Infection associated with central venous catheters: A prospective survey

Objective: To assess the incidence of local and systemic infection caused by central venous catheters in a general hospital population. Setting: Concord Repatriation General Hospital, Sydney, April to August 1991 inclusive. Design: A prospective survey of all patients with in situ central venous catheters. Systemic catheter-related infection was detected by blood and routine catheter tip culture, and local infection by clinical observation of the catheter exit site. Outcome measures: Local and systemic infection and complications. Results: 479 central venous catheters were surveyed in 311 patients. Local infection developed in association with 54 catheters (11%) and systemic infection with 32 (6.7%). Local infection was predictive of systemic infection, but its absence did not exclude systemic infection. Haemodialysis catheters were responsible for a higher systemic infection rate than other catheter types, the most common organism responsible being methicillin-resistant Staphylococcus aureus. Twenty per cent of all bacteraemias (33/160) detected in the hospital occurred in patients with a central venous catheter and 24 of these (73%) were definitely or probably due to the catheter. Staphylococci were the predominant isolates and 40% of the methicillin-resistant S. aureus bacteraemias detected were due to catheter-related infection. Infection complications were few: three patients developed local abscesses; one endocarditis; and two died. Conclusions: Central venous catheter-related infection is common in general hospital populations. Staphylococcal bacteraemia and local infection in a patient with a central venous catheter are strongly suggestive of catheter-related systemic infection. Empirical antibiotic treatment should include at least antistaphylococcal cover.