A Prospective, Randomized, and Comparative Study of 3 Different Methods for the Diagnosis of Intravascular Catheter Colonization

Bouza, Emilio; Alvarado, Neisa; Alcalá, Luís; Sánchez-Conde, Matilde; Pérez, María Jesús; Muñóz, Patricia; Martín‐Rabadán, Pablo; Rodríguez‐Créixems, Marta

doi:10.1086/428576

Cited by 90 publications

(48 citation statements)

References 13 publications

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“…During a one-year period, we prospectively selected all consecutive patients fulfilling the following criteria: (i) age of Ն18 years; (ii) clinical signs of nosocomial sepsis (patients who had been in the hospital for more than 48 h when the first episode of fever was recorded and with one or more of the following signs or symptoms: temperature of Ͼ38°C, heart rate of Ͼ90 beats per min, breathing rate of Ͼ20 breaths per min, leukocyte count of Ͼ12,000 per mm 3 , edema or eythema surrounding the insertion catheter point); (iii) one or more blood cultures with CNS; and (iv) concomitant cultures of a catheter tip suspected as the origin of the infection with CNS isolated in significant counts. All catheters were central venous lines.…”

Section: Selection Of Patients With Cr-bsimentioning

confidence: 99%

Comparison of Phenotypic with Genotypic Procedures for Confirmation of Coagulase-Negative Staphylococcus Catheter-Related Bloodstream Infections

et al. 2006

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We sought here to review the present definition of catheter-related bloodstream infections (CR-BSI) due to coagulase-negative staphylococci (CNS) by comparing the routine phenotypic methods with a genotypic procedure that considers different morphotypes. Our phenotypic characterization of CNS isolates included routine identification with biotype and antibiotype. The genotypic diagnosis was based on longer incubation periods with the consideration of all morphotypes and molecular typing by pulsed-field gel electrophoresis techniques. We prospectively selected 61 episodes of suspected CR-BSI by CNS occurring during 1 year, based on the presence of a compatible clinical setting and the isolation of one or more CNS from blood and catheter tip. Of these episodes, 47 (77%) were identified as true episodes of CR-BSI based on the presence of microorganisms of the same genotype in the blood and on the catheter tip. The sensitivity, specificity, positive predictive, negative predictive, accuracy, positive likelihood ratio, and negative likelihood ratio values obtained by different phenotypic microbiological approaches to establish the diagnosis of CR-BSI were as follows: identity at species level (78. Catheter-related bloodstream infections (CR-BSI) are the main cause of documented sepsis (4, 5) in modern hospitals (2,20,27) and are mainly produced by coagulase-negative staphylococci (CNS) (6,26,32). The confirmed definition of a CR-BSI requires the isolation of one or more identical microorganism/s from blood and the catheter tip (19). However, present definitions are far from clear regarding the demonstration of such identity, particularly in the case of CNS. Most CNS colonies look alike after 24-h incubation, and laboratory routine involves taking a single colony for identification and antimicrobial susceptibility tests from those CNS growing in blood and on catheter tip cultures. The identity of both isolates is usually established on a phenotypic basis when the same genus, species, and antibiotype of the isolates in both samples are present. It is well known, however, that CNS growing on catheter tips may be frequently polyclonal (6, 12), especially when colonies are observed after longer periods of incubation. Moreover, biotype and antibiotype may have a weak correlation with genotype in CNS (22,30,34).7%We compare here the yields of two procedures for the characterization of CNS CR-BSI: "phenotypic" characterization, carried out in microbiology laboratories on a daily basis, and a procedure by which the different morphotypes are obtained after prolonged incubation and the application of genotyping with molecular techniques. MATERIALS AND METHODS Selection of Patients with CR-BSI.During a one-year period, we prospectively selected all consecutive patients fulfilling the following criteria: (i) age of Ն18 years; (ii) clinical signs of nosocomial sepsis (patients who had been in the hospital for more than 48 h when the first episode of fever was recorded and with one or more of the following signs or symptoms: tempera...

