Abstract
Many different methods have been employed to aid in the laboratory diagnosis of intravascular catheter associated infection. However, because of differences in patient populations, the definition of catheter sepsis and types of catheters, comparison of these studies is difficult. Of even more fundamental importance, the question of the pathogenesis of intravascular catheter associated sepsis (i.e. whether the microorganisms migrate to the intravascular space via the internal or external surface of the catheter) has not been resolved and is the subject of ongoing controversy. Semiquantitative culture of catheter tips would appear the easiest and most labour-efficient method available at present to diagnose catheter related infection. With central vein catheter tips, however, a cut-off level below 15 CFU per plate should be adopted as indicating a positive test result, particularly in patient populations with a high prevalence of catheter associated infection. Methods for non-quantitative broth culture of catheter tips are likely to be more sensitive than the semiquantitative method, but are less specific. Quantitative broth methods improve the specificity, but because of the labour costs involved appear not to offer much advantage over the semiquantitative method in the routine clinical laboratory. Many studies have shown that organisms are more frequently seen on staining than recovered by culture of intravascular cathethers. Further studies of intravascular catheter sepsis should include a catheter staining method in addition to culture. Aspiration and culture of blood through an intravascular catheter appears to be reasonably specific in diagnosing the presence of infection on the catheter tip, but is only of low sensitivity (20–40 %) in the absence of associated bacteremia.
Similar content being viewed by others
References
Stamm, W. E.: Infection related to medical devices. Annals of Internal Medicine 1978, 89: 764–769.
Collignon, P. J., Munro, R., Sorrell, T. C.: Systemic sepsis and intravenous devices, a prospective survey. Medical Journal of Australia 1984, 141: 345–348.
Maki, D. G.: Infections associated with intravascular lines. In: Remington, J. S., Swartz, M. N. (ed.): Current clinical topics in infectious diseases. Volume 3. McGraw-Hill, New York, 1983, p. 309–363.
Henderson, D.: Bacteraemia due to percutaneous intravascular devices. In: Mandell, G. L., Douglas, R. G., Bennett, J. E. (ed.): Principles and practice of infectious diseases. John Wiley, New York, 1985, p. 1612–1620.
Collignon, P. J., Soni, N., Pearson, I. Y., Woods, W. P., Munro, R., Sorrell, T. C.: Is semiquantitative culture of central vein catheter tips useful in the diagnosis of catheter associated bacteraemia? Journal of Clinical Microbiology 1986, 24: 532–535.
Collignon, P. J., Soni, N., Pearson, I. Y., Sorrell, T., Woods, P.: Sepsis associated with central vein catheters in critically ill patients. Intensive Care Medicine 1988, 14: 227–231.
Plit, M. L., Lipman, J., Eidelman, J., Gavaudan, J.: Catheter related infection. A plea for consensus with review and guidelines. Intensive Care Medicine 1988; 14: 503–509.
McGeer, A., Righter, J.: Improving our ability to diagnose infections associated with central venous catheters: value of Gram's staining and culture of entry site swabs. Canadian Medical Association Journal 1987, 137: 1009–1021.
Moyer, M. A., Edwards, L. D., Farley, L.: Comparative culture methods on 101 intravenous catheters. Archives of Internal Medicine 1983, 143: 66–69.
Collignon, P. J., Sorrell, T., Garrett, P.: Unsuccessful search for anaerobic bacteria in thrombophlebitis associated with peripheral vein catheters. New England Journal of Medicine 1986, 314: 1323–1324.
Cooper, G. L., Hopkins, C. C.: Rapid diagnosis of intravascular catheter-associated infection by direct Gram staining of catheter segments. New England Journal of Medicine 1985, 312: 1142–1147.
Sitges-Serra, A., Linares, J.: Limitations of semiquantitative method for catheter culture. Journal of Clinical Microbiology 1988, 26: 1974.
Collignon, P., Munro, R.: Limitations of semiquantitative method for catheter culture. Journal of Clinical Microbiology 1988, 26: 1976–1977.
Linares, J., Sitges-Serra, A., Garau, J., Perez, J. L., Martin, R.: Pathogenesis of catheter sepsis: a prospective study with quantitative and semiquantitative cultures of catheter hub and segments. Journal of Clinical Microbiology 1985, 21: 357–360.
Brun-Buisson, C., Abrouk, F., Legrand, P., Huet, Y., Larabi, S., Rapin, M.: Diagnosis of central venous catheter-related sepsis. Critical level of quantitative tip cultures. Archives of Internal Medicine 1987, 147: 873–877.
