Tunnelled central venous catheter-related infection in cardiothoracic critical care

Introduction

Tunnelled central venous cannulae (CVC) are used in cardiothoracic (CT) critical care for long-term inotrope, antibiotic and renal replacement therapy (RRT). The incidence of bloodstream-related infection (BSI) related to all types of CVC is between 2.9 and 11.3 per 1,000 catheter-days [1]. In CT or cardiology practice the incidence for all CVC-related infection is 2.9–4.5 per 1,000 catheter-days. The incidence of BSI is reduced using tunnelled CVC, although there are little published data on the incidence of BSI in tunnelled CVC in CT critical care. CVC-related infection has been recognised as a priority in the UK initiative 'Saving Lives' [2]. We reviewed tunnelled CVC-related infection in a tertiary UK CT centre with a significant transplant population.

Methods

A retrospective analysis from November 2001 to 2006 of culture and sensitivity results of tunnelled CVC tips (Bard Groshong^® cuffed catheter and HemoGlide^®) and blood cultures from the same patients.

Results

Ninety-three CT critical care patients received a tunnelled subclavian CVC. The indications were inotropes (n = 40 (43%)), antibiotic administration (n = 27 (29%)), RRT (n = 14 (15.1%)) and unknown (n = 10 (10.8%)). The mean duration of the catheter remaining in situ was 36 days (SD 44.0, range 1–164). Culture results are presented in Table 1. Twelve patients had an established CVC-related BSI. The mean infection rate/1,000 catheter-days was 3.6.

Table 1 (abstract P80)

Conclusion

The incidence of tunnelled CVC colonisation and positive blood cultures in this group of CT critical care patients is in line with previously published data for all types of CVC. Coagulase-negative staphylococcus was the predominant isolate in both this audit and previously published data [1].