Journal of Islamabad Medical & Dental College (JIMDC); 2016:5(2):63-66

Original Article
Frequency of Central Venous Catheter Related
Infections and their Culture and Sensitivity Pattern
Bashir Ahmed1, Imran Mahmood Khan2 and Muhammad Atif Beg3
1
Consultant Physician, Department of Medicine, Pakistan Atomic Energy Commission General Hospital, Islamabad
2
Assistant Professor, Department of Pediatrics, Islamabad Medical & Dental College, Islamabad
3
Head, Department of Medicine, Pakistan Atomic Energy Commission General Hospital, Islamabad

Abstract Keywords: Antibiotic sensitivity, Central venous

catheter, Culture, Intensive care unit.
Objective: To determine the frequency of central
venous catheter related infections and their culture and Introduction
sensitivity pattern in our setting.
A central venous catheter (CVC) also called a central line or
Material & Methods: This cross sectional study was
central venous access catheter is a long, thin, flexible tube. A
conducted at Department of Medicine of Pakistan
catheter is often inserted in the arm or chest through the skin
Atomic Energy Commission (PAEC) General Hospital,
into a large vein (subclavian vein or axillary vein), in the neck
Islamabad from 21st May 2012 to 20th May, 2013.
(internal jugular vein) or groin (femoral vein).1 The catheter is
Eighty-five patients were selected through simple
threaded through the vein until it reaches a large vein near the
consecutive sampling having indwelling central venous
heart. CVCs are indispensable in medical care today. They
catheters (CVCs). A 10 ml sample of blood collected
are used for monitoring the hemodynamic status of patient by
from a peripheral vein at the time of catheter removal
means of central venous pressure, for obtaining blood
and tip (distal 5- 6 cm) of the catheter were sent to the
samples, for performing haemodialysis, plasmapheresis, and
laboratory for culture and sensitivity. When growth of
for administering medications, fluids, blood products, total
organism was detected, sensitivity pattern for
parenteral nutrition and chemotherapy over a long period of
commonly used drugs were checked. SPSS-16 was used
time usually several weeks or more.2,3 In the United States,
for statistical analysis.
more than 150 million CVCs are sold each year. CVCs are
Results: There were 43 (51%) females and 42 (49%)
available in different types like tunnelled, non-tunnelled,
males. The mean age of the patients was 54.91+15.639
implanted port and peripherally inserted central catheters,
years. The mean duration of CVC was 5.02+1.406 days.
based on their purposes and the anticipated duration of
The frequency of Catheter related infections (CRI) was
catheterization. They can be classified into short-term versus
12.94% (11/85). Out of these, 5 (45.5%) were due to
long-term catheters with the latter requiring surgery for
gram positive and 6 were due to (54.55%) gram
insertion.4 Although, mostly encountered in intensive care
negative bacteria. Coagulase Negative Staphylococcus
units (ICUs), CVCs are increasingly used in non-ICU wards
27%(3) and Pseudomonas aeruginosa 27%(3) were most
also and outpatient settings.5
common followed by Acinetobacter (SPP) baumannii
The use of CVCs is associated with both mechanical and
18%(2), Staphylococcus aureus (2) 18% and Klebsiella
infectious complications.6,7 Mechanical complications include
pneumoniae 9%(1). All five gram positive bacteria were
arterial puncture, pneumothorax, mediastinal hematoma,
sensitive to vancomycin (100%) while 5 out of 6 gram
haemothorax and injury to adjacent nerves. The rate of
negative bacteria were sensitive to Imipenam (83%).
mechanical complications range from 0-12%, according to the
Conclusion: The frequency of CRI in our hospital was experience of the operator and site of catheterization.8,9
Patients with CVCs are at risk of developing local as well as
Corresponding author:
systemic infectious complications like local insertion-site
Dr. Imran Mahmood Khan infection, catheter related blood stream infections, septic
Email: [email protected] thrombophlebitis, endocarditis and other metastatic infections.
Received: Dec 6th 2015; Accepted: May 29th 2016 The most serious complications are bacteraemia, sepsis and
death.10,11 The skin insertion site and the catheter hub are by
12.94%. Empirical therapy for such infections should far the two most important sources; approximately 65% of
consist of vancomycin and Imipenam. CRI originate from the skin flora, 30% from the contaminated

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Journal of Islamabad Medical & Dental College (JIMDC); 2016:5(2):63-66

