J R Mehall1, D A Saltzman, R J Jackson, S D Smith. 1. Department of Pediatric Surgery, Arkansas Children's Hospital, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA.
Abstract
BACKGROUND: Adherence of bacteria and subsequent catheter-related infections (CRI) are greatly enhanced by the fibrin sheath that develops on indwelling catheters. Since the infection rate of catheters without fibrin sheaths is low and the fibrin sheath mediates bacterial adherence, catheter material is not thought to affect the incidence of late catheter-related infection. METHODS: A total of 276 rats had catheters placed in the right jugular vein with the proximal end buried subcutaneously to eliminate exit site infection. Rats were divided into two groups: silastic catheters (SC; n = 133) and polyurethane catheters (PC; n = 143). Injections of 1 x 10(8) CFU/mL of Staphylococcus epidermidis were given via the tail vein on either the day of surgery, day 0 (n = 53 SC, n = 51 PC), or on postoperative day 10 (n = 50 SC, n = 62 PC). Thirty animals from each group (SC, PC) received sterile saline injections on day 10 and served as controls. Animals were sacrificed on postinjection day 3. Catheters were removed via the chest and placed into trypticase soy broth. Broth was incubated at 37 degrees C for 48 h. Microscopy for the fibrin sheath was done on 20 randomly selected catheters (10/group). Data were compared using Fisher's exact test, with p < 0.05 considered significant. RESULTS: Incidence of CRI was equal prior to the formation of the fibrin sheath, while CRI was significantly higher in silastic catheters in the presence of a fibrin sheath. Without a fibrin sheath (day 0), 8/53 silastic catheters and 3/51 polyurethane catheters were infected (p = NS). With a fibrin sheath (day 10), 31/50 silastic catheters were infected versus 20/62 polyurethane catheters (p < 0.05). Control catheters were all culture negative (30/group). With light microscopy, 20/20 catheters had fibrin sheaths at day 10 with no visible difference between silastic and polyurethane catheters. CONCLUSION: Catheter material does affect the incidence of catheter-related infection even when catheters are coated with a fibrin sheath. This difference may relate to a difference in the fibrin sheath itself as it forms on different catheter materials.
BACKGROUND: Adherence of bacteria and subsequent catheter-related infections (CRI) are greatly enhanced by the fibrin sheath that develops on indwelling catheters. Since the infection rate of catheters without fibrin sheaths is low and the fibrin sheath mediates bacterial adherence, catheter material is not thought to affect the incidence of late catheter-related infection. METHODS: A total of 276 rats had catheters placed in the right jugular vein with the proximal end buried subcutaneously to eliminate exit site infection. Rats were divided into two groups: silastic catheters (SC; n = 133) and polyurethane catheters (PC; n = 143). Injections of 1 x 10(8) CFU/mL of Staphylococcus epidermidis were given via the tail vein on either the day of surgery, day 0 (n = 53 SC, n = 51 PC), or on postoperative day 10 (n = 50 SC, n = 62 PC). Thirty animals from each group (SC, PC) received sterile saline injections on day 10 and served as controls. Animals were sacrificed on postinjection day 3. Catheters were removed via the chest and placed into trypticase soy broth. Broth was incubated at 37 degrees C for 48 h. Microscopy for the fibrin sheath was done on 20 randomly selected catheters (10/group). Data were compared using Fisher's exact test, with p < 0.05 considered significant. RESULTS: Incidence of CRI was equal prior to the formation of the fibrin sheath, while CRI was significantly higher in silastic catheters in the presence of a fibrin sheath. Without a fibrin sheath (day 0), 8/53 silastic catheters and 3/51 polyurethane catheters were infected (p = NS). With a fibrin sheath (day 10), 31/50 silastic catheters were infected versus 20/62 polyurethane catheters (p < 0.05). Control catheters were all culture negative (30/group). With light microscopy, 20/20 catheters had fibrin sheaths at day 10 with no visible difference between silastic and polyurethane catheters. CONCLUSION: Catheter material does affect the incidence of catheter-related infection even when catheters are coated with a fibrin sheath. This difference may relate to a difference in the fibrin sheath itself as it forms on different catheter materials.