We carried out a prospective study in two French Comprehensive Cancer Centers (95 and 184 beds, respectively) to assess the validity of a test based on the earlier positivity of central venous blood cultures in comparison with peripheral blood cultures for predicting catheter-related bacteremia. The differences between the times to positivity for the 21 patients with clinical catheter-related bacteremia and the differences between the times to positivity for the nine patients with bacteremia due to another source were compared by the median test. The difference between the median values was significant (P ؍ 0.0003). A receiver operating characteristic curve was constructed to determine the optimum threshold of the test, which appeared to be at the cutoff point of >؉3 h, with 100% specificity and 81% sensitivity. The positive and negative predictive values obtained with this cutoff point confirmed the efficacy of the test for predicting the presence or absence of catheter-related bacteremia in cancer patients. The cutoff point was then used to post-classify the 68 episodes of bacteremia from an unknown source. The characteristics and clinical course of both the positive and negative post-classified episodes did not show that the test was clearly useful for a large number of clinical presentations. We therefore suggest restricting it to febrile neutropenic cancer patients for whom clinical signs of infection are slight or absent and when the test is positive.Patients with cancer often need long-term intravascular devices (IVD), which can be externalized indwelling central venous catheters or subcutaneously implanted venous access systems. The use of IVD has improved the management of critically ill patients, but catheter-related bacteremia (CRB) is a frequent and potentially life-threatening complication (1,8,9,12,23). Several cancer centers have shown that CRB occurs in 10 to 20% of hospitalized patients with cancer (13,16,17). In cancer patients, it is preferable not to remove the IVD if the microorganism species allows it to be left in place, and several authors showed the efficacy of antibiotic treatment of portassociated bacteremia without IVD removal (26).For several years, blood culture has benefited from the advantages of new semiautomatic methods. Time to positivity seems to correlate with the inoculum introduced into a bottle and can be accurately assessed by following indices of growth every 10 to 15 min (21, 28). Lastly, the authors of two recent interesting studies showed that earlier positivity of central venous blood cultures in comparison with peripheral blood cultures is highly predictive of CRB (4, 5).We carried out the present prospective study at the Institut Jean Godinot (Rheims) and the Institut Curie (Paris), French Comprehensive Cancer Centers, with 95 and 184 beds, respectively. The first step was to assess the validity of the test for the diagnosis of CRB by comparing the times to positivity of blood cultures drawn simultaneously from a peripheral vein and from the central IVD. The seco...
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.