Diagnostic and Therapeutic Utility of Positive Intravascular Catheter Tip Cultures

Abstract

In patients with intravascular catheters who are febrile or have positive blood cultures and no other obvious sources of infection, catheter tip cultures are often obtained to evaluate potential catheter-related bloodstream infections. However, previous studies reported that the management of catheter-related bloodstream infection cases is entirely based on blood culture growth and susceptibilities and that catheter tip cultures have low diagnostic positive predictive value.

The applicability of the central line‐associated bloodstream infection (CLABSI) criteria for the evaluation of bacteremia episodes in pediatric oncology patients

“…Limitations are that important data might have been missing in the patient files during evaluation. Also, It remains difficult to diagnose a CVC related bloodstream infection with certainty in pediatric patients as compared to adults since no peripheral blood cultures (which can be used to calculate a differential time to positivity) are obtained and the catheter tip is mostly not cultured due to the limited diagnostic and therapeutic value (i.e., CVC mostly removed under antibiotic therapy) 4,20 . Furthermore, only bacteremia in the first 90 days after CVC insertion were included 5 .…”

“…Also, It remains difficult to diagnose a CVC related bloodstream infection with certainty in pediatric patients as compared to adults since no peripheral blood cultures (which can be used to calculate a differential time to positivity) are obtained and the catheter tip is mostly not cultured due to the limited diagnostic and therapeutic value (i.e., CVC mostly removed under antibiotic therapy). 4,20 Furthermore, only bacteremia in the first 90 days after CVC insertion were included. 5 Therefore, it is possible that these results cannot be extrapolated to bacteremia episodes after 90 days, since these might have occurred under different circumstances (e.g., consolidation instead of induction chemotherapy).…”

Gram-negative sepsis caused by a rare pathogenPhytobacter ursingii

“…Vancomycin was discontinued and the infectious disease service was consulted. While catheter tip cultures are considered part of the gold standard for confirmation of central line-associated bloodstream infections, their diagnostic and therapeutic value has come into question 5. Given the cogent source of bacteraemia (related to Hickman removal/leak), four of four peripheral cultures growing bacteria and the decision to remove the new Hickman catheter regardless of tip culture results, the infectious disease team did not obtain these cultures.…”