hub and 5% from other pathways like contaminated infusion percentages were calculated for gender, bacteria and their
solution or haematogenous dissemination from a distant sensitivity to commonly used drugs like Vancomycin for
focus.12,13 In a study done in USA, infection rate was 4% gram-positive and Imipenam for gram-negative bacteria.
while that of Bahrain, India and Pakistan was 9.7%, 27.77%,
20% respectively.14-17 No such study was done in PAEC Results
General Hospital, Islamabad before so we have no idea about
In this study, total 85 patients were included and their CVCs
CRI rate and bacteria involved and their sensitivity pattern in
were microbiologically examined. The mean age of the
our hospital. This research study was carried out to fill this
patients was 54.91 years +15.64 SD and ranged from 18-85
gap in patient management.
years. There were 43 (51%) females and 42 (49%) males. The
mean duration of CVCs was 5.02 days +1.406 SD and range
Materials and Methods from 3-10 days. Out of 85 patients, cultures of 11(12.94%)
After seeking permission from ethics review committee of patients were found positive, three from peripheral blood and
hospital, this cross-sectional study was conducted at 10 from tip of catheter. There were two patients who had
Department of Medicine of Pakistan Atomic Energy positive cultures both from blood and from tip of the catheter
Commission (PAEC) General Hospital, Islamabad from 21st showing same bacteria in both cultures. In these 11 positive
May 2012 to 20th May, 2013. Sample size turned out to be 85 cultures, 5 (45.45%) had gram positive bacteria and 6
by using WHO sample size calculator, taking confidence level (54.55%) had gram negative bacteria. The most common
95%, anticipated population proportion 32.67%, and absolute organisms found in the culture were Coagulase Negative
precision 10%.12 Both male and female, older than 18 years of Staphylococcus (CONS) 3(27.27%), Pseudomonas
age admitted in intensive care unit that required central venous aeruginosa 3 (27.27%) followed by Acinetobacter (SPP)
catheter line were included. baumannii 2 (18.18%), Staphylococcus aureus 2 (18.18%)
Two types of patients were excluded from the study; 1. and Klebsiella pneumoniae (9.09%) as elaborated in Table I.
Patients who have central venous catheter already in place at
the time of admission; 2. Patients who have skin burn at the Table 1: Frequencies of bacteria in culture (n 11)
site of catheter insertion. Patients were recruited through a non Bacterium Number Percentage
randomized, simple consecutive sampling due to short period Coagulase Negative
3 27.27
of study. Informed consent was taken from patients or next of Staphylococcus
kin. Data was collected through a structured questionnaire Pseudomonas aeruginosa 3 27.27
written in English language. Questionnaire had four Acinetobacter (Spp) baumannii 2 18.18
components: (1) Demographic details; (2) Date of insertion Staphylococcus aureus 2 18.18
and removal of catheter; (3) Result of Culture and sensitivity Klebsiella pneumoniae 1 9.09
of tip of catheter: (4) Result of culture and sensitivity of
peripheral blood. In all five gram positive bacteria, Vancomycin was found
In order to maximize the sensitivity of detection of CRIs, both (100%) sensitive. In gram negative bacteria cultures 5 out of 6
catheter tip and peripheral blood samples were sent for culture were sensitive to Imipenam (83.3%). Only one gram negative
and sensitivity. Samples were collected as follows. A 10 ml bacteria showed resistance (16.7%) to Imipenam as shown in
sample of blood was collected from a peripheral vein at the table 2.
time of catheter removal and sent for culture and sensitivity in
50 ml BHI broth bottle. The central vascular catheter was
aseptically removed by the ICU medical team. The tip (distal Table 2: Distribution of sensitivity of antibiotics
5- 6 cm of the catheter) was cut off with sterile scissors and Sensitivity To Antibiotics Frequency Sensitivity Resistance
sent to the laboratory in 50 ml BHI Broth bottle. The two Vancomycin-sensitive 0%
samples were cultured by routine microbiological methods. 5/5 100%
Gram Positive
When growth observed, organism was identified by gram
staining, Analytical Profile Index (API) Staph, API 20 E and Imipenam- sensitive 16.7%
5/6 83.3%
20 NE and other biochemical tests as required. Sensitivity for Gram Negative
commonly used drugs especially Vancomycin for gram-
positive organisms and Imipenam for gram-negative Discussion
organisms was checked on miller hinton agar plate as per Central Venous catheters are the most frequently used
CLSI guidelines. Result was finalized by Consultant indwelling medical devices and have become necessary tools
Pathologist/ Microbiologist of PAEC General Hospital. for the successful treatment of patients with chronic or critical
Data analysis was performed on SPSS version 16. Descriptive illness. Extensive experience with this technique has lead to
frequencies were calculated as mean and standard deviations the recognition of infectious complications. Thus, the
for age and duration of CVC line (in days). Frequency/ definitive diagnosis of CRI can be made only by using a

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Journal of Islamabad Medical & Dental College (JIMDC); 2016:5(2):63-66

combination of clinical signs and symptoms together with the In our study, sample size is small and study carried out in
culture of the catheter and blood.18 A prominent problem in single centre. More studies should be done with big sample
detecting infection of intravascular catheters is the difficulty in size and in multiple centres to further improve the results.
distinguishing infection from contamination. Semi quantitative
culture technique for identifying infection due to intravenous Conclusion
catheters, found this technique to be 100% sensitive and
The incidence of CRI in our hospital was 12.94%.
100% specific in detecting the catheter associated infections.19
Vancomycin was 100% sensitive for Gram-positive bacteria
In our study, out of 85 patients, cultures of 11(12.94%)
while Imipenam was 83.3% sensitive for gram negative
patients were found positive, three from peripheral blood and
bacteria. Empirical therapy for such infections in health care
10 from tip of catheter. There were two patients who had
settings should consist of vancomycin and Imipenam.
positive cultures both from blood and from tip of the catheter
showing same bacteria in both cultures. Napalkov et al in a
study done in USA reported CRI rate as 4%. While in Bosnia Acknowledgement
and Herzegovina, the infection rate was 6% 12 and that of We extend our gratitude to Dr, Shaukat Ali, Dr Shahid, Adnan
Bahrain was 9.7%.15 In above studies infection rate was very Manzar and staff of my hospital for their cooperation, valuable
low as compared to our study. The study in India showed CRI suggestions to compile this article. We also thank all the
rate as 27.77% while that done in Rawalpindi and participants of the study who assisted in data collection.
Abbottabad, Pakistan showed CRI rate as 20%.17 These rates
are slightly higher than that of our study. Maki et al. in their Conflict of Interest
review stated that catheters placed in the emergency room This study has no conflict of interest as declared by any author.
were more likely to produce severe phlebitis than were
catheters placed in an inpatient unit. Similarly, the experience References
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