858Evaluation of Current Methods for the Diagnosis of Catheter-Related Blood Stream Infections (CRBSI) at the Hospital for Sick Children

Abstract

Background. Central-line associated blood stream infections (CLABSI) are a significant cause of morbidity and mortality for critically ill and immunocompromised patients. The diagnosis can be challenging in children, as prophylactic antibiotics are often started prior to cultures. The purpose of this study was to review the value of catheter tip cultures in diagnosing CLABSI in children and to determine whether alternative laboratory methods of diagnosis might be indicated.Methods. We performed a retrospective review of all semi-quantitative catheter tip cultures from 2010-11. All blood culture data in the preceding two weeks were reviewed to determine their predictive value for CLABSI. Central lines that had a second culture ( peripheral or other central line culture) taken within 24h of each other were analyzed separately as a pair. A survey of HCP ( physicians and nurse practitioners) on the diagnosis of CLABSI in children with central lines was conducted.Results. A total of 274 catheter tips were cultured from 237 patients. The majority of patients had cultures performed in the preceding two weeks (87%). Positive tips cultures were obtained in 13% (n = 35); 28 (80%) had a preceding blood culture with the same organism. Of those patients, 86% (n = 24) had a set of paired cultures sent.Analysis of tip cultures is outlined in the figure, and paired cultures are described further in the table.The survey was distributed to 300 people, with a 25% response rate. Respondents felt line removal had significant clinical impact. Respondents were generally in agreement with IDSA guidelines on indications for line removal.Analysis of tip cultures, and paired cultures.