Vascular access ports (VAP) may be associated with nosocomial infections. Identification of the infection type can help determine the best management strategy. The authors are from Hopital Saint Louis and Hopital Bichat-Claude Bernard AP-HP in Paris.
Systemic VAP-related bloodstream infection:
(1) positive peripheral blood culture
(2) no detectable focus of infection except the VAP
(3) one or more of the following:
(3a) presence of local purulence about the VAP with isolation of the same organism from the pus as is in the peripheral blood
(3b) presence of clinical symptoms associated with positive quantitative cultures from the VAP catheter tip or internal lumen showing the same organism as found in the peripheral blood cultures
Local VAP-related infection:
(1) confirmed site infection or skin induration above the silicone septum that measures < 2 cm from the septum
(2) absence of concomitant blood stream infection (sterile peripheral blood cultures)
VAP colonization:
(1) growth of a microbial pathogen in quantitative culture from the catheter tip or septum with colony count < 1,000 CFU/mL
(2) absence of concommitant bloodstream infection (negative peripheral blood cultures)
where:
• Local purulence about a VAP = tunnel infection and/or induration extending at least 3 cm from the insertion port.
• Clinical symptoms of infection = body temperature >= 38°C or < 36°C, and shivering after handling of the VAP
• In the Brun-Buisson quantitative culture protocol >= 1,000 CFU/mL (colony forming units per mL) is considered positive and < 1,000 CFU/mL is considered nonsignificant.
• Measurement of local induration appears to be radial from the silicone septum rather than the diameter across the septum.
• There appears to be a 1 cm gap for the zone of induration about the VAP in the criteria, with a local infection < 2 cm and local purulence >= 3 cm.
