Diagnosis of venous access port colonization requires cultures from multiple sites: should guidelines be amended?

Bouza, Emilio; Martín‐Rabadán, Pablo; Echenagusía, Antonio; Camúñez, F; Rodríguez-Rosales, G.; Simó, Gonzalo Varela; Echenagusia, M.; Guembe, María

doi:10.1016/j.diagmicrobio.2013.11.004

Cited by 11 publications

(8 citation statements)

References 27 publications

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“…In contrast, among 24 positive TIVAP-cultures, nine were tip-culture negative, while the corresponding reservoirs and septa were culture positive, meaning that a large proportion of TIVAP-cultures (as high as 38 %) would have been false negative without reservoir culture. Thus, our study provides further evidence that culture of the TIVAP reservoir may increase the sensitivity and the accuracy of the test for a definitive diagnosis of TIVAP-related BSI and confirms previous observations that support the importance of reservoir culture in the diagnosis of TIVAP-related BSI [15,16,27]. From a practical point of view, in this study we separated the septum from the reservoir with the aid of scissors and tweezers.…”

Section: Discussionsupporting

confidence: 88%

“…Previous studies have compared different methods as diagnostic procedures for catheter culture, but such comparisons have rarely been reported for TIVAPs [15,16]. Therefore, more evidence is needed to identify the optimal method to recover micro-organisms from colonized catheters and decrease false negative results in the diagnosis of TIVAPrelated bloodstream infections.…”

Section: Introductionmentioning

confidence: 99%

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Comparison of methods for the microbiological diagnosis of totally implantable venous access port-related infections

Kaya

Tollapi²,

Pastore³

et al. 2020

Journal of Medical Microbiology

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Introduction. Totally implanted venous access ports (TIVAPs) are widely used in patients receiving long-term chemotherapy but may lead to serious complications such as catheter-related bloodstream infections (CRBSIs). Diagnosis of CRBSI requires catheter culture, but there is no consensus on microbiological culture methods to be adopted. Aim. To compare three different procedures to recover bacterial cells from colonized catheters and to determine which section of the TIVAP (i.e. tip, septum, reservoir) is the probable source of infection. To investigate the correlation between blood culture results and TIVAP culture in order to get further evidence about the utility of differential time to positivity (DTP) as a diagnostic tool before TIVAP removal. Hypothesis/Gap statement. Comparisons of different diagnostic procedures for catheter culture have been rarely reported for TIVAPs. We hypothesized that the optimization of methods to recover micro-organisms from different parts of TIVAPs may help to decrease the number of false-negative results in the diagnosis of TIVAP-related bloodstream infections. Methodology. A total of 53 TIVAPs removed because of suspected infection (n=36) or end of use (n=17) were evaluated. The reservoir, the septum and the catheter tip were separated and subjected to different treatments for the recovery of adherent micro-organisms: (a) flushing of the catheter lumen, (b) sonication and flushing, (c) treatment with dithiothreitol and flushing. The three methods were also evaluated in an in vitro catheter infection model with Staphylococcus epidermidis . Culture results were compared to those obtained from paired blood cultures drawn from TIVAP and peripheral vein and to the relative DTP. Results. The results obtained demonstrated that vigorous flushing/vortexing of the catheter lumen/septum, allows the recovery of a number of micro-organisms comparable to that of more complex procedures such as sonication or chemical treatment. Among 24 positive TIVAP-cultures, nine were tip-culture negative, whereas the corresponding reservoirs and septa were culture positive. A good correlation was observed between DTP and TIVAP cultures (P<0.001). Conclusions. The results support the evidence that sending the port reservoir in addition to the catheter tip to the microbiology laboratory may increase the sensitivity and the accuracy of CRBSI diagnosis. Moreover, when a TIVAP-related infection is suspected, DTP is a useful diagnostic tool to decide between device removal or a more conservative approach.