Maki, D. G., Weise, C. E., Sarafin, H. W.: A semiquantitative culture method for identifying intravenous catheter-related infection. New England Journal of Medicine 1977, 296: 1305–1309.
Zuffery, J., Rime, B., Francioli, P., Bille, J.: Simple method for rapid diagnosis of catheter-associated infection by direct acridine oranges staining of catheter tips. Journal of Clinical Microbiology 1988, 26: 175–177.
Coutlee, F., Lemieux, C., Paradis, J.: Value of direct catheter staining in the diagnosis of intravascular catheter-related infection. Journal of Clinical Microbiology 1988, 26: 1088–1090.
Collignon, P. M., Chan, R., Munro, R.: Rapid diagnosis of intravascular catheter-related sepsis. Archives of Internal Medicine 1987, 147: 1609–1612.
Cooper, G. L., Schiller, A. L., Hopkins, C. C.: Possible role of capillary action in pathogenesis of experimental catheter-associated dermal tunnel infeections. Journal of Clinical Microbiology 1988, 26: 8–12.
Haslett, T., Isenberg, H., Hilton, E., Tucci, V., Kay, B., Vellozzi, E.: Microbiology of indwelling central intravascular catheters. Journal of Clinical Microbiology 1988, 26: 696–701.
Dealler, S., Millar, M. R., MacKay, P.: Transdermal potential and bacterial colonisation of intravascular catheters. Lancet 1988, i: 703.
Maki, D. G., Jarrett, F., Sarafin, H. W.: A semiquantitative culture method for identification of catheter related infection in the burn patient. Journal of Surgical Research 1977, 22: 513–520.
Wilkins, E. G. L., Roberts, C., Davidson, D. C.: Quantitative bacteriology of peripheral venous cannulae in neonates. Journal of Hospital Infection 1985, 6: 209–217.
Wing, E. J., Norden, C. W., Shadduck, R. K., Winkelstein, A.: Use of quantitative bacteriologic techniques to diagnose catheter-related sepsis. Archives of Internal Medicine 1979, 139: 482–483.
Andremont, A., Paulet, R., Nitenberg, G., Hill, C.: Value of semiquantitative cultures of blood drawn through catheter hubs for estimating the risk of catheter tip colonization in cancer patients. Journal of Clinical Microbiology 1988, 26: 2297–2299.
Raucher, H. S., Hyatt, A. C., Barzilai, A., Harris, M. B., Weiner, M. A., LeLeiko, N. S., Hodes, D. S.: Quantitative blood cultures in the evaluation of septicemia in children with Broviac catheters. Journal of Pediatrics 1984, 104: 29–33.
Mosca, R., Curta, S., Forbes, B., Meguid, M.: The benefits of Isolator cultures in the management of suspected catheter sepsis. Surgery 1987, 102: 718–723.
Flynn, P. M., Shenep, J. L., Stokes, D. C., Barrett, F. F.: In situ management of confirmed central venous catheter-related bacteremia. Pediatric Infectious Diseases Journal 1987, 6: 729–734.
Flynn, P. M., Shenep, J. L., Barrett, F. F.: Differential quantitation with a commercial blood culture tube for diagnosis of catheter-related infection. Journal of Clinical Microbiology 1988, 26: 1045–1046.
Weightman, N. S., Speller, D. C. E.: Pour plate blood cultures to detect bacteremias related to indwelling central venous catheters. Journal of Hospital Infection 1986, 8: 203–206.
Pinilla, J. C., Ross, D. F., Martin, T., Crump, H.: Study of the incidence of intravascular catheter infection and associated septicemia in critically ill patients. Critical Care Medicine 1983, 11: 21–25.
Snydman, D. R., Murray, S. A., Kornfeld, S. J., Majka, J. A., Ellis, C. A.: Total parenteral nutrition-related infections. American Journal of Medicine 1982, 73: 695–699.
Cleri, D. J., Corrado, M. L., Seligman, S. J.: Quantitative culture of intravenous catheters and other intravascular inserts. Journal of Infectious Diseases 1980, 141: 781–786.
Braunstein, H.: Rapid diagnosis of intravascular catheter associated infection by direct gram staining of catheter segments. New England Journal of Medicine 1985, 313: 754–755.
Sitges-Serra, A., Linares, M. D., Garau, J.: Catheter sepsis: the clue is the hub. Surgery 1985, 97: 355–357.
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Collignon, P.J., Munro, R. Laboratory diagnosis of intravascular catheter associated sepsis. Eur. J. Clin. Microbiol. Infect. Dis. 8, 807–814 (1989). https://doi.org/10.1007/BF02185853
Issue Date:
DOI: https://doi.org/10.1007/BF02185853