A PROSPECTIVE-STUDY OF A NEW PROTOCOL FOR INSITU DIAGNOSIS OF CENTRALVENOUS CATHETER-RELATED BACTEREMIA

59 patients with suspected central venous catheter related bacteraemia (CRB), while receiving parenteral nutrition, were studied prospective ly. 41 (Group 1) were managed conservatively: cultures were taken from the catheter hub lumen, skin at the catheter entry site and periphera l blood; the catheter was then heparinised and locked for 24-48 h. The catheter was withdrawn only if cultures were positive; otherwise pare nteral nutrition was resumed. In 18 patients the catheter was immediat ely withdrawn (Group 2) and the same cultures plus tip culture were pe rformed. 13 patients of Group 1 with positive hub or skin cultures, ha d their catheters removed and 12 had blood cultures matching for the s ame micro-organism. Negative skin and hub cultures had a negative pred ictive value for CRB of 96%. A positive hub culture had a 100% positiv e predictive value for CRB. CRB was diagnosed in 11 patients out of th e 18 in whom catheters were withdrawn immediately (Group 2). Thus, 1 o ut of 41 catheters and 7 out of 18 catheters were removed unnecessaril y in Groups 1 and 2 respectively (p = 0.001, Fisher's test). In all, 2 4 CRBs were documented and 15 were due to coagulase negative staphyloc occi. The catheter hub was the commonest origin of CRB followed by the infusate and the skin. In febrile patients on parenteral nutrition, n egative skin and hub cultures accurately predict or rule out CRB and s hould be used more often to avoid withdrawal of sterile catheters.