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Value of routine central venous line tip culturing at catheter removal: prospective microbiological study of associated rates of colonisation and sepsis
  1. V Ponnusamy1,
  2. V Venkatesh2,
  3. A Curley2,
  4. N Brown3,
  5. C Tremlett4,
  6. P Clarke1
  1. 1Neonatal Intensive Care Unit, Norfolk & Norwich University Hospitals NHS Foundation Trust, Norwich, UK
  2. 2Neonatal Intensive Care Unit, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
  3. 3Clinical Microbiology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
  4. 4Department of Microbiology, Norfolk & Norwich University Hospitals NHS Foundation Trust, Norwich, UK

Abstract

Background and aims Percutaneous central venous catheters (PCVCs) are routinely inserted in NICUs. Lines may become colonised and act as foci for sepsis. We examined the bacteriology associated with PCVC tips at line removal, and associated rates of sepsis and colonisation.

Methods Prospective study in two UK tertiary NICUs of all PCVCs indwelling for >24 h removed during a 14-month period. After disinfecting the skin exit site, the PCVC was aseptically removed and the tip cultured using the Maki Roll technique.

Results 189 lines were removed, from 142 (75%) well and 47 (25%) clinically-septic infants. Overall, 36/189 (19%) PCVC line tips cultured positive, in 20/47(43%) clinically-septic babies versus 16/142(11%) well babies(p<0.0001, χ2 test) (table 1). 39/47 (83%) clinically-septic infants were already on antibiotics at line removal and only 23 (49%) had a positive peripheral blood culture. 7/24 (29%) blood culture-negative septic babies had a positive PCVC tip growth (all coagulase-negative staphylococci).

View this table:
Abstract PF.21 Table 1

Bacteriology of the 36 culture-positive PCVC line tips

Data are n (%);*one tip grew both CONS and a coliform.

Conclusions At PCVC removal, routine line tip cultures provide a higher yield in babies with suspected sepsis than in well babies. Prior antibiotic treatment may decrease positive blood culture rates, yet a significant minority of blood culture-negative babies(29%) nevertheless have a positive PCVC tip culture. PCVC tip cultures may usefully inform the clinical management of septic babies.

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