In situ diagnosis of intravascular catheter-related bloodstream infection: A comparison of quantitative culture, differential time to positivity, and endoluminal brushing

Catton, James; Dobbins, Brian; Kite, P.; Wood, Jonathan; Eastwood, K.; Sugden, Sarah; Sandoe, Jonathan; Burke, Dermot; McMahon, Michael; Wilcox, Mark H.

doi:10.1097/01.ccm.0000157968.98476.f3

Cited by 101 publications

(48 citation statements)

References 22 publications

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“…The early increase of PCT may reflect the colonization of the catheter with subclinical infection ultimately leading to BSI [17]. CRP was discriminative only at 1 day after blood culture collection; even at this point, PCT had a superior diagnostic accuracy.…”

Section: Discussionmentioning

confidence: 97%

Serum Procalcitonin for Discrimination of Blood Contamination from Bloodstream Infection due to Coagulase-Negative Staphylococci

2007

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The diagnostic value of serum procalcitonin (PCT) to distinguish blood contamination from bloodstream infection (BSI) due to coagulase-negative staphylococci was evaluated. Patients with BSI had higher PCT concentration than those with blood contamination at day -1, day 0 and day +1 with regard to blood culture collection (p < 0.05), whereas serum Creactive protein values were significantly higher only on day +1. At a cutoff of 0.1 ng/dl, PCT had a sensitivity of 86% and 100%, and a specificity of 60% and 80% for the diagnosis of BSI on day -1 and 0, respectively. In addition to clinical and microbiological parameters, PCT may help discriminating blood contamination from BSI due coagulase-negative staphylococci.

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Section: Discussionmentioning

confidence: 97%

Serum Procalcitonin for Discrimination of Blood Contamination from Bloodstream Infection due to Coagulase-Negative Staphylococci

2007

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“…Only tips of RRT catheters were cultured on removal. Catheter lumens can be cultured using endoluminal brush either in situ or after removal in the laboratory or by culturing sections of the catheter (31). Consequently, the rate of endoluminal colonization could have been underestimated.…”

Section: Discussionmentioning

confidence: 99%

Continuous Renal Replacement Therapy May Increase the Risk of Catheter Infection

Parienti

Dugué

Daurel³

et al. 2010

Clinical Journal of the American Society of Nephrology

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Background and objectives:Little is known about the risks of catheter-related infections in patients undergoing intermittent hemodialysis (IHD) as compared with continuous renal replacement therapy (CRRT) techniques. We compared the two modalities among critically ill adults requiring acute renal replacement therapy (RRT).Design, setting, participants, & measurements: We used the multicenter Cathedia study cohort of 736 critically ill adults requiring RRT. Cox marginal structural models were used to compare time to catheter-tip colonization at removal (intent-totreat, primary endpoint) among patients who started IHD (n ‫؍‬ 470) versus CRRT (n ‫؍‬ 266). On-treatment analysis was also conducted to take into account changes in prescription of RRT modality.Results: Hazard rate of catheter-tip colonization did not increase within the first 10 days of catheter use. Predictors of catheter-tip colonization were higher lactate levels and hypertension, while systemic antibiotics, antiseptics-impregnated catheters, and mechanical ventilation were associated with decreased risk. The incidence of catheter-tip colonization per 1000 catheter-days was 42.7 in the IHD group and 27.7 in the CRRT group (P < 0.01). This association was no longer significant after correction for channeling bias (weighted HR, 0.96; 95% CI: 0.77 to 1.20, P ‫؍‬ 0.73). On-treatment analysis revealed an increased risk of primary endpoint during CRRT exposure as compared with IHD exposure (weighted HR, 0.71; 95% CI: 0.56 to 0.92, P < 0.009).Conclusions: Our results do not support the use of CRRT when IHD could be an alternative to reduce the risk of catheter-related infection.

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“…TCQBC for the diagnosis of microbial colonization TCQBC has been previously used for detecting microbial colonization of central venous catheters 42 , and for the diagnosis of CRBSI without catheter removal [43][44][45] .…”

Section: Microbiology Methodsmentioning

confidence: 99%

Cathasept Line Lock and Microbial Colonization of Tunneled Hemodialysis Catheters: A Multicenter Randomized Controlled Trial

Kanaa

Wright

Akbani

et al. 2015

American Journal of Kidney Diseases

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BackgroundCatheter-related bloodstream infections (CRBSI) are associated with increased morbidity and mortality in hemodialysis patients (HD). Cathasept (Tetra-sodium EDTA) solution has antimicrobial and anticoagulant activities. Study DesignMulti-center, prospective, randomized, and controlled study. Setting & Participants117 maintenance HD patients with confirmed uncolonised tunneled hemodialysis catheters (t-HDC) were recruited from four hemodialysis centers. InterventionPatients were randomly assigned to remain on heparin 5000 units/ml locks (Heparin Group -HG) or to receive Cathasept 4% locks (Cathasept Group -CG) thrice weekly according to the catheter lumen volume and were followed up until their catheter was removed or for a maximum of 8 months. OutcomesPrimary outcome was the incidence rate of clinically significant microbial colonization of t-HDC defined as through-catheter quantitative blood culture (TCQBC) yielding ≥1000 CFU/ml of bacteria or yeast. Secondary outcomes included CRBSI rate, catheter patency, and biomarkers of inflammation and anemia. MeasurementsWeekly TCQBC. hs-CRP was measured fortnightly, and FBC and Ferritin monthly. ResultsCatheter colonization rate was 0.14/1000 catheter-days in the CG and 1.08/1000 catheter-days in the HG [Incidence rate ratio (IRR) 0.13; 95% CI, 0.003-0.94; p=0.02]. CRBSI rate was 0.28/1000 catheter-days in the CG and 0.68/1000 catheter 4 days in the HG [IRR 0.40; 95% CI, p=0.3]. The proportion of dialysis sessions with achieved prescribed blood flow rate was significantly lower in the CG (66.8% vs 75.3%; p<0.001), with more patients required thrombolytic locks or infusion to maintain catheter patency (22 vs 9; p=0.01). On average, hs-CRP was 11.6 (SE ±5.3) mg/l lower for patients in the HG (p=0.03). Anemia markers were comparable in both groups. LimitationsThe study was underpowered to assess the effect on CRBSI, was terminated early due to slow recruitment, and was not double-blinded. ConclusionCathasept significantly reduced t-HDC colonization but the reduction in CRBSI was not statistically significant, and it was associated with more thrombotic complications.Its safety profile was comparable to heparin lock solution.

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In situ diagnosis of intravascular catheter-related bloodstream infection: A comparison of quantitative culture, differential time to positivity, and endoluminal brushing

Cited by 101 publications

References 22 publications

Serum Procalcitonin for Discrimination of Blood Contamination from Bloodstream Infection due to Coagulase-Negative Staphylococci

Serum Procalcitonin for Discrimination of Blood Contamination from Bloodstream Infection due to Coagulase-Negative Staphylococci

Continuous Renal Replacement Therapy May Increase the Risk of Catheter Infection

Cathasept Line Lock and Microbial Colonization of Tunneled Hemodialysis Catheters: A Multicenter Randomized Controlled Trial

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