Quantitative blood cultures for diagnosis and management of catheter-related sepsis in pediatric hematology and oncology patients

Douard, Marie-Cécile; Arlet, Guillaume; Leverger, Guy; Paulien, R; Waintrop, C.; Clémenti, E.; Eurin, B; Schaison, G

doi:10.1007/bf01708406

Cited by 65 publications

(23 citation statements)

References 19 publications

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“…More than 50% of CVC-related bacteremias were undiagnosed with this method and the ratio was above 30 in four cases of infections unrelated to CVC infection. Douard et al [23] found similar results in a pediatric population. On the other hand, Snydman [20] and Vanhyngen [11] using a semi-quantitative method, and Mosca [21] using a quantitative method were nearly 100% accurate in predicting CVC-related bacteremia.…”

Section: Discussionsupporting

confidence: 74%

“…Since the reinsertion of a new CVC can be hazardous and some CVC-related infection may be treated without CVC removal [12], several studies have sought a way of predicting catheter colonization without removing the CVC. Three main techniques have been evaluated: skin cultures at the CVC insertion point, hub cultures of the CVC [13][14][15][16][17][18][19] and quantitative or semi-quantitative blood cultures collected simultaneously via CVC and peripheral vein [11,[20][21][22][23]. The contribution of skin and hub cultures towards the diagnosis of catheter colonization has been variable among these different studies.…”

Section: Introductionmentioning

confidence: 99%

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Skin versus hub cultures to predict colonization and infection of central venous catheter in intensive care patients

et al. 1994

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Central venous catheters (CVC) are an important source of nosocomial infection in intensive care units. The unnecessary removal of CVC suspected to be infected can probably be minimized. In order to test the accuracy of non-invasive methods for predicting catheter colonization, we prospectively compared the results of 50 consecutive CVC tip cultures, with cultures of the CVC hub and the skin at the insertion site. The CVC were separated into two groups based upon the underlying reason for CVC removal: group I (n = 20), suspicion of infection; group II (n = 30), no suspicion of infection. The skin culture (with a threshold of 15 CFU) was useful in both groups for assessing catheter colonization since it was always positive in cases of catheter colonization and always negative in the absence of catheter colonization. The contribution of the CVC hub cultures alone was minimal since there was no case of catheter colonization with negative skin cultures and positive hub cultures suggesting that the main route of catheter colonization was via the skin. Catheter-related bacteremia was identified in seven patients (six in group I and one in group II). In these patients, the ratio of bacterial colony counts (central/peripheral) was greater than 10:1 in only two cases.

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Section: Discussionsupporting

confidence: 74%

Section: Introductionmentioning

confidence: 99%

Skin versus hub cultures to predict colonization and infection of central venous catheter in intensive care patients

et al. 1994

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“…In the past, quantitative blood cultures were used to help elucidate the true source of infection. There are many methods of interpretation, but in general, a blood culture drawn from a central line that grows Ͼ100 CFU/ml bacteria or has a colony count that is 3-to 5-fold greater than a paired peripheral blood draw was indicative of a catheter-associated bloodstream infection (28)(29)(30).…”

Section: Blood Culture Collectionmentioning

confidence: 99%

Diagnosis of Bloodstream Infections in Children

Bard

TeKippe

2016

J Clin Microbiol

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Identification of bloodstream infections is among the most critical tasks performed by the clinical microbiology laboratory. While the criteria for achieving an adequate blood culture specimen in adults have been well described, there is much more ambiguity in pediatric populations. This minireview focuses on the available pediatric literature pertaining to the collection of an optimal blood culture specimen, including timing, volume, and bottle selection, as well as rapid diagnostic approaches and their role in the management of pediatric bloodstream infections. Blood cultures remain the mainstay of laboratory diagnosis of bloodstream infections (BSIs) in infants and children. Recovery of a pathogen is advantageous, as it confirms the diagnosis of bacteremia and allows for identification and susceptibility testing on the organism to optimize antimicrobial therapy and duration. A negative blood culture is just as important, as it rules out cases of bacteremia and prompts continued investigation of other infectious or noninfectious etiologies or cessation of unnecessary empirical antimicrobial therapy.The spectrum of pathogens causing pediatric BSI varies widely by age, presenting symptoms, and immune status. In 1979, an evaluation of pediatric blood culture found Haemophilus influenzae to be the most prevalent organism followed by Streptococcus pneumoniae and Staphylococcus aureus (1). Today, H. influenzae and S. pneumoniae are rare bloodstream pathogens due to widespread vaccination. A 2012 study of infants of Ͻ3 months of age found the leading causes of bacteremia to be Escherichia coli, group B Streptococcus (Streptococcus agalactiae), and S. aureus (2). The rate of BSI in otherwise healthy children drops precipitously after the first few months of life, but if occurring, the most common pathogens are S. aureus, S. pneumoniae due to communityacquired pneumonia, and Neisseria meningitidis in adolescents. Immunocompromised children are susceptible to a broad range of bloodstream pathogens, including all of those previously mentioned as well as Pseudomonas aeruginosa and Candida spp. (3).The majority of studies related to the laboratory diagnosis of BSI focus on the adult population. Thus, this minireview will be devoted to children and the multifactorial aspects involved in obtaining an optimal pediatric blood culture specimen, including timing, volume, and bottle selection. Lastly, a discussion on the rapid diagnostic approaches currently available and their impact on pediatric management and outcomes will be reviewed. BLOOD CULTURE COLLECTIONFactors that may influence the recovery of pathogens from the blood include the timing of blood collection, number of sets collected, and blood volume. It is well accepted that the volume of blood collected is the single most important factor. Evidence from both adult and pediatric studies show that the probability of recovering a pathogen from blood culture increases with the volume of blood obtained. In addition, the time to detection inversely correlates with the volum...