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Section: Selection Of Patients With Cr-bsimentioning

confidence: 99%

Comparison of Phenotypic with Genotypic Procedures for Confirmation of Coagulase-Negative Staphylococcus Catheter-Related Bloodstream Infections

et al. 2006

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“…Of the 283 catheters randomized to tip culture and cultivated, 20 Nor are there statistical difference between rates of CRI of closed systems (1.56%, 3.5 cases/1000 catheter/days) and open systems (4.51%, 11.5 cases/1000 catheter/days), p=0.132. However, we observed a 69% RRR in CRI in closed systems randomized to tip culture and cultured (HR 0.31; 95% CI: 0.03-1.61 (Table 2)).…”

Section: Resultsmentioning

confidence: 92%

“…In this sense the current IDSA recommendations are not only utopian but can also lead to an underestimation of infection rates and the existing health hazard. In fact, despite the multiplicity of existing alternatives, the Maki technique [19] remains the reference standard in clinical microbiology laboratories for its speed and simplicity [20]. It is considered the 'gold standard' for the diagnosis of CRI in PVC, though not in CVC.…”

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confidence: 99%

COSMOS Study Microbiological Results: Bacterial Colonization and Infection of Long-Term Peripheral Catheters

Strauss¹

2014

Clin Microbial

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BackgroundAs the use of intravenous devices (IVD) has risen so have the number of serious complications, mainly infectious, associated with its use. In fact, IVD are currently the most important independent cause of nosocomial infection in the health care sector [1,2]. Catheter-related infections (CRI) are the leading cause of primary septicemia with a high prevalence leading to increased hospital stays and costs. Furthermore they carry a 3% mortality [3]. Catheter-related infection in peripheral cathetersSpanish data from the program of surveillance of infections in AbstractBackground: Peripheral venous catheters (PVC) have a lower risk of the infection than central venous catheters (CVC), however, their high frequency of use makes PVC a major problem.

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“…Catheter tip colonization was defined as a positive semiquantitative tip culture of Ն15 CFU/ml for the roll plate method or Ն100 CFU/catheter segment for the sonication technique, as described elsewhere (3,14,23,24).…”

Section: Methodsmentioning

confidence: 99%

“…The number of prospective studies that compare the semiquantitative and quantitative techniques, however, is limited (3,11,13,18,23,28). These studies report conflicting results and are nonhomogenous with respect to the type of catheter studied or the length of time that devices remained in place, two important factors that determine the risk of CRBSI (8,15).…”

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confidence: 99%

Comparison of the Roll Plate Method to the Sonication Method To Diagnose Catheter Colonization and Bacteremia in Patients with Long-Term Tunnelled Catheters: a Randomized Prospective Study

et al. 2009

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Diagnosing catheter-related bloodstream infection (CRBSI) still often involves tip culture. The conventional method is the semiquantitative roll plate method. However, the use of a quantitative sonication technique could have additional value, as it may detect endoluminal microorganisms more easily. Because endoluminal infection tends to occur in long-term central venous catheters, we compared both techniques for patients with long-term tunnelled catheters. For 313 consecutive Hickman catheter tips from 279 hematological patients, colonization detection rates were compared by performing both techniques in a random order, using conventional detection cutoffs. Additionally, for the subgroup of patients with clinical suspicion of CRBSI (n ‫؍‬ 89), the diagnostic values of both techniques were compared. The overall tip colonization rate was 25%. For each technique, the detection rate tended to be better if that technique was performed first. The diagnostic performance for the subgroup of patients with clinical suspicion of CRBSI was limited and not different for both methods. Sensitivity and specificity were 45% and 84%, respectively, for sonication versus 35% and 90%, respectively, for the roll plate technique. The fact that 35 of 40 patients with CRBSI received antimicrobial therapy before catheter removal and tip culture, in an attempt to salvage the catheter, may partly explain this poor performance. No differences were observed when catheters were stratified according to in situ time below or above the median of 4 weeks. The sonication culture technique was not better than the roll plate method to diagnose tip colonization or CRBSI in patients with long-term tunnelled catheters.

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A Prospective, Randomized, and Comparative Study of 3 Different Methods for the Diagnosis of Intravascular Catheter Colonization

Cited by 90 publications

References 13 publications

Comparison of Phenotypic with Genotypic Procedures for Confirmation of Coagulase-Negative Staphylococcus Catheter-Related Bloodstream Infections

Comparison of Phenotypic with Genotypic Procedures for Confirmation of Coagulase-Negative Staphylococcus Catheter-Related Bloodstream Infections

COSMOS Study Microbiological Results: Bacterial Colonization and Infection of Long-Term Peripheral Catheters

Comparison of the Roll Plate Method to the Sonication Method To Diagnose Catheter Colonization and Bacteremia in Patients with Long-Term Tunnelled Catheters: a Randomized Prospective Study

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