title: Bacterial Contamination During Diagnostic and Interventional Neuroangiography is a Frequent Finding: But Does It Matter? An Observational Study.
abstract: BACKGROUND
  Bacterial contamination during angiographic procedures is a potential source of bacteremia. It is largely unknown whether it is clinically relevant. Our aim was to evaluate the incidence of contamination of liquids during catheter-based neuroangiographic examinations, the spectrum of microorganisms, a comparison of two different trolley-settings, and a follow-up of all patients with regard to clinical and lab signs of infection.
  
  
  METHODS
  A total of 170 patients underwent either diagnostic angiography (n = 111) or arterial neuroendovascular procedures (n = 59). To study the impact of airborne contamination of sterile liquids, we randomly assigned equal numbers of procedures to two distinct setups. Group A with standard open-surface bowls and group B with repetitive coverage of liquids throughout the procedure. Patient preparation was performed with utmost care. After each procedure, samples of the liquids were sent for microbiological evaluation. Patients were followed for signs of infection (fever, white blood cell count, C-reactive-protein).
  
  
  RESULTS
  Of all samples, 25.3 % were contaminated. Contamination consisted of resident skin microbiota only and was more common with procedures (28.8 %) than with diagnostic angiography (23.4 %) and less common in uncovered (23.5 %) than in covered bowls (27.1 %). However, these differences were insignificant. None of the patients developed clinical or lab signs of infection.
  
  
  CONCLUSIONS
  Contamination during diagnostic and interventional angiography does occur and cannot be avoided by intermittent coverage. Despite a surprisingly high incidence, our findings support the common strategy that antibiotic coverage is unnecessary in most patients undergoing arterial angiography as it lacks clinical impact. Airborne contamination does not appear to play a role.
authors.affiliation: Neuroradiologie, Universitätsklinik Köln, Cologne, Germany.
authors.forename: C
authors.initials: C
authors.lastname: Kabbasch
authors.affiliation: Neuroradiologie, Universitätsklinik Köln, Cologne, Germany.
authors.forename: F
authors.initials: F
authors.lastname: Dorn
authors.affiliation: Institut für Medizinische Mikrobiologie, Immunologie und Hygiene, Universitätsklinik Köln, Cologne, Germany.
authors.forename: H M
authors.initials: HM
authors.lastname: Wenchel
authors.affiliation: Institut für Diagnostische und Interventionelle Radiologie, Universitätsklinik Köln, Cologne, Germany.
authors.forename: B
authors.initials: B
authors.lastname: Krug
authors.affiliation: Neuroradiologie, Universitätsklinik Köln, Cologne, Germany.
authors.forename: A
authors.initials: A
authors.lastname: Mpotsaris
authors.affiliation: Neuroradiologie, Universitätsklinik Köln, Cologne, Germany. thomas.liebig@uk-koeln.de.
authors.forename: T
authors.initials: T
authors.lastname: Liebig
mesh_terms: D001424:Bacterial Infections / Q000453:epidemiology* / Q000382:microbiology*; D002533:Cerebral Angiography / Q000295:instrumentation* / Q000706:statistics & numerical data; D004866:Equipment Contamination / Q000706:statistics & numerical data*; D005260:Female; D005858:Germany / Q000453:epidemiology; D006801:Humans; D008297:Male; D015995:Prevalence; D015641:Radiography, Interventional / Q000295:instrumentation / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D012307:Risk Factors; D062666:Vascular Access Devices / Q000382:microbiology* / Q000706:statistics & numerical data
keywords: Angiography; Bacteremia; Contamination; Contrast; Intervention