An instant procedure to demonstrate catheter-tip colonization may help clinicians

Bouza, Emilio; Alvarado, Neisa; Alcalá, Luís; Muñóz, Patricia; Rabadán, Pablo Martín; Rodríguez‐Créixems, Marta

doi:10.1016/j.diagmicrobio.2006.05.006

Cited by 8 publications

(3 citation statements)

References 12 publications

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“…Gram staining of a catheter tip is a simple and rapid test. Previously, the predictive performance of gram staining for CRBSI detection was investigated for all microorganisms, including Candida species, and sensitivity, specificity, PPV, and NPV, respectively, of 73%, 98%, 90%, and 94% were obtained [ 10 ]. These results are generally similar to those of the present study.…”

Section: Discussionmentioning

confidence: 99%

Predictive Performance of Gram Staining of Catheter Tips for Candida Catheter-Related Bloodstream Infections

Yamada

Iwamoto

Ishikane

et al. 2022

Open Forum Infectious Diseases

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Section: Discussionmentioning

confidence: 99%

Predictive Performance of Gram Staining of Catheter Tips for Candida Catheter-Related Bloodstream Infections

Yamada

Iwamoto

Ishikane

et al. 2022

Open Forum Infectious Diseases

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“…Acridine orange and Gram staining have been used to provide a rapid diagnosis of catheter-related bloodstream infection (CRBSI) with and without the removal of CVCs with a short indwelling time (1,5,14); however, no information about this procedure is available for long-term CVCs.…”

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confidence: 99%

“…In the present study, it was demonstrated that the roll-plate technique was at least as efficient as sonication for the overall group of catheters received in the microbiology laboratory, although the number of long-term catheters was limited. Moreover, both techniques were compared in selected subpopulations with tunneled central venous catheters (CVCs).Acridine orange and Gram staining have been used to provide a rapid diagnosis of catheter-related bloodstream infection (CRBSI) with and without the removal of CVCs with a short indwelling time (1,5,14); however, no information about this procedure is available for long-term CVCs.The objectives of our study were to compare the roll-plate and sonication methods to diagnose catheter colonization and CRBSI and to assess the validity of Gram staining as a rapid procedure to predict or exclude colonization and CRBSI in patients with longterm tunneled CVCs. …”

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How Should Long-Term Tunneled Central Venous Catheters Be Managed in Microbiology Laboratories in Order To Provide an Accurate Diagnosis of Colonization?

et al. 2012

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Guidelines recommend the roll-plate technique for short-term central venous catheter (CVC) tip cultures. However, the issue of whether the roll-plate technique is better than the sonication method for long-term CVCs remains unresolved. In addition, no data are available for predicting the value of direct Gram staining in anticipating catheter colonization or catheter-related bloodstream infection (CRBSI) in these long-term CVCs. Our objectives were to compare the roll-plate technique and the sonication method and to define the validity values of Gram staining for the prediction of colonization and CRBSI in patients with longterm tunneled CVCs. During the study period, all tunneled CVCs removed at our institution were prospectively and routinely sent to the microbiology laboratory for Gram staining (first) and tip culture (the Maki technique and sonication, in a random order). We received 149 tunneled CVCs, 39 (26.2%) of which were colonized and 11 (7.4%) of which were associated with CRBSI. Overall, the roll-plate method detected 94.9% of the colonized catheters, whereas sonication detected only 43.6% (P < 0.001).The validity values of Gram staining for the detection of colonization and CRBSI were as follows: a sensitivity of 35.9% to 60.0%, a specificity of 100% to 94.2%, a positive predictive value of 100% to 42.9%, and a negative predictive value of 81.5% to 97.0%. The roll-plate technique proved to be better than sonication for the detection of bacteria in long-term tunneled CVCs. Gram staining of the tips of tunneled CVCs can anticipate a positive culture and rule out CRBSI. In our opinion, direct Gram staining should be incorporated into routine microbiological assessments of long-term catheter tips. The recently reported Infectious Diseases Society of America (IDSA) Clinical Practice Guidelines for the Diagnosis and Management of Intravascular Catheter-Related Infection recommend the roll-plate technique for the routine clinical microbiological analysis of short-term catheter tips (9). However, for the analysis of long-term catheter tips, in which the endoluminal progression of microorganisms is more frequent, the best methodology for culture remains an unresolved issue (7,12,15).Although the sonication of catheter tips can better detect the microbiological colonization of the inner surface, both the inner and outer surfaces can be colonized simultaneously (6). The results of the few studies comparing the roll-plate and sonication methods are not homogenous for catheter type or the sequence order of the procedure (2,6,11,16). In the present study, it was demonstrated that the roll-plate technique was at least as efficient as sonication for the overall group of catheters received in the microbiology laboratory, although the number of long-term catheters was limited. Moreover, both techniques were compared in selected subpopulations with tunneled central venous catheters (CVCs).Acridine orange and Gram staining have been used to provide a rapid diagnosis of catheter-related bloodstream infection (CRBSI) wit...

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Performing Gram stain directly on catheter tips: assessment of the quality of the observation process

Guembe

Pérez‐Granda

Rivera

et al. 2015

Eur J Clin Microbiol Infect Dis

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A previous study performed in our institution showed that catheter tip (CT) staining by combining acridine orange and Gram stain (GS) before culture anticipated catheter colonization with exhaustive and careful observation by a highly trained technician. Our objective was to assess the validity values of GS without acridine orange on an external smear of CT for predicting catheter colonization and catheter-related bloodstream infection (C-RBSI). We compared different periods of observation and the results of two technicians with different levels of professional experience. Over a 5-month period, the roll-plate technique was preceded by direct GS of all CTs sent to the microbiology laboratory. The reading was taken at ×100 by two observers with different skill levels. Each observer performed a routine examination (3 min along three longitudinal lines) and an exhaustive examination (5 min along five longitudinal lines). The presence of at least one cell was considered positive. All slides were read before culture results were known. We included a total of 271 CTs from 209 patients. The prevalence of catheter colonization and C-RBSI was 16.2 % and 5.1 %, respectively. Routine and exhaustive examinations revealed only 29.5 % and 40.9 % of colonized catheters, respectively (p < 0.001). In contrast, they revealed high negative predictive values for C-RBSI (96.5 % and 96.3 %, respectively). Our study shows that the yield of GS performed directly on CTs is greater when staining is performed exhaustively. However, the decision to implement this approach in daily routine will depend on the prevalence rate of catheter colonization at each institution.

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An instant procedure to demonstrate catheter-tip colonization may help clinicians

Cited by 8 publications

References 12 publications

Predictive Performance of Gram Staining of Catheter Tips for Candida Catheter-Related Bloodstream Infections

Predictive Performance of Gram Staining of Catheter Tips for Candida Catheter-Related Bloodstream Infections

How Should Long-Term Tunneled Central Venous Catheters Be Managed in Microbiology Laboratories in Order To Provide an Accurate Diagnosis of Colonization?

Performing Gram stain directly on catheter tips: assessment of the quality of the observation process

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