INFECTION ASSOCIATED WITH CENTRAL VENOUS CATHETERS - A PROSPECTIVE SURVEY

Objective: To assess the incidence of local and systemic infection cau sed by central venous catheters in a general hospital population. Sett ing: Concord Repatriation General Hospital, Sydney, April to August 19 91 inclusive. Design: A prospective survey of all patients with in sit u central venous catheters. Systemic catheter-related infection was de tected by blood and routine catheter tip culture, and local infection by clinical observation of the catheter exit site. Outcome measures: L ocal and systemic infection and complications. Results: 479 central ve nous catheters were surveyed in 311 patients. Local infection develope d in association with 54 catheters (11%) and systemic infection with 3 2 (6.7%). Local infection was predictive of systemic infection, but it s absence did not exclude systemic infection. Haemodialysis catheters were responsible for a higher systemic infection rate than other cathe ter types, the most common organism responsible being methicillin-resi stant Staphylococcus aureus. Twenty per cent of all bacteraemias (33/1 60) detected in the hospital occurred in patients with a central venou s catheter and 24 of these (73%) were definitely or probably due to th e catheter. Staphylococci were the predominant isolates and 40% of the methicillin-resistant S. aureus bacteraemias detected were due to cat heter-related infection. Infection complications were few: three patie nts developed local abscesses; one endocarditis; and two died. Conclus ions: Central venous catheter-related infection is common in general h ospital populations. Staphylococcal bacteraemia and local infection in a patient with a central venous catheter are strongly suggestive of c atheter-related systemic infection. Empirical antibiotic treatment sho uld include at least antistaphylococcal cover.