Dr Md Choudhury1,2,3, Dr Hanna Sidjabat1, Dr Hosam Zowawi1, Dr Nicole Marsh3,4, Mrs Emily Larsen3,4, Dr Naomi Runnegar3,5, Professor David Paterson1, Dr David McMillan2, Professor Claire Rickard3,4,5
1The University of Queensland, UQ Centre for Clinical Research (UQCCR), Brisbane, Australia ,
2University of the Sunshine Coast, Brisbane, Australia ,
3Alliance for Vascular Access Teaching and Research (AVATAR) Group, Menzies Health Institute Queensland, and School of Nursing and Midwifery, Griffith University, Brisbane, Australia , 4Royal Brisbane and Women’s Hospital, Brisbane, Australia ,
5Princess Alexandra Hospital, Brisbane, Australia
Peripheral intravenous catheters (PIVCs) are an invasive device requiring entry through the protective skin barrier; pre-insertion antiseptic disinfection and sterile dressings are essential to reduce risk of catheter-related bloodstream infection (CRBSI). The aim of this study was to determine the impact of skin colonization on PIVC tip colonization and infection and to explore the distribution of bacterial species colonizing PIVC tips (and paired PIVC skin sites).
Patients were selected conveniently from within a multi-centre randomised controlled trial conducted at the Royal Brisbane and Women’s Hospital and Princess Alexandra Hospital. Following PIVC dressing removal, skin swabs from the PIVC insertion site and PIVC tip samples were collected. Skin swabs and PIVC tips were cultured and the recovered bacteria were identified through Vitek MS and sequencing. Bacterial clonal relationship was analysed through repetitive element sequence-based PCR (rep-PCR), a genomic-based typing method.
In total, 137 (79%) patients paired PIVC skin site swabs and tips were processed for microbiological cultures. Of these patients, 45 (33%) had colonised skin sites and/or PIVC tips. Sixteen patients demonstrated paired colonisation of both the skin site and PIVC tips; 11 (69%) were colonised with matching bacterial species. Of these, 77% were clonally related, including one identical clone of Pseudomonas aeruginosa in a patient with systemic infection, with the same organism identified in blood culture (confirmed CRBSI).
The results demonstrate that colonisation of opportunistic pathogens at the skin site poses a significant risk for PIVC colonisation and CRBSI.
Dr Md Abu Choudhury is a PhD infection control microbiologist, nurse, and co-author of The Lancet medical journal. Dr Choudhury is interested in hospital-acquired infections (HAIs) prevention, particularly (1) preventing catheter-related bloodstream infections (CRBSIs), (2) developing innovative tools for preventing HAIs and outbreaks that caused by antimicrobial-resistant organisms and (3) identifying risks of healthcare-associated infections. He has attracted funding for his research from a variety of national and international sources. He is interested in developing multidisciplinary/industry collaboration for infection control research.