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Section: Discussionsupporting

confidence: 88%

Section: Introductionmentioning

confidence: 99%

Comparison of methods for the microbiological diagnosis of totally implantable venous access port-related infections

Kaya

Tollapi²,

Pastore³

et al. 2020

Journal of Medical Microbiology

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“…For example, the 120-min cutoff is less accurate for Candida sp. and S. aureus [61]. The accuracy of the technique is based on sampling the same amount of blood from both the catheter and peripherally.…”

Section: Diagnosis Of Crbsi With Catheter In Placementioning

confidence: 99%

A state of the art review on optimal practices to prevent, recognize, and manage complications associated with intravascular devices in the critically ill

et al. 2018

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Intravascular catheters are inserted into almost all critically ill patients. This review provides up-to-date insight into available knowledge on epidemiology and diagnosis of complications of central vein and arterial catheters in ICU. It discusses the optimal therapy of catheter-related infections and thrombosis. Prevention of complications is a multidisciplinary task that combines both improvement of the process of care and introduction of new technologies. We emphasize the main component of the prevention strategies that should be used in critical care and propose areas of future investigation in this field.

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“…Bouza et al. reported that combination of cultures of multiple sites of TIVAP was the best technique to diagnose TIVAP colonization . Another frequent challenge is to diagnose CRBSI in patients who already received systemic antibiotics, leading to false‐negative results of blood or catheter tip culture.…”

Section: Diagnosismentioning

confidence: 99%

“…Indeed, one study reported that after TIVAP removal, tip culture was only 46% sensitive, whereas septum culture was 93.3% sensitive for confirming the diagnosis of TIVAP-related BSI (74). Bouza et al reported that combination of cultures of multiple sites of TIVAP was the best technique to diagnose TIVAP colonization (75,76). Another frequent challenge is to diagnose CRBSI in patients who already received systemic antibiotics, leading to false-negative results of blood or catheter tip culture.…”

Section: Diagnosismentioning

confidence: 99%

Central venous catheters and biofilms: where do we stand in 2017?

Gominet

Compain

Beloin

et al. 2017

APMIS

127

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The use of central venous catheters (CVC) is associated with a risk of microbial colonization and subsequent potentially severe infection. Microbial contamination of the catheter leads to the development of a microbial consortia associated with the CVC surface and embedded in an extracellular matrix, named biofilm. This biofilm provides bacterial cells the ability to survive antimicrobial agents and the host immune system and to disseminate to other sites of the body. The best preventive strategy is to avoid any unnecessary catheterization or to reduce indwelling duration when a CVC is required. Beside aseptic care and antibiotic-impregnated catheters (like minocycline/rifampin), preventive locks can be proposed in some cases, whereas non-biocidal approaches are under active research like anti-adhesive or competitive interactions strategies. When the diagnosis of catheter-related bloodstream infection (CRBSI) is suspected on clinical symptoms, it requires a microbiological confirmation by paired blood cultures in order to avoid unnecessary catheter removal. The treatment of CRBSI relies on catheter removal and systemic antimicrobials. However, antibiotic lock technique (ALT) can be used as an attempt to eradicate biofilm formed on the inside lumen of the catheter in case of uncomplicated long-term catheter-related BSI caused by coagulase-negative staphylococci (CoNS) or Enterobacteriaceae. Recently, promising strategies have been developed to improve biofilm eradication; they rely on matrix degradation or destabilization or the development of anti-persister compounds, targeting the most tolerant bacterial cells inside the biofilm. Understanding biofilm formation at the molecular level may help us to develop new approaches to prevent or treat these frequent infections.

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Diagnosis of venous access port colonization requires cultures from multiple sites: should guidelines be amended?

Cited by 11 publications

References 27 publications

Comparison of methods for the microbiological diagnosis of totally implantable venous access port-related infections

Comparison of methods for the microbiological diagnosis of totally implantable venous access port-related infections

A state of the art review on optimal practices to prevent, recognize, and manage complications associated with intravascular devices in the critically ill

Central venous catheters and biofilms: where do we stand in 2017?

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