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Low incidence of arterial catheter infections in a Swedish intensive care unit: risk factors for colonisation and infection
Linköping University, Department of Clinical and Experimental Medicine, Infectious Diseases . Linköping University, Faculty of Health Sciences. (Ryhov County Hospital, Jönköping)
Linköping University, Department of Medicine and Health Sciences, Thoracic Surgery. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart Centre, Department of Thoracic and Vascular Surgery.
Linköping University, Department of Clinical and Experimental Medicine, Infectious Diseases . Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre for Medicine, Department of Infectious Diseases in Östergötland.
Linköping University, Department of Clinical and Experimental Medicine, Infectious Diseases . Linköping University, Faculty of Health Sciences. (Futurum the Academy for Health Care, Jönköping)
2010 (English)In: Journal of Hospital Infection, ISSN 0195-6701, E-ISSN 1532-2939, Vol. 76, no 2, 130-134 p.Article in journal (Refereed) Published
Abstract [en]

There is growing concern that arterial catheters (ACs) cause catheter-related infections (CRIs). Limited data are available concerning risk factors for AC-CRI and there are no studies concerning incidence and micro-organisms from northern Europe. The aims of this study were to determine the incidence of, and micro-organisms responsible for, AC colonisation and AC-CRI in a Swedish intensive care unit (ICU), and to determine risk factors contributing to AC colonisation and AC-CRI. We prospectively studied all patients (N=539) receiving ACs (N=691) in a mixed ICU of a county hospital. Six hundred (87%) of all ACs were assessed completely. The total catheterisation time for 482 patients was 2567 days. The incidence of positive tip culture was 7.8 per 1000 catheter-days, with the predominant micro-organism being coagulase-negative staphylococci (CoNS). The incidence of AC-CRI was 2.0 per 1000 catheter-days (with no cases of bacteraemia). All AC-CRIs were caused by CoNS. Multivariate analysis revealed that immunosuppression, central venous catheter (CVC) colonisation and CVC infection were significant risk factors for AC-CRI. We conclude that AC colonisation and infection with systemic symptoms occur at a low rate in our ICU which supports our practice of basic hygiene routines for the prevention of AC-CRI. Colonisation and infection of a simultaneous CVC seem to be risk factors. The role of contemporaneous colonisation and infection of multiple bloodstream catheters has received little attention previously. Further studies are needed to verify the significance of this finding.

Place, publisher, year, edition, pages
2010. Vol. 76, no 2, 130-134 p.
National Category
Medical and Health Sciences
Identifiers
URN: urn:nbn:se:liu:diva-59067DOI: 10.1016/j.jhin.2010.05.021OAI: oai:DiVA.org:liu-59067DiVA: diva2:349743
Available from: 2010-09-08 Created: 2010-09-08 Last updated: 2017-12-12
In thesis
1. Preventing Infections Related to Central Venous and Arterial Catheters
Open this publication in new window or tab >>Preventing Infections Related to Central Venous and Arterial Catheters
2013 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Central venous catheters (CVCs) are indispensable in modern medical practice. Serious complications associated with CVC use include catheter-related infection (CRI) and catheter related-bloodstream infection (CRBSI) both of which contribute to morbidity, mortality and healthcare costs. Several studies have shown that implementation of basic hygiene routines, for CVC insertion and care, can significantly reduce the number of CRBSIs. However, there are limited data on the long-term effects after such an intervention. CVC infections, in terms of incidences and microorganisms, vary between different units and countries. Studies from Scandinavian hospitals are rare and not published recently. It has been stated that arterial catheters (ACs) are less prone to be responsible for CRI and CRBSI when compared with CVCs. However, recent studies outside Scandinavia have shown that they cause infections in significant numbers. The general view has been that nosocomial Candida infections in ICU patients evolve from the patient’s endogenous flora. However, a few studies have indicated that transmission of Candida spp. can occur between patients on an ICU as is well-described for certain bacteria. Candida spp. are among the most common microorganisms responsible for CRI/CRBSI.

The aim of this thesis was to study the incidences of, and microorganisms related to CVC (Study 1) and AC (Study 2) infections after implementation of evidence-based routines for insertion and care. The populations studied were patients with CVCs treated throughout the entire hospital (Studies 1 and 4) and patients with ACs treated on the ICU (Study 2). The aim was further to analyse risk factors contributing to these infections (Studies 1, 2 and 4). We also evaluated the long-term effects and endurance, of evidence-based routines, assessed as temporal variations in CVC colonisation and infections over a six-year period (Study 4). As we found that Candida spp. were common causes of CRI/CRBSI in Study 1, we decided to see if transmission of Candida spp. possibly occurred between patients on our ICU (Study 3).

We found low incidence rates, compared to international studies, for CRI and CRBSI related to the 495 CVCs studied over a short period (16 months, Study 1) and the 2045 CVCs studied over long-term follow-up (six years, Study 4). We found no cases of AC-CRBSI but a low number of AC-CRI in the 600 ACs studied. The type of microorganisms responsible for infections related to CVCs and ACs were similar to those found in international studies. However, the proportion of Candida spp. was high in Studies 1 and 4 evaluating CVC infections. There was no difference in the CVC-catheterisation time for CRI/CRBSI caused by Candida spp. as compared to CRI/CRBSI caused by bacteria. Risk factors for CRI associated with CVCs were chronic haemodialysis (Study 1), all haemodialysis in general (Study 4) and CVCs inserted via the internal jugular vein as compared to the subclavian vein (Study 4). Risk factors for CRI related to ACs were colonisation or infection of a simultaneous CVC and immunosuppression. Genotypes of Candida albicans and Candida glabrata had a heterogeneous distribution between ICU patients over time. Comparison with a reference group and cluster analysis indicated that transmission of Candida spp. between ICU patients is possible.

In, conclusion, we have found, after implementation of evidence-based routines for CVC and AC insertion and care, low incidences of CRI and CRBSI associated with these catheters. Furthermore, we found that transmission of Candida spp. between patients on the ICU is possible.

Place, publisher, year, edition, pages
Linköping: Linköping University Electronic Press, 2013. 71 p.
Series
Linköping University Medical Dissertations, ISSN 0345-0082 ; 1360
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-89955 (URN)978-91-7519-661-9 (ISBN)
Public defence
2013-04-12, Originalet, Qulturum, Länssjukhuset Ryhov, Jönköping, 13:00 (Swedish)
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Available from: 2013-03-12 Created: 2013-03-12 Last updated: 2013-03-12Bibliographically approved

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Hammarskjöld, FredrikBerg, SörenHanberger, HåkanMalmvall, Bo-Eric

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Infectious Diseases Faculty of Health SciencesThoracic SurgeryDepartment of Thoracic and Vascular SurgeryDepartment of Infectious Diseases in Östergötland
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Journal of Hospital Infection
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