BACKGROUND: No consensus exists on the best methods for diagnosis of intravascular device (IVD)-related bloodstream infection. PURPOSE: To identify the most accurate methods for diagnosis of IVD-related bloodstream infection. DATA SOURCES: 51 English-language studies published from 1966 to 31 July 2004. STUDY SELECTION: Studies of diagnostic tests for IVD-related bloodstream infection that described a reference standard and provided sufficient data to calculate sensitivity and specificity. DATA EXTRACTION: Study quality, diagnostic tests examined, patient characteristics, prevalence, sensitivity, and specificity. DATA SYNTHESIS: Pooled sensitivity and specificity were calculated for 8 diagnostic methods. Summary measures of accuracy were Q* (the upper leftmost point on the summary receiver-operating characteristic curve) and mean D (a log odds ratio). Subgroup analyses were used to assess heterogeneity. Overall, the most accurate test was paired quantitative blood culture (Q* = 0.94 [95% CI, 0.88 to 1.0]), followed by IVD-drawn quantitative [corrected] blood culture (Q* = 0.89 [CI, 0.79 to 0.99]) and the acridine orange leukocyte cytospin test (Q* = 0.89 [CI, 0.79 to 0.91]). The most accurate catheter segment culture test was quantitative culture (Q* = 0.87 [CI, 0.81 to 0.93]), followed by semi-quantitative culture (Q* = 0.84 [CI, 0.80 to 0.88]). Significant heterogeneity in pooled sensitivity and specificity was observed across all test categories. LIMITATIONS: The limited number of studies of some of the diagnostic methods precludes precise estimates of accuracy. CONCLUSIONS: Paired quantitative blood culture is the most accurate test for diagnosis of IVD-related bloodstream infection. However, most other methods studied showed acceptable sensitivity and specificity (both >0.75) and negative predictive value (>99%). The positive predictive value of all tests increased greatly with high pretest clinical probability. Catheters should not be cultured routinely but rather only if IVD-related bloodstream infection is suspected clinically.
BACKGROUND: No consensus exists on the best methods for diagnosis of intravascular device (IVD)-related bloodstream infection. PURPOSE: To identify the most accurate methods for diagnosis of IVD-related bloodstream infection. DATA SOURCES: 51 English-language studies published from 1966 to 31 July 2004. STUDY SELECTION: Studies of diagnostic tests for IVD-related bloodstream infection that described a reference standard and provided sufficient data to calculate sensitivity and specificity. DATA EXTRACTION: Study quality, diagnostic tests examined, patient characteristics, prevalence, sensitivity, and specificity. DATA SYNTHESIS: Pooled sensitivity and specificity were calculated for 8 diagnostic methods. Summary measures of accuracy were Q* (the upper leftmost point on the summary receiver-operating characteristic curve) and mean D (a log odds ratio). Subgroup analyses were used to assess heterogeneity. Overall, the most accurate test was paired quantitative blood culture (Q* = 0.94 [95% CI, 0.88 to 1.0]), followed by IVD-drawn quantitative [corrected] blood culture (Q* = 0.89 [CI, 0.79 to 0.99]) and the acridine orange leukocyte cytospin test (Q* = 0.89 [CI, 0.79 to 0.91]). The most accurate catheter segment culture test was quantitative culture (Q* = 0.87 [CI, 0.81 to 0.93]), followed by semi-quantitative culture (Q* = 0.84 [CI, 0.80 to 0.88]). Significant heterogeneity in pooled sensitivity and specificity was observed across all test categories. LIMITATIONS: The limited number of studies of some of the diagnostic methods precludes precise estimates of accuracy. CONCLUSIONS: Paired quantitative blood culture is the most accurate test for diagnosis of IVD-related bloodstream infection. However, most other methods studied showed acceptable sensitivity and specificity (both >0.75) and negative predictive value (>99%). The positive predictive value of all tests increased greatly with high pretest clinical probability. Catheters should not be cultured routinely but rather only if IVD-related bloodstream infection is suspected clinically.
Authors: Mohammad D Mansouri; Timothy J Opperman; John D Williams; Charles Stager; Rabih O Darouiche Journal: Antimicrob Agents Chemother Date: 2012-01-23 Impact factor: 5.191
Authors: Leonard A Mermel; Michael Allon; Emilio Bouza; Donald E Craven; Patricia Flynn; Naomi P O'Grady; Issam I Raad; Bart J A Rijnders; Robert J Sherertz; David K Warren Journal: Clin Infect Dis Date: 2009-07-01 Impact factor: 9.079
Authors: Joshua T Freeman; Anna Elinder-Camburn; Catherine McClymont; Deverick J Anderson; Mary Bilkey; Deborah A Williamson; Leanne Berkahn; Sally A Roberts Journal: Infect Control Hosp Epidemiol Date: 2012-11-20 Impact factor: 3.254