Clinical Utility of Blood Cultures Drawn from Indwelling Central Venous Catheters in Hospitalized Patients with Cancer

Abstract

In hospitalized hematology-oncology patients, culture of blood drawn through either the central catheter or peripheral vein shows excellent negative predictive value. Culture of blood drawn through an indwelling central venous catheter has low positive predictive value, apparently less than from a peripheral venipuncture. Therefore, a positive result from a catheter needs clinical interpretation and may require confirmation. However, the use of a catheter to obtain blood for culture may be an acceptable method for ruling out bloodstream infections.

Prevention of catheter-related bacteremia in children on hemodialysis: time for action

“…It was shown in oncology patients that a positive blood culture drawn through an indwelling central venous catheter with no confirmation from a culture from a peripheral vein had low positive predictive value. Therefore, a positive result from a catheter needs clinical interpretation and may require confirmation [31], and the diagnosis of CRB in a patient with a positive blood culture only from the TCC should be considered as probable and not definite [25]. However, using the most rigorous definition, it is possible to miss some cases of true CRB.…”

Blood Cultures and Central Catheters: Is the "Easiest Way" Best Practice?

“…First, if peripheral access is not possible, 2 blood samples may be collected through different lumens (when available) of the same central catheter, although this technique may be associated with higher false-positive rates. [2][3][4] Another exception to collecting blood samples for culture via venipuncture is patients with central catheters who have no obvious source of infection and thus may have a catheter-related bloodstream infection. In these cases, 1 set of samples should be obtained peripherally and the second set should be obtained through the distal lumen of the catheter suspected to be infected (as determined by catheter duration, especially >48 hours, or the presence of purulence or cellulitis at the insertion site) 8,10 by using the steps outlined in Table 3.…”

“…1 Although it may be convenient to obtain blood samples for culture from central catheters, expert opinion and clinical guidelines discourage this practice because of concerns of contamination that increases false-positive rates, as well as catheter-related bloodstream infection that may lead to greater (and sometimes unnecessary) use of antibiotics, longer hospital stays, and higher costs associated with the longer stays. 2 Thus, the following PICO question (patient/ problem, intervention, comparison, outcome) was raised by our clinical team: Among hospitalized patients, are samples obtained via peripheral venipuncture or central catheters, as well as single or paired blood culture sets, associated with the greatest sensitivity and specificity in detecting bacteremia? In examining the literature on this original question, other best-practice pearls related to timing, preparing, obtaining samples, and labeling were uncovered.…”

Blood stream infection after hematopoietic stem cell transplantation is associated with increased mortality

“…22 For bacteria that typically colonize the skin, such as coagulase-negative Staphylococcus, Propionibacterium, viridans group of Streptococcus and non-JK strains of Corynebacterium, two consecutive positive blood cultures, two positive blood cultures within 72 h, or one positive blood culture and one positive intravascular catheter tip culture within 72 h constituted a BSI. All blood cultures were obtained in response to an indication of infection, usually fever (oral temperature X381C).…”