Positive tip cultures and related risk factors associated with intravascular catheterization in pediatric cardiac patients

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Abstract
The incidence and risk factors of positive catheter tip cultures were studied prospectively in 392 consecutive children undergoing cardiac surgery under cover of cephalothin prophylaxis. A total of 1649 catheter tips were cultured and 58 (3.5%) yielded positive cultures. Specifically, the incidence of positive catheter tip cultures for iv, central venous, arterial and pulmonary arterial (PA) catheters was 0.9%, 5.9%, 3.9% and 10.6%, respectively, whereas one of the six surgically placed venous and arterial catheters had a positive tip culture and none of the 279 transthoracic catheters. Staphylococcus epidermidis was isolated from 79% of the positive tip cultures. Ten percent of the children had one or more positive tip cultures but none developed catheter-related septicemia or endocarditis. Stepwise logistic regression analysis revealed that longer in situ time (p less than .001), younger age (p less than .001), and inotropic support (p = .003) were significant independent predictors of risk for children developing positive catheter tip cultures. The safe in situ period for arterial, central venous, and PA catheters is 3 days in infants under 1 yr and 4 and 6 days for arterial and central venous catheters, respectively, in older children, if 0.95 cumulative probability of remaining free of a positive tip culture is accepted. The data generally support the bacteriologic safety of invasive hemodynamic monitoring in infants and children undergoing cardiac surgery.

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