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Emilia Cercenado, PharmD; Javier Ena, MD; Marta Rodríguez-Créixems, MD; Immaculada Romero; Emilio Bouza, MD, PhD

Arch Intern Med. 1990;150(7):1417-1420.

Abstract
• A prospective study was done in 139 intravascular catheters (IVCs) that had been removed for different reasons. The purpose of the study was to compare laboratory procedures for the diagnosis of catheter-related infections and also to attempt to clarify the present controversy regarding the portal of entry of such infections. The IVCs were removed by one of us and multiple samples were studied according to a standard procedure. Semiquantitative cultures were performed of the tips, the interior of the hub, and the skin around the insertion point. Quantitative cultures were performed of the infusion fluid and of the IVC tips. Of the 139 IVCs studied, 53 (38.1%) were infected (15 colony-forming units per plate in the semiquantitative culture). Semiquantitative and quantitative cultures gave comparable results, but the semiquantitative procedure proved to be easier and faster. All but three infected catheters had a positive (15 colony-forming units per plate) skin and/or hub culture (superficial cultures), with microorganisms identical to those isolated in the IVC tip. Our results showed two possible and differentiable portals of entry. Thirty (56.6%) had an external origin (semiquantitative skin culture positive), 12(22.6%) had an internal origin (semiquantitative hub culture positive), and 8 (15.1%) had both origins. All catheters with negative superficial cultures had a negative tip. The predictive value of positive superficial cultures in the diagnosis of catheter-related infection was 66.2% and that of negative cultures was 96.7%. In patients with suspected catheter-related infections but negative superficial cultures, the possibility of infection may reasonably be ruled out, thereby avoiding many unnecessary catheter withdrawals.

(Arch Intern Med. 1990;150:1417-1420)

Author Affiliations
From the Departments of Clinical Microbiology (Drs Cercenado, Rodríguez-Créixems, and Bouza, and Ms Romero), and Internal Medicine (Dr Ena), "Gregorio Marañón" General Hospital, Madrid, Spain.

Footnotes
Accepted for publication December 1,1989.

Read in part before the 28th Interscience Conference on Antimicrobial Agents and Chemotherapy, Los Angeles, Calif, October 24,1988.

Reprint requests to the Servicio de Microbiología Clínica y Medicina Interna, Hospital General Gregorio Marañón, Dr Esquerdo 46,28007 Madrid, Spain (Dr Cercenado).

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