H Bouzidi1, A Emirian2, A Marty1, E Chachaty2, A Laplanche3, B Gachot4, F Blot5. 1. Service de Réanimation, Gustave Roussy-Cancer Campus, Villejuif, France. 2. Service de Microbiologie Médicale, Gustave Roussy-Cancer Campus, Villejuif, France. 3. Département de Statistiques Médicales, Gustave Roussy-Cancer Campus, Villejuif, France. 4. Unité de Pathologie Infectieuse, Gustave Roussy-Cancer Campus, Villejuif, France. 5. Service de Réanimation, Gustave Roussy-Cancer Campus, Villejuif, France. Electronic address: francois.blot@gustaveroussy.fr.
Abstract
OBJECTIVES: Differential time to positivity of cultures of blood drawn simultaneously from central venous catheter and peripheral sites is widely used to diagnose catheter-related bloodstream infections without removing the catheter. However, the accuracy of this technique for some pathogens, such as Staphylococcus aureus, is debated in routine practice. METHODS: In a 320-bed reference cancer centre, the charts of patients with at least one blood culture positive for S. aureus among paired blood cultures drawn over a six-year period were studied retrospectively. Microbiological data were extracted from the prospectively compiled database of the microbiology unit. Data concerning the 149 patients included were reviewed retrospectively by independent physicians blinded to the absolute and differential times to positivity, in order to establish or refute the diagnosis of catheter-related sepsis. Due to missing data, 48 charts were excluded, so 101 cases were actually analysed. The diagnosis was established in 62 cases, refuted in 15 cases and inconclusive in the remaining 24 cases. RESULTS: For the 64 patients with both central and peripheral positive blood cultures, the differential positivity time was significantly greater for patients with catheter-related bloodstream infections due to S. aureus (P<0.02). However, because of the high number of false-negative cases, the classic cut-off limit of 120 min showed 100% specificity but only 42% sensitivity for the diagnosis of catheter-related bloodstream infection due to S. aureus. CONCLUSIONS: These results strongly suggest that despite its high specificity, the differential time to positivity may not be reliable to rule out catheter-related bloodstream infection due to S. aureus.
OBJECTIVES: Differential time to positivity of cultures of blood drawn simultaneously from central venous catheter and peripheral sites is widely used to diagnose catheter-related bloodstream infections without removing the catheter. However, the accuracy of this technique for some pathogens, such as Staphylococcus aureus, is debated in routine practice. METHODS: In a 320-bed reference cancer centre, the charts of patients with at least one blood culture positive for S. aureus among paired blood cultures drawn over a six-year period were studied retrospectively. Microbiological data were extracted from the prospectively compiled database of the microbiology unit. Data concerning the 149 patients included were reviewed retrospectively by independent physicians blinded to the absolute and differential times to positivity, in order to establish or refute the diagnosis of catheter-related sepsis. Due to missing data, 48 charts were excluded, so 101 cases were actually analysed. The diagnosis was established in 62 cases, refuted in 15 cases and inconclusive in the remaining 24 cases. RESULTS: For the 64 patients with both central and peripheral positive blood cultures, the differential positivity time was significantly greater for patients with catheter-related bloodstream infections due to S. aureus (P<0.02). However, because of the high number of false-negative cases, the classic cut-off limit of 120 min showed 100% specificity but only 42% sensitivity for the diagnosis of catheter-related bloodstream infection due to S. aureus. CONCLUSIONS: These results strongly suggest that despite its high specificity, the differential time to positivity may not be reliable to rule out catheter-related bloodstream infection due to S. aureus.
Authors: Maximilian Christopeit; Martin Schmidt-Hieber; Rosanne Sprute; Oliver A Cornely; Georg Maschmeyer; Dieter Buchheidt; Marcus Hentrich; Meinolf Karthaus; Olaf Penack; Markus Ruhnke; Florian Weissinger Journal: Ann Hematol Date: 2020-10-20 Impact factor: 3.673
Authors: Boris Böll; Enrico Schalk; Dieter Buchheidt; Justin Hasenkamp; Michael Kiehl; Til Ramon Kiderlen; Matthias Kochanek; Michael Koldehoff; Philippe Kostrewa; Annika Y Claßen; Sibylle C Mellinghoff; Bernd Metzner; Olaf Penack; Markus Ruhnke; Maria J G T Vehreschild; Florian Weissinger; Hans-Heinrich Wolf; Meinolf Karthaus; Marcus Hentrich Journal: Ann Hematol Date: 2020-09-30 Impact factor: 3.673