Low incidence of subsequent bacteremia or fungemia after removal of a colonized intravascular catheter tip.

OBJECTIVES We determined the frequency of subsequent bloodstream infection >2 days after removal of a catheter with positive tip cultures. METHODS We conducted a nationwide, observational study on intravascular catheter (IVC) tip cultures in Switzerland from 2008 to 2015 using data from the Swiss Antibiotic Resistance Surveillance System (ANRESIS). An IVC tip culture was included in the analysis if ≥1 microorganism could be cultivated from it. We excluded all data from patients with concurrent bacteremia with the same microorganism identified 7 days before to 2 days after IVC removal. Subsequent bloodstream infection (sBSI) was defined as isolating (from blood cultures performed >2 days up to 7 days after catheter removal) the same microorganism as the one recovered from the IVC. Data on antibiotic therapy were not available in this surveillance study. RESULTS Over the 8-year period, 15'033 positive IVC tip cultures were identified. Our study population comprised 12'513 episodes of positive IVC tip cultures without concurrent bacteremia. The frequency of sBSI was 1.8% (n=219). Subsequent bloodstream infections were more frequently detected after the identification of C. albicans (10/113, 8.8%), S. marcescens (9/169, 5.3%) and S. aureus (30/623, 4.8%) on a catheter tip. CONCLUSIONS A very low incidence of subsequent BSI was observed if a microorganism was identified on a removed IVC tip without concurrent bacteremia. The risk of subsequent BSI increased if C. albicans, S. aureus or S. marcescens were identified in this context