Intraluminal antibiotic treatment of central venous catheter infection in patients receiving total parenteral nutrition

Full text

Catheter guidewire exchange has been suggested as an effective method of treatment of catheter-related infection (CRI) in nontunneled central venous catheters. However, the old line is usually intraluminally colonised, so contamination of the new line through the guidewire occurs early. To minimise this event, we evaluated a method of treatment consisting of catheter guidewire exchange followed by intraluminal antibiotic administration.

Methods

Eight consecutive patients with CRI were studied. They received TPN through a subclavian vein catheter for a period of 8-19 days prior to CRI. In the suspicion of CRI, the catheter was removed and exchanged over a guidewire with a new catheter, followed by catheter tip culture and peripheral blood culture. TPN administration was stopped for 2-3 days until isolation and identification of the responsible bacteria. After identification of the bacteria, TPN administration was started again and the appropriate antibiotic, as indicated by microbiological sensitivity, was administered through the new central venous catheter for a period of 10 days. All new catheters were removed after 10 days and cultured.

Results

In all the patients was noted defervescence of the clinical signs of infection following catheter removal. The responsible pathogens were Staphylococcus (S. epidermidis in 4, S. aureus in 3, all sensitive to vancomycin), and Enterococcus in one (sensitive to ampicillin). There were no further problems with the new catheters in 7 patients, and the new cultures were sterile after 10 days of intraluminal antibiotic treatment; however, one patient developed a new episode of CRI in the 9th day of treatment, and the catheter tip culture showed colonisation by Proteus. In this patient, CRI was finally treated by removal of the catheter and replacement at a different site.

Conclusion

Our results suggest that, in the majority of cases, CRI can be successfully treated by exchange of the catheter over a guidewire followed by administration of the appropriate antibiotic through the new catheter for at least 10 days.