Colonization and infection of pulmonary artery catheter in cardiac surgerypatients: Epidemiology and multivariate analysis of risk factors

Objective: To assess the incidence and etiology of colonization and infecti on of pulmonary artery catheters inserted in cardiac surgery patients. To d etermine the influence of some variables on the risk of developing pulmonar y artery catheter colonization and infection. Design: Prospective observational study of pulmonary artery catheters inser ted into the internal jugular vein that were in place for >48 hrs over a 13 -month period. Data collected included age, gender, nature of the cardiac s urgery intervention, duration of extracorporeal circulation, date of insert ion and removal, subsequent infection, and curative antimicrobial therapy. End points were pulmonary artery catheter colonization with greater than or equal to 10(3) colonies on quantitative cultures and pulmonary artery cath eter-related bacteremia. Risk factors for colonization were determined by m ultiple logistic regression. Setting: A 17-bed cardiac surgery intensive care unit in a 480-bed teaching hospital in Paris. Patients: Patients undergoing cardiac surgery procedures between May 1, 199 7, and May 31, 1998. Interventions: None. Measurements and Main Results: Of 164 pulmonary artery catheters inserted i n 157 patients, 19 (11.6%) and 1 (0.6%) were associated with colonization ( mean duration of catheterization, 7.5 +/- 2.8 days) and bacteremia, respect ively. These data represent an incidence of 17.7 and 0.93 episodes per 1000 catheterization-days, respectively. Pulmonary artery catheter colonization was caused by Gram-positive cocci in 48% (67% were coagulase-negative stap hylococci), Gram-negative rods in 48%, and Candida albicans in 4%. From mul tivariate analysis, >4 days of catheterization was the single variable asso ciated with a significantly increased risk of pulmonary artery catheter col onization (odds ratio, 9.81; 95% confidence interval, 1.24-77.5, p = .03). Conclusions: Our data show that the risk of pulmonary artery catheter-relat ed colonization and bacteremia is quite low despite the use of a high-risk insertion site. In cardiac surgery patient populations, a trial evaluating the impact of a systematic pulmonary artery catheter removal after 4 days i s warranted.