A retrospective cohort study was carried
out during the period between September 2000 and December 2007 to determine the
role of positive Catheter Cultures
(PCC) in predicting subsequent blood
The setting was an ICU, with nine beds,
at the University Hospital of Clermont-Ferrand, Clermont-Ferrand, France.
PCC was defined by a quantitative culture
of a swab from the catheter's distal tip that yielded ≥103 colony-forming
was a reference to
the identification of the causative microorganism of the PCC, in the culture of
the peripheral blood of the patient taken between day 3 and day 30 after
Numerous studies done earlier on ICU
patients, have evaluated the diagnostic significance and accuracy of the positive catheter culture (PCC) in
detecting subsequent blood stream infection (BSI) from catheters. These studies
indicate that a PCC may be considered as a warning signal.
A total of 138 isolated PCCs yielding 149
selected pathogenic microorganisms inserted in 109 patients were studied.
Arterial, venous, and dialysis catheters,
that were inserted for 24 hrs and later removed in ICU patients who survived
>48 hrs after catheter removal, were considered for the study.
As a routine, all the catheters removed
in the ICU were routinely sent to the department of bacteriology and the
details are recorded.
Catheters with isolated PCCs yielding selected pathogenic microorganisms
included in the study.
Selected pathogenic microorganisms
include Gram-positive cocci such as Streptococcus
spp., S. aureus
coagulase-negative staphylococci, and Enterococci and also Gram-negative rods
such as Haemophilus influenzae
, and Candida
Data was collected from the records of
all ICU patients whose catheters were study samples. Positive blood cultures
were singled out from the bacteriology record.
Antimicrobial catheters are not employed
in this ICU.
Antibiotic (AB) treatment was usually on
the day of catheter removal and also within 48 hrs before and after removal. To
what extent it affected the subsequent BSI is not easily discernable.
Results & Conclusion
The study found that isolated PCC is
associated with a low risk of developing
within the 30 days of hospital convalescence after catheter
The results of similar studies vary
widely due to discrepancies in population, study design, in the causative
organisms, indwelling duration, in the AB used in treatment.
To some extent the causative organism
played a role in bringing about subsequent blood infection. For example
S.aureus and candida were more involved in infections.
study also suggests that in patients with such isolated PCC antibiotics must
not be systematically administered as a measure to stop a possible subsequent
Critical Care Medicine 2011.