Analysis of central venous catheter-related bloodstream infections in a teaching medical ICU: 2 years of follow-up

Introduction

Central venous catheters (CVCs) are frequently used in the ICU. Infection, the most frequent complication of CVC use, is associated with increased morbidity and mortality.

Hypothesis

The purpose of this study is to describe the epidemiology and to determine infection rates related to CVC use, the causative agents and its influence in ICU stay.

Methods

We evaluated prospectively (NNISS-CDC/Atlanta) all laboratory-confirmed CVC-related bloodstream infections (LBSI) in an 18-bed medical ICU of a university centre between January 2002 and June 2004. Catheter insertion was performed by cardiology residents. Data collected: number of LBSI, device utilization (DU), time of ICU stay, demographic data (sex, age), causative agents and rates of infection/1000 CVC days.

Results

A total 174 episodes of LBSI were studied. They represented 28% of all diagnosed ICU infections. The lethality was 47% in 30 days (medium ICU mortality was 28%). Ninety-seven (55.7%) episodes occurred in men and 77 (44.3%) in women (P = not significant). Sixty percent of the episodes occurred in patients 60–90 years old. A total 20.6% occurred in the first week and 37% after 28 days. The ICU stay of these patients was 26 days (ICU general medium stay was 12 days). The percentage incidences of the main infective agents in 2002, 2003 and 2004 were, respectively: S. aureus – 19%, 16.5%, 2.5%; S. epidermidis – 22%, 31%, 34%; E. faecalis – 4%, 5%, 7.3%; K. pneumoniae – 21%, 16.5%, 14.6%; P. aeroginosa – 13%, 10.5%, 7.3%; other Gram-negatives – 19.4%, 19.4%, 24.5%; Candida sp. – 0.8%, 0%, 9.8%.

Conclusions

BSI remains an important problem increasing the ICU stay and costs. The biphasic incidence calls attention to the need for better selection for admitting patients from other hospitals and to improve adherence to standardized infection control practices.