Comparative assessment of two conservative methods for the diagnosis of catheter-related blood stream infection (CRBSI)

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Intravenous literature: Gowardman, J.R., Jeffries, P., Lassig-Smith, M., Stuart, J., Jarrett, P., Deans, R., McGrail, M., George, N.M., Nimmo, G.R. and Rickard, C.M. (2012) A comparative assessment of two conservative methods for the diagnosis of catheter-related infection in critically ill patients. Intensive Care Medicine. 26th September. [epub ahead of print].

Abstract:

Purpose – To assess the utility of two in situ techniques, differential time to positivity (DTP) and semiquantitative superficial cultures (SQSC) for diagnosing catheter-related bloodstream infection (CR-BSI) in critically ill adults.

Methods – This was a prospective cohort study in patients with suspected CR-BSI arising from a short-term arterial catheter (AC) or a central venous catheter (CVC). On suspicion of CR-BSI, devices were removed. Blood, skin, catheter tip and hub cultures were taken. Infection rates were compared against the diagnosis of CR-BSI using matched tip and blood cultures.

Results – Of 120 episodes of clinically suspected CR-BSI in 101 patients examined, 9 (7.5 %) were confirmed as CR-BSI. Validity values (95 % CI) for the diagnosis of CR-BSI arising from both AC and CVC for DTP were: sensitivity 44 % (15–77 %), specificity 98 % (93–100 %), positive predictive value (PPV) 67 % (24–94 %), negative predictive value (NPV) 96 % (90–98 %), positive likelihood ratio (LR+) 25 (5–117), negative likelihood ratio (LR−) 0.6 (0.3–1.0), diagnostic odds ratio (DOR) 44 (7–258), and accuracy 94 % (92–98 %). Validity values (95 % CI) for SQSC were: sensitivity 78 % (41–96 %), specificity 60 % (50–69 %), PPV 14 % (6–26 %), NPV 97 % (89–99 %), LR+ 1.9 (1.0–2.3), LR− 0.4 (0.1–1.3), DOR 5.1 (1.1–19), and accuracy 61 % (51–69 %). DTP combined with SQSC improved sensitivity and NPV to 100 % whilst the DOR increased to 25.8 (95 % CI 3–454).

Conclusions – CR-BSI can be ruled out by undertaking DTP and SQSC concurrently for both ACs and CVCs with 100 % sensitivity and NPV.

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