Cultures of Blood Drawn by Catheters vs Venipuncture

Tonnesen, Alan S.; Peuler, Martin J.; Lockwood, W. R.

doi:10.1001/jama.1976.03260430047025

Cited by 46 publications

(15 citation statements)

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“…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.…”

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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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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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“…They were also conducted in patients hospitalized in ICU or oncology wards who had pairs of blood cultures obtained from the intravascular catheter and by peripheral venipuncture. In addition to the studies included in our analysis, these studies that examined the comparative characteristics of blood cultures obtained from an intravascular catheter and a peripheral vein also suggested that the first test has higher sensitivity in diagnosing true bacteraemia than the second (Felices et al, 1979;Tonnesen et al, 1976;Juste et al, 2000). Some of the studies suggested that blood culture through intravascular catheters might be both sensitive and sufficiently specific for the diagnosis of bacteraemia (Felices et al, 1979;Tonnesen et al, 1976;Wormser et al, 1990).…”

Section: Evaluation Of Outcomesmentioning

confidence: 98%

“…We identified eight other studies, seven prospective and one retrospective, relevant to our research question, which provided us useful information but could not be included in our analysis due to their design or reported data (Bozzetti et al, 1984;Everts et al, 2001;Felices et al, 1979;Juste et al, 2000;Vaisanen et al, 1985;Levin et al, 2000;Tonnesen et al, 1976;Wormser et al, 1990). They were also conducted in patients hospitalized in ICU or oncology wards who had pairs of blood cultures obtained from the intravascular catheter and by peripheral venipuncture.…”

Section: Evaluation Of Outcomesmentioning

confidence: 99%

“…In addition to the studies included in our analysis, these studies that examined the comparative characteristics of blood cultures obtained from an intravascular catheter and a peripheral vein also suggested that the first test has higher sensitivity in diagnosing true bacteraemia than the second (Felices et al, 1979;Tonnesen et al, 1976;Juste et al, 2000). Some of the studies suggested that blood culture through intravascular catheters might be both sensitive and sufficiently specific for the diagnosis of bacteraemia (Felices et al, 1979;Tonnesen et al, 1976;Wormser et al, 1990). It is also supported that when cultures obtained from arterial lines and peripheral venipuncture are compared, the results of cultures from both sources are in most cases equivalent (Levin et al, 2000).…”

Section: Evaluation Of Outcomesmentioning

confidence: 99%

“…However, there is evidence deriving from published studies that blood cultures obtained from central vascular catheters are sufficiently sensitive for detection of bloodstream infection (Felices et al, 1979;Tonnesen et al, 1976;Wormser et al, 1990). Given their convenience, a clinically important question arises whether blood cultures obtained from intravascular catheters have such test characteristics (sensitivity, specificity, and positive and negative predictive value) in diagnosing bacteraemia to be considered equivalent or even better than blood cultures obtained by peripheral venipuncture.…”

Section: Introductionmentioning

confidence: 99%

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Comparison of utility of blood cultures from intravascular catheters and peripheral veins: a systematic review and decision analysis

Falagas

Kazantzi

Bliziotis

2008

Journal of Medical Microbiology

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Blood cultures are sometimes obtained from intravascular catheters for convenience. However, there is controversy regarding this practice. The authors compared the diagnostic test characteristics of blood cultures obtained from intravascular catheters and peripheral veins. Relevant studies for inclusion in this review were identified through PubMed (January 1970-October 2005 and the Cochrane Central Register of Controlled Trials. Studies that reported clear definitions of true bacteraemia were included in the analysis. Two reviewers independently extracted the data. Six studies were included in the analysis, providing data for 2677 pairs of blood cultures obtained from an intravascular catheter and a peripheral venipuncture. A culture obtained from an intravascular catheter was found to be a diagnostic test for bacteraemia with better sensitivity (OR 1.85, 95 % CI 1.14-2.99, fixed effects model) and better negative predictive value (almost with statistical significance) (OR 1.55, 95 % CI 0.999"2.39, fixed effects model) but with less specificity (OR 0.33, 95 % CI 0.18-0.59, random effects model) and lower positive predictive value (OR 0.41, 95 % CI 0.23-0.76, random effects model) compared to a culture taken by peripheral venipuncture. In a group of 1000 patients, eight additional patients with true bacteraemia would be identified and 59 falsely diagnosed as having bacteraemia by a blood culture obtained from an intravascular catheter compared to results of the peripheral blood culture. Given the consequences of undertreating patients with bacteraemia, the authors believe that, based on the available evidence, at least one blood culture should be obtained from the intravascular catheter.

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Clinical Issues of Blood Cultures

Chandrasekar

Brown²

1994

Arch Intern Med

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changes in the methods of obtaining blood cultures in clinical practice have recently occurred owing to factors such as the rising number of patients at risk for infection, "newer" pathogens occurring in the bloodstream, widespread use of indwelling intravascular devices, and our improved ability to recover and identify microorganisms in blood. Guidelines for the "proper" practice of obtaining blood cultures are needed.Blood cultures must be obtained under sterile conditions when there is suspicion of bacteremia/ mycobacteremia, fungemia, or viremia. This review provides recent information on optimal blood culture practices during suspected bloodstream infection in hospitalized patients including those with continuous or intermittent bacteremia, patients with intravascular devices, and compromised hosts such as immunodeficient patients and those in intensive care units. The traditional two\x=req-\

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Cultures of Blood Drawn by Catheters vs Venipuncture

Cited by 46 publications

References 1 publication

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

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

Comparison of utility of blood cultures from intravascular catheters and peripheral veins: a systematic review and decision analysis

Clinical Issues of Blood Cultures

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