Intravenous literature: Fontana, C., Favaro, M., Bossa, M.C., Minelli, S., Altieri, A., Pelliccioni, M., Falcione, F., Di Traglia, L., Cicchetti, O. and Favalli, C. (2012) Improved diagnosis of central venous catheter-related bloodstream infections using the HB&L UROQUATTROâ„¢ system. European Journal of ClinicalÂ Microbiology & Infectious Diseases. Jun 27. [Epub ahead of print].
The diagnosis of catheter-related bloodstream infections (CRBSIs) in febrile patients with indwelling central venous catheters (CVCs) needs improvement. To diagnose CRBSIs more efficiently, we have developed a novel culture approach using the catheter tips removed from febrile patients. CVCs and blood cultures from 1,070 patients with only CVC-related infections were obtained over a period of 3 years (January 2009 to December 2011). The CVCs were evaluated by a semi-quantitative catheter culture method according to Maki’s method and by our novel method, which is based on the use of the HB&L UROQUATTROâ„¢ system (Alifax, Padova, Italy). Using our new method, 571 (571/1,070) of the infections were confirmed as CRBSIs. The remaining 487 patients had infections that were associated with hematologic malignancies, neutropenia, prior exposure to antibiotics, and a decreased CVC removal rate. Twelve samples were identified as false-positives. The percentage of patients with CRBSIs confirmed using the HB&L UROQUATTROâ„¢ system was 53.36 % versus 34.95 % (p-value 0.004) using Maki’s method (374/1,070 CVC Maki-positive samples). Our results indicate that our new culture method allows for an improved CRBSI diagnosis rate. A significant number of tip cultures (18.41 %) tested positive for CRBSIs using our system but were negative when tested using Maki’s method. Moreover, the use of the HB&L UROQUATTROâ„¢ system allowed us to significantly reduce diagnosis time; a negative CRBSI diagnosis could be made within 6 h and a positive diagnosis could be made within 22-28 h.