Three-year experience with sonicated vascular catheter cultures in a clinical microbiology laboratory

Sherertz, Robert J.; Raad, Issam; Belani, Anusha; Koo, Lilia C.; Rand, Kenneth H.; Pickett, Diane; Straub, Simon; Fauerbach, L.L.

doi:10.1128/jcm.28.1.76-82.1990

Cited by 349 publications

(94 citation statements)

References 21 publications

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“…Staphylococci are the most frequently isolated pathogens in CRI [15,27,[35][36][37][38][39][40], particularly CNS, followed by enterococci, S. aureus and Candida species [41,42]. Before 1986, S. aureus was the most frequently reported pathogen (data from the NNIS system, USA).…”

Section: P a T H O G E N E S I S A N D E T I O L O G Ymentioning

confidence: 99%

“…This is the reason why new diagnostic techniques that do not require catheter withdrawal have been developed. We will describe the most widespread diagnostic techniques used, either non-conservative [39,[50][51][52][53][54] or conservative [21,[55][56][57][58][59].…”

Section: I a G N O S I Smentioning

confidence: 99%

“…Maki and colleagues have reported a specificity ranging between 76 and 96% and a positive predictive value for CR-BSI of 16-31% in four studies. The positive predictive value for CR-BSI of this method ranges from 8.8 to 72%, depending on the mean placement time of the catheter and the prevalence of associated sepsis [35,39,54,63]. Siegman-Ygra et al report an 85% sensitivity and an 85% specificity in a meta-analysis of the diagnosis of CR-BSI [60].…”

Section: Non-conservative Procedures To Assess Crimentioning

confidence: 99%

“…A method of quantitative culture after sonication was proposed by Sherertz in 1990 [39]. Compared with semiquantitative cultures (roll plate method), this method is 20% more sensitive for the diagnosis of catheter infection, and >20% more sensitive than the method of flushing the individual catheter lumens [65].…”

Section: Non-conservative Procedures To Assess Crimentioning

confidence: 99%

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Catheter-related infections: diagnosis and intravascular treatment

Bouza

Burillo

Muñóz

2002

Clinical Microbiology and Infection

179

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The diagnosis of catheter-related infections relies on the presence of clinical manifestations of infection and the evidence of colonization of the catheter tip by bacteria, mycobacteria, or fungi. The reference method to confirm the latter requires the withdrawal of the catheter for culturing, which frequently turns out to be inconvenient, unnecessary and costly. New methods try to avoid these drawbacks and to assess the presence of tip colonization without withdrawal. Comparative quantitative blood cultures with a marked increase (> or = 5) in colony counts between blood obtained from the catheter lumen and from a peripheral vein simultaneously is one of those methods. It has a high sensitivity (>80%) and specificity (94-100%) but it is cumbersome and requires both an easy backflow of blood in the catheter and the existence of bacteremia. Cytocentrifugation and acridine orange staining of blood withdrawn from an infected catheter lumen has a sensitivity and a specificity of over 90% for the diagnosis of tip colonization. 'Superficial cultures' comprise the semiquantitative culture of the hub, of the skin surrounding the catheter entrance and of the first subcutaneous portion (1 cm) of the catheter after swabbing. The sensitivity of this method is >90%, specificity is >80%, and positive and negative predictive values for catheters (considering together those with and without clinical data of infection) are 66 and 97%, respectively. Endoluminal brushing has proved to be an impractical and unreliable procedure, at least in our experience. New methods based on the speed of bacterial growth to detectable levels of micro-organisms in conventional blood cultures are a new and interesting way of assessing catheter-related infections. Moreover, as the use of antimicrobial-coated catheters becomes more prevalent, the existing definitions of catheter colonization and catheter-related infection may need to be modified, because such coatings may lead to false-negative culture results. Many catheter infections, diagnosed without catheter withdrawal, can be handled nowadays with the so-called 'antibiotic lock-in technique', which consists in 'locking' the infected catheter lumen with a solution containing antibiotics. A high proportion of infected catheters, mainly those with coagulase-negative staphylococci, can be maintained in place and sterilized with this technique, including catheters in patients with therapeutic failure after receiving conventional intravenous antibiotic therapy. New diagnostic and therapeutic techniques may avoid the unnecessary withdrawal of thousands of efficient, difficult to replace and expensive intravascular lines.

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Section: P a T H O G E N E S I S A N D E T I O L O G Ymentioning

confidence: 99%

Section: I a G N O S I Smentioning

confidence: 99%

Section: Non-conservative Procedures To Assess Crimentioning

confidence: 99%

Section: Non-conservative Procedures To Assess Crimentioning

confidence: 99%

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Catheter-related infections: diagnosis and intravascular treatment

Bouza

Burillo

Muñóz

2002

Clinical Microbiology and Infection

179

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“…Although useful, these methods are time-consuming; they depend on the skill of the observer and may not be routinely used [68]. Importantly, cut-off for the diagnosis of CRI varies according to the technique used: in particular, quantitative culture techniques using sonication (!1000 CFUs) [16], vortex (!100 CFUs) [14]; and roll-plate semiquantitative technique (>15 CFUs) [15].…”

Section: Diagnosismentioning

confidence: 99%

Overview of catheter-related infections with special emphasis on prevention based on educational programs

Eggimann

Pittet

2002

Clinical Microbiology and Infection

110

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Intra-vascular access is an unavoidable tool in sophisticated modern medical practice, and catheter-related infection remains a leading cause of nosocomial infections, particularly in intensive care units where it is associated with significant patient morbidity, mortality, and additional hospital costs. The incidence of catheter-related bloodstream infection ranges from 2 to 14 episodes per 1000 catheter-days. On average, microbiologically documented, device-related bloodstream infections complicate the use of a central venous line in three to five per 100 cases. But this represents only the visible part of the iceberg and most episodes of clinical sepsis are nowadays considered to be catheter-related. We briefly review the pathophysiology of these infections, highlighting the importance of the skin insertion site and the intravenous line hub as principal sources of colonization and infection. Principles of therapy are briefly addressed. A large proportion of these infections are preventable and this has been the objective of creating precise guidelines. It was recently suggested that the situation may evolve with the introduction of antibiotic/antiseptic-coated devices, whose impact on the epidemiology of antibiotic resistance remains to be determined. Recently, educational programs and/or a global preventive strategy based on the strict application of specific preventive measures and careful control of all factors associated with infection proved to be even more effective than coated devices in reducing rates of infection. Practical aspects regarding educational approaches will help clinicians to adapt and incorporate educational programs into clinical practice.

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