Quimica

Diagnosis of triple-lumen catheter infection:
comparison of roll plate, sonication, and
flushing methodologies.
R J Sherertz, S O Heard and I I Raad
J. Clin. Microbiol. 1997, 35(3):641.

These include:
CONTENT ALERTS

Receive: RSS Feeds, eTOCs, free email alerts (when new articles
cite this article), more»

Information about commercial reprint orders:http://journals.asm.org/site/misc/reprints.xhtml
To subscribe to to another ASM Journal go to: http://journals.asm.org/site/subscriptions/

Downloaded from http://jcm.asm.org/ on February 18, 2013 by guest

Updated information and services can be found at:
http://jcm.asm.org/content/35/3/641

JOURNAL OF CLINICAL MICROBIOLOGY, Mar. 1997, p. 641–646
0095-1137/97/$04.00 0
Copyright 1997, American Society for MicrobiologyVol. 35, No. 3

Diagnosis of Triple-Lumen Catheter Infection: Comparison of
Roll Plate, Sonication, and Flushing Methodologies
ROBERT J. SHERERTZ,1* STEPHEN O. HEARD,2

AND

ISSAM I. RAAD3

Division of Infectious Diseases, Department of Medicine, Bowman Gray School of Medicine, Winston-Salem, North
Carolina1; Department of Anesthesiology, University of Massachusetts Medical Center,Worcester, Massachusetts2;
and Division of Infectious Diseases, Department of Medicine, M. D. Anderson Cancer Center, Houston, Texas3
Received 28 August 1996/Returned for modification 1 October 1996/Accepted 24 November 1996

some of the limitations of the roll plate method. Removable
catheters have been cultured by flushing with broth (8), centrifugation (3), swabbing the catheter hub followedby vortexing the swab (21), vortexing (4), and sonication (19, 43). Removable catheters have also been studied by Gram staining
(11, 12) or acridine orange staining (12, 49) of catheters or
Gram staining of a touch preparation from the catheter (9).
The diagnosis of infections from nonremovable catheters has
also been approached in a variety of different ways. These
include using a wire brushto obtain a culture sample from the
catheter lumen in situ (26), Gram staining (29) or acridine
orange staining (39) of blood drawn through the catheter,
performing paired blood cultures (1, 2, 5, 14, 16, 17, 30, 36, 46,
48), or doing quantitative cultures or Gram stains of the skin at
the catheter exit site (3, 21, 27, 45).
Combinations of different culture methods have been used
to tryand localize the source of contamination (3, 6, 7, 13, 15,
21, 22, 28, 31, 37, 38). Some studies have also attempted to
compare different methods for their relative abilities to diagnose vascular catheter infection (6, 7, 13, 18, 20, 21, 35, 37, 38).
This study attempted to confirm whether there was any advantage of the sonication method over the roll plate method as
well as to compare both ofthese methods to the flush technique in culturing triple-lumen central catheters.

Vascular catheters are said to be infected when there is
purulence or cellulitis at the catheter exit site or, more commonly, when a quantitative catheter culture grows a significant
number of organisms. The latter should be more appropriately
termed “significant colonization,” because it does not always
correlatewith demonstrable clinical findings (4, 22, 24, 34, 40,
43). The first quantitative culture method used was the semiquantitative method described by Maki et al. (24) in 1977. That
study demonstrated that rolling a catheter back and forth on
the surface of an agar plate and then quantitating the numbers
of CFU of microorganisms was superior to culturing a catheter
in broth. While the roll platemethod was clearly a major
improvement and is still the method most commonly used,
subsequent investigations found that it had limitations. In a
study of stiff, Teflon hemodialysis catheters (41), the roll plate
method was sometimes difficult to perform, because when the
catheters came out they were bent into shapes that would not
roll easily. For patient populations with low rates of...