Intravenous literature: Chen, W.T., Liu, T.M., Wu, S.H., Tan, T.D., Tseng, H.C. and Shih, C.C. (2009) Improving diagnosis of central venous catheter-related bloodstream infection by using differential time to positivity as a hospital-wide approach at a cancer hospital. Journal of Infection. 59(5), p.317-23.
OBJECTIVES: Considering the difficulty of diagnosing catheter-related bloodstream infection (CRBSI), Koo Foundation Sun Yat-Sen Cancer Center uses differential time to positivity (DTP) as a hospital-wide approach to improve the diagnosis of CRBSI in febrile patients with indwelling central venous catheters (CVCs). This study describes the result of a hospital-wide use of DTP in a real practice setting.
METHODS: During January 2003-August 2007, 142 positive paired blood cultures from 125 patients without infection focus other than CVC were included. These were evaluated by DTP and semi-quantitative catheter culture (SQCC) to confirm the diagnosis of CRBSI, and were further divided into two groups: confirmed (either by DTP or SQCC) and non-confirmed CRBSI (neither DTP nor SQCC positive).
RESULTS: Fifty-nine point two percent (84/142) of episodes were confirmed as CRBSI, of which DTP was positive in 83.3% (n=70). Non-confirmed CRBSI was associated with hematologic malignancy, neutropenia status, previous antibiotics exposure and a lower CVC removal rate.
CONCLUSIONS: A hospital-wide approach of DTP was practical and feasible in improving the diagnosis of CRBSI in a real practice setting.