Bacteriological assessment of intravascular catheter-related bloodstream infections versus colonisations
Abstract number: R2332
Radulescu A., Hagau N., Slavcovici A., Flonta M., Almas A., Studnicska D., Cocu S., Mlesnita M., Gavrus R.
Background: Catheter-related bloodstream infections (CRBSI) due to multidrug resistant bacteria represent a leading cause of nosocomial infections.
Objectives: Bacteriological assessment of colonisation vs. CRBSI.
Methods: Prospective study upon all consecutive cases admitted in a surgical intensive care unit, between May 2006 and June 2007. In all cases either jugular or subclavian polyurethane or silver impregnated short-term central venous catheters were placed. Bloodstream infection was defined as definite if a) the same pathogen grew in at least one blood culture and from the distal segment of catheter or b) same pathogen grew in at least one peripherally and centrally drawn blood culture, the differential time to positivity of central vs. peripheral blood culture was >120 minutes. Colonisation was defined in the absence of criteria for bloodstream or localised infection with bacterial growth from the catheter (external culture and intraluminal lavage) measured through quantitative and semi quantitative methods. Bacteriologic assessment was performed using the automatic system BactT/Alert and resistance patterns were determined with API 20E, Api 20NE and ATB automatic methods under CLSI 2006 standards.
Results: There were 188 documented infections and colonisations related to intravascular catheters. Average duration of in-place catheter was 9 days with similar gender, underlying diseases and type of catheter distribution. The cumulative incidence of colonisation was almost equal regardless of the catheter type (24/100 vs. 25/100 patients with in-place catheter) but smaller rates of CRBSI were found if silver-impregnated catheters were used (2.6/100 vs. 8/100 patients, NS). The most commonly isolated organisms were Gram-positive cocci-159 strains-85% (S. aureus-27.7%, coagulase negative stafilococci-28.7%, enterococci-24%). Almost all staphylococci were meticillin resistant, highly resistant to clindamicin and gentamycin but glycopeptide resistance was never found. One third of enterococci were resistant to ampicillin and 89% to gentamycin. All the 33 strains of Gram-negative rods (17.5%) were multidrug resistant. Sixty eight percent of all strains were multidrug resistant.
Conclusion:Staphylococcus spp. and enterococci are the most frequent colonizers or pathogens related to intravascular catheters. The multidrug resistant bacteria represent a therapeutic challenge. New technologies are important tools in prevention of CRBSI.
|Session name:||18th European Congress of Clinical Microbiology and Infectious Diseases|
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