Review of central venous catheter-related infections in neurointensive care patients in a tertiary referral centre

Introduction

Intravenous catheter-related bloodstream infections (ICR-BSI) are a major contributing factor to in-hospital mortality and morbidity, extending the inpatient stay by 10 days and expenditure per patient by £2,000 to £30,000 [1]. A prospective survey was conducted in our unit on all patients with central venous catheters to ascertain the incidence of ICR-BSI, identify the organisms and determine the occurrence of infection from the various sites - femoral, internal jugular and subclavian lines.

Methods

The survey was carried out over a period of 13 weeks. Data collected from patients' case notes included site of central line insertion, length of line in situ, reason for line removal and positive blood culture reports.

Results

During the study period, 104 patients were treated on the unit. Fifty-two central venous lines were inserted in 36 patients (63.5% femoral (n = 33), 32.7% internal jugular (n = 17) and 3.9% subclavian lines (n = 2)). The lines were reviewed daily and removed if indicated clinically (pyrexia or raised white cell count) or if not required. A total 51.5% of femoral lines (n = 17) were removed due to clinical indications, as were 29% (n = 5) of internal jugular and 50% (n = 1) of subclavian lines. The average duration of a line remaining in situ was 4.5 days for femoral, 6 days for internal jugular and 5 days for subclavian lines. Blood cultures were taken at the time of line removal. These yielded positive results in eight femoral, seven internal jugular and one subclavian line. Our survey indicated that the incidence of ICR-BSI in our unit is 30.8% (of this 62.5% coagulase-negative staphylococci (CNS), 12.5% E. coli and Pseudomonas each, and 6.25% MSSA and MRSA each).

Conclusions

The distribution of microorganisms causing bacteraemia is broadly similar in our unit to that in other teaching hospitals in the UK [2], in that CNS was the commonest organism isolated. However, E. coli and Pseudomonas were the next common organisms, unlike other units where Staphylococcus aureus was the second most prevalent organism. The incidence of bacteraemia from femoral lines (53.7/1,000 catheter-days) was lower than that from internal jugular lines (68.6/1,000 catheter-days) possibly due to a higher index of suspicion in the case of femoral lines and earlier removal (Figure 1). Our study highlights the fact that femoral lines, which are often the safest option for unstable patients with head injury, can be effectively managed with strict adherence to guidelines to reduce ICR-BSI.

Figure 1

Incidence of ICR-BSI in The Walton Centre for Neurology and Neurosurgery intensive therapy unit.