Prospective study of arterial and central venous catheter colonization and of arterial- and central venous catheter–related bacteremia in intensive care units*

Abstract

To compare the rates of positive quantitative culture (PQC) of arterial catheter (AC) and central venous catheter (CVC) tips and of CVC- and AC-related bacteremia in intensive care unit patients undergoing placement of both ACs and CVCs. Prospective, descriptive survey. To control for a difference in the severity of patients having an AC or CVC, only patients having both an AC and a CVC were included. An adult, nine-bed medical/surgical intensive care unit at a university teaching hospital. The analysis included 308 CVCs and 299 ACs inserted in 212 severely ill patients, with a mean +/- sd Simplified Acute Physiology Score II of 52 +/- 22 and an intensive care unit mortality of 33% (69 of 212). None. The same insertion and maintenance procedures were used for both types of catheter. A PQC was defined by a catheter tip culture yielding >/=10(3) colony forming units/mL. Catheter-related bacteremia was defined by a PQC and a blood culture positive for the same microorganism. The cumulative incidence (PQCs/number of catheters inserted) was 9.4% (29/308) for CVCs and 7.7% (23/299) for ACs (p = .44). Incidence density (PQCs/1,000 catheter days) was 12.0 for CVCs versus 9.3 for ACs. At the femoral site, there was no significant difference between CVCs and ACs in the cumulative incidences and incidence densities of PQCs. Two instances of catheter-related bacteremia were observed, one involving a CVC and one involving an AC. Among severely ill patients with both CVCs and ACs, the epidemiology of PQCs of CVCs and ACs is comparable when the same infection control measures are used for the insertion and maintenance of both types of catheters.