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579 Central Venous Catheter Colonisation and Catheter Related Sepsis: Lessons Learnt from Exit Site Skin Swab
  1. V Ponnusamy1,
  2. V Venkatesh2,
  3. A Curley2,
  4. A Perperoglou3,
  5. N Brown4,
  6. C Tremlett5,
  7. P Clarke1
  1. 1Neonatal Intensive Care Unit, Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich
  2. 2Neonatal Intensive Care Unit, Cambridge University Hospitals NHS Foundation Trust, Cambridge
  3. 3Norwich Medical School, University of East Anglia, Norwich
  4. 4Clinical Microbiology, Cambridge University Hospitals NHS Foundation Trust, Cambridge
  5. 5Department of Microbiology, Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, UK

Abstract

Background and Aim Percutaneous central venous catheters (PCVCs) are commonly inserted in neonates after topical antisepsis. Presence of a PCVC is a risk factor for catheter-related sepsis (CRS). We examined the relationship between bacteriology of exit site skin swabs (ESSS) taken at line removal and line colonisation/CRS.

Design/methods For all PCVCs removed, ESSS and three separate PCVC segments (proximal, middle and tip) were sent for bacteriological culture. For clinically-septic neonates a peripheral blood culture was additionally obtained. PCVC colonisation was defined as a positive growth in any PCVC segment from a well neonate. Definite CRS was defined as positive growths with the same organism in any PCVC segment plus the blood culture from a clinically-septic neonate.

Results ESSS were culture-positive for 39/187 (21%) lines removed. Univariate analysis showed that with a positive ESSS, line colonisation was 8 times higher (log odds ratio 2.13 [95%CI: 1.18–3.08], p<0.001), and definite CRS was 14 times higher (2.63 [1.14–4.14], p<0.005). Adjusting for various covariates, multivariate analysis using a logistic regression model confirmed an increased risk of CRS with a positive ESSS (log odds ratio 2.00 [95%CI: 0.44–3.58], p=0.01).

Conclusion Positive ESSS correlate strongly with PCVC-colonisation and definite CRS. Improved topical antisepsis, skin and catheter care is required to reduce the risk of colonised skin insertion sites associated with catheter placement, and the consequent risks of line colonisation and subsequent CRS.

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