K-3412. Fungal Infection and Disease Severity are Associated with Failure in Central Venous Catheter Reinsertion after Catheter Related Blood Stream Infection
Session: Poster Session: Catheter-Related Bloodstream Infections
Monday, October 27, 2008: 12:00 AM
Room: Hall C
Backgroud : Catheter related bloodstream infections (CR-BSIs) are serious complication of central venous catheter (CVC) use. However, optimal time to place a new catheter after CR-BSIs has not been established. We reviewed CR-BSIs and analyzed risk factors for CVC reinsertion failure (CVCRF) associated with recurrent catheter related infection (CRIs). Methods : A retrospective cohort study was performed at the 2,000 bed teaching hospital for three years. CR-BSI was defined by the positive blood cultures obtained from a peripheral vein and semiquantitative catheter tip cultures yielding ≥ 15 CFU for the same organism without other apparent infection focus. CVCRF was defined as below. 1) Persistent BSI, 2) Recurrent CRI or CR-BSI with same microorganism, 3) Persistent SIRS which was resolved after catheter removal without other specific management (Clinical CRI). Clinical data and catheter free time between catheter removal and CVC reinsertion were reviewed. Results : 112 CR-BSIs were identified during study period. Candida albicans (28, 25%) was the most common pathogen followed by S.aureus (18) and S.epidermidis (16). Among 112 CR-BSIs, 64 patients reinserted CVC and 47 cases were eligible for evaluation of CVCRF. 27 (57.5%) among 47 eligible cases were considered as CVCRF and persistent BSIs were most common (15, 55.6%) followed by recurrent CR-BSI or CRI (11) and clinical CRI (1). Among risk factors associated with CVCRF, fungal infection compared with bacterial infection and high APACHE II score were associated with frequent CVCRF (P value 0.043 and 0.007, respectively). The catheter free time before reinsertion was slightly shorter in CVCRF group (0.23 vs. 0.7 day), but it was not statistically significant. Conclusion : CVCRF was associated with fungal infection and disease severity. Shorter catheter free time before CVC reinsertion revealed tendency for CVCRF but it was not significant.
Bum Sik Chin, MD1, Chang Oh Kim, Fellow2, Han Sung Lee3, Hee Kyung Choi, MD4, Jun Yong Choi, staff2, June Myung Kim, MD5, Sang Hoon Han, MD5, Su Jin Jeong, Resident2, Suk Hoon Choi, Fellowship6, Young Goo Song, MD7 and  B. Chin, None., (1)Yonsei University Medical Center, Seoul, Korea, Republic of, (2)Yonsei University College of Medicine, Seoul, Korea, Republic of, (3)Department of Internal Medicine and AIDS Research Institute, Yonsei University College of Medicine, (4)Yonsei university college of medicine, Seoul, Korea, Republic of, (5)AIDS Research Institute, Yonsei University College of Medicine, Seoul, South Korea, (6)Yonsei university collage of medicine, Department of Internal Medicine, Seoul, Moldova, Republic of, (7)Yonsei Univ. Coll. of Med., Seoul, Korea, Republic of