Role of culturing from the tip and the tunneled segment of the catheters in tunneled catheter infection

PURPOSE Both the tip and the tunneled segment of removed tunneled jugular catheters were cultured to determine whether there is a difference between both cultures in diagnosis of the catheter infections. The role of interventional radiology in prevention, diagnosis, and management of the tunneled catheter infections is also discussed. MATERIALS AND METHODS In this prospective study, 22 tunneled jugular catheters were removed due to infection in a single center between January 2006 and January 2007. The clinical indications for catheter removal secondary to infection were repetitive positive catheter cultures, persistent fever with no other known etiology, tunnel infections, and sepsis most likely attributed to the catheter. RESULTS Mean duration of catheter placement was 110.7 days; 13 patients (59%) whose catheters were removed had negative catheter cultures. Cultures from 9 catheters were positive from the tip and/or tunneled segment. Among those, 7 patients had catheter-related bloodstream infections and 2 had local tunnel infections. CONCLUSION Despite the limited number of patients, our study demonstrated that catheter tip cultures are sensitive indicators of catheter-related bloodstream infections, while tunneled part cultures are sensitive in cases of local infections. Obtaining additional cultures from the tunneled segment may not only increase the sensitivity and specificity of the diagnosis of catheter infection, but may also show antibiotic sensitivity in cases of negative tip culture.