2101. Catheter related infections complicating central venous catheter access device insertion; a retrospective audit and comparison of two cohorts
Session: Poster Abstract Session: Healthcare Epidemiology: Device-associated HAIs
Saturday, October 6, 2018
Room: S Poster Hall
Posters
  • CVAD.pdf (2.4 MB)
  • Background: Central venous access devices (CVAD) are essential for long term intra-venous treatment of malignancies and other conditions. Catheter-related infections (CRI) complicate long term CVAD use at rates between 1.5-5%, resulting in significant morbidity and mortality. Current evidence does not support a role for antibiotic prophylaxis pre-insertion. We aim to determine rates of CRIs complicating CVAD insertions by vascular surgery and interventional radiology in a single institution and examine the role of antibiotic prophylaxis in prevention.

    Methods: A retrospective audit was carried out on CVAD insertions (tunnelled central venous catheter (CVC) or subcutaneous port) by the Vascular Surgery and Radiology Departments at a tertiary teaching hospital in Sydney, Australia from January 2014 to December 2016. Data were collected on patient demographics, antibiotic prophylaxis, skin preparation and CRIs. Rates of CRIs were compared by Chi-Square test (α 0.05).

    Results: 95 (11 tunnelled CVC; 84 subcutaneous ports) and 222 (21 tunnelled CVC; 201 subcutaneous ports) CVAD insertions were performed by vascular surgery and radiology respectively. Median age was 56 years (IQR 48-66) in the vascular cohort and 64 years (IQR 55-72) in the radiology cohort. Females were predominant in both vascular (70; 73.7%) and radiology (119, 53.6%) cohorts and the most common indication was chemotherapy (vascular 84; 88.4% and radiology 205; 92.8% n=1 missing). Antibiotic prophylaxis was used in 88 (92.6%) vascular insertions but only 2 (0.95%; n=12 missing) insertions by radiology. Iodine skin preparation was preferred for vascular insertions (92; 98.9%, n=2 missing) compared to chlorhexidine for radiology insertions (214; 97.7%, n=3 missing). CRIs occurred in 4 (4.2%) of the vascular cohort and 8 (3.6%) of radiology cohort (P=0.80).

    Conclusion: Rates of CRIs complicating CVAD procedures were similar in a vascular cohort where most received antibiotic prophylaxis, and in a radiology cohort where antibiotic prophylaxis was rarely used. There was no evidence to support antibiotic prophylaxis in prevention of CRIs, although choice of skin preparation and other factors may have confounded findings.

    Anne Hoey, BSc BMBS DTM&H MSc1,2, Milan Edinger-Reeve, MBBS2, Melissa Anshaw, BN3, Hubert Chan, MBBS1 and Pamela Konecny, MBBS MD MPH DTM&H FRACP FAChSHM1,2, (1)Department of Infectious Diseases, Immunology & Sexual Health, St George Hospital, Sydney, Australia, (2)St George & Sutherland Clinical School, University of New South Wales, Sydney, Australia, (3)Medical Imaging, St George Hospital, Sydney, Australia

    Disclosures:

    A. Hoey, None

    M. Edinger-Reeve, None

    M. Anshaw, None

    H. Chan, None

    P. Konecny, None

    Findings in the abstracts are embargoed until 12:01 a.m. PDT, Wednesday Oct. 3rd with the exception of research findings presented at the IDWeek press conferences.