A randomized and prospective study of 3 procedures for the diagnosis of catheter-related bloodstream infection without catheter withdrawal.

BACKGROUND Suspicion of catheter-related bloodstream infection (CR-BSI) leads frequently to unnecessary catheter withdrawals, and many catheter-tip cultures yield negative results. The objective of this study was to compare the yield of 3 microbiological procedures to assess CR-BSI without catheter withdrawal. METHODS The study was prospectively performed in a group of patients without neutropenia or blood disorders who were admitted to the intensive care unit during a 37-month period with sepsis suspected on clinical grounds and who had central venous catheters inserted for >48 h. The microbiological procedures compared were semiquantitative cultures from hub and skin (superficial), differential quantitative blood cultures, and differential time to positivity between cultures of blood obtained from catheter hubs and peripheral blood. RESULTS Of the 204 episodes of suspected CR-BSI included in the study, 28 were confirmed to be CR-BSI. We obtained the following results for sensitivity, specificity, positive and negative predictive values, and accuracy: superficial cultures, 78.6%, 92.0%, 61.1%, 96.4%, and 90.2%, respectively; differential quantitative blood cultures, 71.4%, 97.7%, 83.3%, 95.6%, and 94.1%, respectively; and differential time to positivity, 96.4%, 90.3%, 61.4%, 99.4%, and 91.2%, respectively. CONCLUSIONS CR-BSI can be assessed without catheter withdrawal in patients without neutropenia or blood disorders who have catheters inserted for a short time and are hospitalized in the intensive care unit. Convenience, use of resources, and expertise should determine the technique of choice in different medical contexts. Because of ease of performance, low cost, and wide availability, we recommend combining semiquantitative superficial cultures and peripheral vein blood cultures to screen for CR-BSI, leaving differential quantitative blood cultures as a confirmatory and more specific technique.

[1]  D. Raveh,et al.  Prospective hospital-wide studies of 505 patients with nosocomial bacteraemia in 1997 and 2002. , 2006, The Journal of hospital infection.

[2]  A. Tobías,et al.  Nosocomial Infection Surveillance in a Surgical Intensive Care Unit in Spain, 1996-2000: A Time-Trend Analysis , 2006, Infection Control & Hospital Epidemiology.

[3]  E. Bouza,et al.  The challenge of anticipating catheter tip colonization in major heart surgery patients in the intensive care unit: Are surface cultures useful? , 2005, Critical care medicine.

[4]  E. Bouza,et al.  A prospective, randomized, and comparative study of 3 different methods for the diagnosis of intravascular catheter colonization. , 2005, Clinical infectious diseases : an official publication of the Infectious Diseases Society of America.

[5]  J. Fine,et al.  Meta-Analysis: Methods for Diagnosing Intravascular DeviceRelated Bloodstream Infection , 2005, Annals of Internal Medicine.

[6]  Megan B Bestul,et al.  Antibiotic Lock Technique: Review of the Literature , 2005, Pharmacotherapy.

[7]  V. Kvetan,et al.  The incidence of infectious complications of central venous catheters at the subclavian, internal jugular, and femoral sites in an intensive care unit population* , 2005, Critical care medicine.

[8]  M. Desco,et al.  On Behalf of the Cooperative Group of the European Study Group on Nosocomial Infections (esgni) , 2022 .

[9]  G. Dimitracopoulos,et al.  Intravenous catheter infections associated with bacteraemia: a 2-year study in a university hospital. , 2004, Clinical microbiology and infection : the official publication of the European Society of Clinical Microbiology and Infectious Diseases.

[10]  A. Wilmer,et al.  Watchful waiting versus immediate catheter removal in ICU patients with suspected catheter-related infection: a randomized trial , 2004, Intensive Care Medicine.

[11]  J. Tarrand,et al.  Differential Time to Positivity: A Useful Method for Diagnosing Catheter-Related Bloodstream Infections , 2004, Annals of Internal Medicine.

[12]  D. Maki,et al.  The pathogenesis of catheter-related bloodstream infection with noncuffed short-term central venous catheters , 2004, Intensive Care Medicine.

[13]  E. Bouza,et al.  A needleless closed system device (CLAVE) protects from intravascular catheter tip and hub colonization: a prospective randomized study. , 2003, The Journal of hospital infection.

[14]  H. Seifert,et al.  Bloodstream Infection in Neutropenic Cancer Patients Related to Short-Term Nontunnelled Catheters Determined by Quantitative Blood Cultures, Differential Time to Positivity, and Molecular Epidemiological Typing with Pulsed-Field Gel Electrophoresis , 2003, Journal of Clinical Microbiology.

[15]  W. Peetermans,et al.  Catheter-tip colonization as a surrogate end point in clinical studies on catheter-related bloodstream infection: how strong is the evidence? , 2002, Clinical infectious diseases : an official publication of the Infectious Diseases Society of America.

[16]  E. Bouza.  Intravascular catheter-related infections: a growing problem, the search for better solutions. , 2002, Clinical Microbiology and Infection.

[17]  A. Wilmer,et al.  Difference in time to positivity of hub-blood versus nonhub-blood cultures is not useful for the diagnosis of catheter-related bloodstream infection in critically ill patients , 2001, Critical care medicine.

[18]  L. Mermel,et al.  Guidelines for the Management of Intravascular Catheter-Related Infections , 2001, Infection Control & Hospital Epidemiology.

