The use of a rapid in situ test in the detection of central venous catheter-related bloodstream infection: a prospective study.
BACKGROUND
Acridine orange leukocyte cytospin (AOLC) is a highly sensitive and specific test for the detection of catheter-related bloodstream infection (CRBSI). We evaluated the role of the AOLC test in early detection or exclusion of CRBSI and compared the cost of managing patients with suspected CRBSI.


METHODS
On the day of clinical suspicion of CRBSI, blood samples were obtained from the catheters for the AOLC test, and peripheral blood samples were obtained for quantitative blood cultures. Catheters with positive AOLC results were immediately removed for culture and replaced if necessary. Catheters with negative AOLC tests were left in situ. We compared the catheter lifespan in patients with suspected CRBSI who had positive and negative AOLC tests and calculated the cost of using the AOLC test to prevent indiscriminate catheter removal.


RESULTS
Fifty patients with suspected CRBSI were tested and prospectively followed up. Catheters were removed in 10 patients (20%) with a positive AOLC test, and CRBSI was confirmed in each case subsequently. Selective removal of catheters based on AOLC tests significantly extended the lifespan of catheters compared with an indiscriminate removal of catheters based on clinical suspicion of CRBSI (median, 24 versus 11 days; p < .0001). The cost of an AOLC test and selective catheter replacement strategy was significantly lower than the cost of routine removal and replacement of catheters (median, pounds sterling 9.53 versus pounds sterling 64.20; p < .0001).


CONCLUSIONS
The AOLC test enables a rapid detection of CRBSI, avoids unnecessary removal of catheters, and provides a cost-efficient management approach in patients with suspected CRBSI.
Bong
Jin J
JJ
Division of Surgery, The University of Leeds, United Kingdom. jjb@jinbong.freeserve.co.uk
Kite
Peter
P
Ammori
Basil J
BJ
Wilcox
Mark H
MH
McMahon
Michael J
MJ
D000165:Acridine Orange; D002405:Catheterization, Central Venous / Q000009:adverse effects*; D002408:Catheters, Indwelling / Q000009:adverse effects* / Q000382:microbiology; D003365:Costs and Cost Analysis; D004866:Equipment Contamination / Q000191:economics; D005456:Fluorescent Dyes; D006801:Humans; D010289:Parenteral Nutrition, Total / Q000295:instrumentation; D011237:Predictive Value of Tests; D011446:Prospective Studies; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D018805:Sepsis / Q000175:diagnosis* / Q000382:microbiology; D013194:Staining and Labeling
D005456:Fluorescent Dyes; D000165:Acridine Orange