Infections Associated with Pigtail Catheters

Clinical Definitions and Classification

The Centers for Disease Control and Prevention, as reported by MMWR Recommendations and Reports, defines exit site infection as characterized by erythema, induration, and/or tenderness within 2 cm of the catheter exit site, often associated with pus emerging from the exit site, with or without concomitant bloodstream infection 1, 3
Clinical manifestations of catheter-related infections include purulent drainage from the catheter exit site, according to Clinical Infectious Diseases 1
Clinical manifestations of catheter-related infections also include erythema or induration around the catheter insertion site, as defined by MMWR Recommendations and Reports 3
Clinical manifestations of catheter-related infections include fever, chills, or other systemic signs of infection, as reported by Clinical Infectious Diseases 2
Microbiological definition of catheter-related infection is exudate at catheter exit site yields a microorganism with or without concomitant bloodstream infection, according to Clinical Infectious Diseases 4

Collecting cultures of the drainage material to identify causative organisms is recommended by Clinical Infectious Diseases 1
A Gram stain of the drainage may be helpful for rapid diagnosis of local infections, though it is less sensitive than quantitative methods, as reported by Clinical Infectious Diseases 1
Differential time to positivity between catheter-drawn and peripheral blood cultures can help determine if the catheter is the source of infection, according to Clinical Infectious Diseases 5

The presence of purulent drainage with blood from a pigtail catheter strongly suggests infection at the catheter site and possibly catheter-related bloodstream infection, as reported by Clinical Infectious Diseases 2
This finding has greater specificity but poor sensitivity for diagnosing intravascular device-related infection, according to Clinical Infectious Diseases 1

Do not rely solely on clinical findings for establishing a diagnosis of catheter-related infection, as they have poor specificity and sensitivity, as reported by Clinical Infectious Diseases 1
Avoid confusing colonization with infection, as catheter colonization is defined as significant growth of a microorganism in culture without clinical signs of infection, according to MMWR Recommendations and Reports 3
Prompt identification and appropriate management of catheter-related infections are essential to reduce morbidity and mortality associated with these complications, as reported by Clinical Infectious Diseases 1, 5