448 Central Venous Catheter Microbial Colonization in relation to Insertion and Care Practices in Intensive Care Units of Ain Shams University Hospital

Saturday, March 20, 2010
Grand Hall (Hyatt Regency Atlanta)
Maha Fathy, MD , Faculty of Medicine, Ain Shams University, Cairo, Egypt
Maha Hamdy, MD , Faculty of Medicine, Ain Shams University, Cairo, Egypt
Maha ElTouny, MD , Faculty of Medicine, Ain Shams University, Cairo, Egypt
Noha Nagy, MSc , Faculty of Medicine, Ain Shams University, Cairo, Egypt
Background: Central venous catheter (CVC) related infections are associated with increased morbidity and mortality rates.  Objective: To determine the extent of adherence to evidence based guidelines for the prevention of CVC associated infections in intensive care units (ICUs) of Ain Shams University Hospital. Also to identify risk factors and organisms associated with CVC significant colonization with their antimicrobial susceptibility to help selection of antibiotics for empirical therapy when indicated.
Methods: The study was done in 6 ICUs (51 beds) of Ain Shams University tertiary care Hospital in the period from May 2006 to July 2006. A survey of ICU characteristics and CVC insertion and care practices was done. Patients receiving CVCs were followed up for the period of the study. Forty six inpatients, 26 males and 20 females, were included in the study. Their ages ranged from 17 to 85 years with a mean ± SD of 55.63 ± 16.72 years. The removed CVCs were cultured by two methods, (semi-quantitative and quantitative). The isolated pathogens (49 isolates) were identified by standard techniques and were tested for antibiotic susceptibility.
Results: The CVC significant colonization rate was 47.8% (22/46), with a statistically high concordance between the 2 methods used for culture (K =0.6, P<0.001). Higher frequencies of significant colonization were detected from CVCs inserted without applying the maximal sterile barrier technique (66.7%),  in CVC catheters with 2 (72.7%) or 3 (42.9%) lumens and in CVCs through which blood was infusated (73%). Coagulase negative Staphylococci (CNS) were the most frequent isolated organisms (73.47%). Staphylocoocus aureus (S. aureus), enteric Gram negative bacilli (Klebsiella pneumoniae [k. pneumoniae], klebsiella oxytoca and Enterobacter cloacae), Stenotrophomonas maltophilia and Pseudomonas aeruginosa (P.aeruginosa) were the following organisms causing significant CVC colonization in the rates of 16.3%, 6.1%, and 2% respectively. All the S. aureus isolates were methicillin resistant. The isolated CNS showed high rates of resistance to oxacillin, penicillin, cefoxitin and erythromycin. The three isolates of Enterobacteriaceae were resistant to ampicillin, ampicillin/ sulbactam, cephalothin, cefoxitin, cefoperazone, and pipracillin. One of the three isolates was ESβL produer (k. pneumoniae). The isolated P.aeruginosa and Stenotrophomonas maltophilia were resistant to azeteonam, pipracillin, cefoxitin, ceftazidime, cefipime and tobramycin.  
Conclusions: Non adherence to maximal sterile barrier technique, multiple lumens and blood infusion were associated with increased rates of CVC significant colonization in ICUs of Ain Shams University Hospitals. The isolated bacteria from colonized catheters showed a wide range of antibiotic resistance.