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“…Although quantitative blood cultures (QBC) collected simultaneously through a CVC and peripheral venipuncture (PV) have been used for the diagnosis of catheter-related bloodstream infections (3,6,14), the usefulness of QBC collected through CVC for the diagnosis of bacteremia from any source has not been thoroughly investigated.…”

mentioning

confidence: 99%

Prospective Study of the Value of Quantitative Culture of Organisms from Blood Collected through Central Venous Catheters in Differentiating between Contamination and Bloodstream Infection

et al. 2006

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Collection of blood through a central venous catheter for the diagnosis of bacteremia is a debated topic. Quantitative cultures of organisms from blood collected through central venous catheters were found to be highly sensitive, specific, and predictive of bacteremia, especially when a cutoff point of 15 colonies of skin organisms was used.Drawing of blood through a central venous catheter (CVC) for the diagnosis of bacteremia is highly debated (2,4,(11)(12)(13)15) due to the possibility of culturing blood contaminated by organisms adhering to CVC lumen. Although quantitative blood cultures (QBC) collected simultaneously through a CVC and peripheral venipuncture (PV) have been used for the diagnosis of catheter-related bloodstream infections (3,6,14), the usefulness of QBC collected through CVC for the diagnosis of bacteremia from any source has not been thoroughly investigated.Between September 1999 and May 2002, we followed up adult cancer patients who required new insertions of a peripherally inserted or subclavian silicone CVC at the M. D. Anderson Cancer Center in order to evaluate the sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of QBC collected through CVC for the diagnosis of bacteremia. Maximal sterile barrier precautions were followed during catheter insertions (9). Patients were followed up until catheter removal or up to 100 days, whichever occurred first. At the onset of fever or the suspicion of catheter-related bloodstream infections, simultaneous QBC collected through CVC and PV were obtained. When the CVC remained in place beyond 100 days, blood cultures were performed, even in the absence of signs and symptoms of infection (SSI). Microorganisms were identified according to standard methods (8). An initial 10 ml of CVC-collected blood was discarded to avoid contact with previously infused drugs with antimicrobial activity. Subsequently, two 20-ml blood samples were drawn for QBC, one through the CVC and the other through PV, and a 10-ml portion of each was cultured aerobically (Bactec 9240, Bactec Plus Aerobic/F; BD Diagnostic Systems, Sparks, MD).At our institution, anaerobes constitute less than 0.1% of positive cultures; most of these are found to be possible contaminants. The remaining 10 ml was placed into isolator tubes (Isolator 10; Wampole, Cranbury, NJ) to be cultured quantitatively (lysis centrifugation method) (5). We defined bacteremia according to guidelines from the Centers for Disease Control and Prevention (CDC) (7). Possible contaminating microorganisms included skin microorganisms such as coagulase-negative staphylococci (CNS), diphtheroids, and Bacillus spp., whereas pathogenic microorganisms included Staphylococcus aureus, alpha-hemolytic Streptococcus spp., gram-negative bacilli, and Candida spp. A QBC collected through CVC was considered a true positive if (i) a pathogen was isolated in the presence of SSI such as fever, hypotension, and rigors or when the same pathogen was isolated from a peripheral blood culture within 48...

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Quantitative blood cultures for diagnosis and management of catheter-related sepsis in pediatric hematology and oncology patients

Cited by 65 publications

References 19 publications

Skin versus hub cultures to predict colonization and infection of central venous catheter in intensive care patients

Skin versus hub cultures to predict colonization and infection of central venous catheter in intensive care patients

Diagnosis of Bloodstream Infections in Children

Prospective Study of the Value of Quantitative Culture of Organisms from Blood Collected through Central Venous Catheters in Differentiating between Contamination and Bloodstream Infection

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