[19]  M. Pennisi,et al.  Nosocomial Infection Rates in an Italian Intensive Care Unit Using the National Nosocomial Infection Surveillance System , 2001, Infection Control & Hospital Epidemiology.

[20]  E. Bouza,et al.  Catheter-Related Infections: Diagnosis and Intravascular Treatment , 2001, Journal of chemotherapy.

[21]  Á. Asensio,et al.  Semiquantitative culture of subcutaneous segment for conservative diagnosis of intravascular catheter-related infection. , 2000, JPEN. Journal of parenteral and enteral nutrition.

[22]  C. Brun-Buisson,et al.  Diagnosis of catheter-related bacteraemia: a prospective comparison of the time to positivity of hub-blood versus peripheral-blood cultures , 1999, The Lancet.

[23]  S Chevret,et al.  Attributable Morbidity and Mortality of Catheter-Related Septicemia in Critically Ill Patients: a Matched, Risk-Adjusted, Cohort Study , 1999, Infection Control & Hospital Epidemiology.

[24]  M. Rogers,et al.  The use of continuous monitoring blood culture systems in the diagnosis of catheter related sepsis. , 1998, Journal of clinical pathology.

[25]  V. González,et al.  [Diagnostic value of Gram staining of peri-catheter skin and the connection in the prediction of intravascular-catheter-related bacteremia]. , 1998, Enfermedades infecciosas y microbiologia clinica.

[26]  J. A. Capdevila,et al.  Catheter-related infection: an update on diagnosis, treatment, and prevention. , 1998, International journal of infectious diseases : IJID : official publication of the International Society for Infectious Diseases.

[27]  A. Laplanche,et al.  Earlier Positivity of Central-Venous- versus Peripheral-Blood Cultures Is Highly Predictive of Catheter-Related Sepsis , 1998, Journal of Clinical Microbiology.

[28]  P. Bollaert,et al.  Differential quantitative blood cultures in the diagnosis of catheter-related sepsis in intensive care units. , 1997, Clinical infectious diseases : an official publication of the Infectious Diseases Society of America.

[29]  J. Rello,et al.  Serial surveillance cultures of skin and catheter hub specimens from critically ill patients with central venous catheters: molecular epidemiology of infection and implications for clinical management and research , 1997, Journal of clinical microbiology.

[30]  M. Robb,et al.  Comparison of standard and quantitative blood cultures in the evaluation of children with suspected central venous line sepsis. , 1992, Diagnostic microbiology and infectious disease.

[31]  I. Gasser,et al.  Value of differential quantitative blood cultures in the diagnosis of catheter-related sepsis , 1992, European Journal of Clinical Microbiology and Infectious Diseases.

[32]  F. Nolte,et al.  Quantitative aspects of septicemia , 1990, Clinical Microbiology Reviews.

[33]  E. Bouza,et al.  A conservative procedure for the diagnosis of catheter-related infections. , 1990, Archives of internal medicine.

[34]  J. Washington,et al.  Quantitative blood cultures for catheter-associated infections , 1990, Journal of clinical microbiology.

[35]  M. Farnell,et al.  Limited usefulness of quantitative culture of blood drawn through the device for diagnosis of intravascular-device-related bacteremia , 1989, Journal of clinical microbiology.

[36]  S. Fan,et al.  Evaluation of central venous catheter sepsis by differential quantitative blood culture , 1989, European Journal of Clinical Microbiology and Infectious Diseases.

[37]  S. Fan,et al.  Predictive value of surveillance skin and hub cultures in central venous catheters sepsis. , 1988, The Journal of hospital infection.

[38]  D. Armstrong,et al.  Prospective study of infections in indwelling central venous catheters using quantitative blood cultures. , 1988, The American journal of medicine.

[39]  F. Barrett,et al.  Differential quantitation with a commercial blood culture tube for diagnosis of catheter-related infection , 1988, Journal of clinical microbiology.

[40]  S. Curtas,et al.  The benefits of Isolator cultures in the management of suspected catheter sepsis. , 1987, Surgery.

[41]  A. Sitges-Serra,et al.  Pathogenesis of catheter sepsis: a prospective study with quantitative and semiquantitative cultures of catheter hub and segments , 1985, Journal of clinical microbiology.

[42]  E. Jaurrieta,et al.  Hub colonization as the initial step in an outbreak of catheter-related sepsis due to coagulase negative staphylococci during parenteral nutrition. , 1984, JPEN. Journal of parenteral and enteral nutrition.

[43]  B. Wong,et al.  Clinical correlations of serial quantitative blood cultures determined by lysis-centrifugation in patients with persistent septicemia , 1984, Journal of clinical microbiology.

[44]  F. Yates,et al.  Tests of Significance for 2 × 2 Contingency Tables , 1984 .

[45]  G. Roberts,et al.  Clinical evaluation of the lysis-centrifugation blood culture system for the detection of fungemia and comparison with a conventional biphasic broth blood culture system , 1984, Journal of clinical microbiology.

[46]  D. Maki,et al.  A semiquantitative culture method for identifying intravenous-catheter-related infection. , 1977, The New England journal of medicine.

[47]  Ellen Jo Baron,et al.  Manual of clinical microbiology , 1975 .

[48]  A. Saito,et al.  [Bloodstream infection]. , 2002, Nihon rinsho. Japanese journal of clinical medicine.