract: In order to assess the value of vascular catheter tip culture in patients with negative blood cultures, all tip samples from hospitalised patients were prospectively randomised (1:1) to two different routines for processing catheters: culture of all tips (routine A) vs culture only of tips from patients with concomitant bacteraemia or fungaemia (routine B). Over a nine-month period, 426 catheters from 318 patients were randomly assigned to routine A and 429 catheters from 322 patients to routine B (n=40 [corrected] patients). We compared the outcome and costs from both groups. No statistically significant differences were found with respect to demographic data, mortality, hospital stay or antimicrobial use. In non-bacteraemic/fungaemic cases (N=517), days on antimicrobial therapy after catheter withdrawal were significantly higher in patients from group A [10.0 days (interquartile range, IQR): 6.0-14.0] vs 8.0 days (IQR: 4.7-12.2), P=0.03], as was the number of daily defined doses (DDDs) of antimicrobials [10.8 DDDs (IQR: 2.4-26.9) vs 7.5 DDDs (IQR: 1.5-20.0), P=0.03]. Median antimicrobial cost per treated patient was significantly higher in group A: €222.30 (IQR: €20.30-€1,030.60) vs €109.10 (IQR: €10.90-€653.20), P=0.05. If all vascular catheter tips were processed according to routine B, the microbiology laboratory workload would decrease by 77% for the total number of catheters processed. Microbiology laboratories should not routinely culture catheter tips in patients without bacteraemia or fungaemia.
authors.affiliation: Department of Clinical Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Marañón, Universidad Complutense, Madrid, Spain. alfonsperezp@gmail.com
authors.forename: A
authors.initials: A
authors.lastname: Pérez-Parra
authors.forename: M
authors.initials: M
authors.lastname: Guembe
authors.forename: P
authors.initials: P
authors.lastname: Martín-Rabadán
authors.forename: P
authors.initials: P
authors.lastname: Muñoz
authors.forename: A
authors.initials: A
authors.lastname: Fernández-Cruz
authors.forename: E
authors.initials: E
authors.lastname: Bouza
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000191:economics / Q000627:therapeutic use*; D057785:Catheters / Q000382:microbiology*; D002648:Child; D002675:Child, Preschool; D003428:Cross Infection / Q000191:economics / Q000517:prevention & control*; D005260:Female; D006801:Humans; D007223:Infant; D017053:Infection Control / Q000191:economics / Q000379:methods*; D008297:Male; D008828:Microbiological Techniques / Q000191:economics / Q000379:methods*; D008875:Middle Aged; D011446:Prospective Studies; D016896:Treatment Outcome; D016526:Workload / Q000706:statistics & numerical data*; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents