Differential time to positivity: a useful method for diagnosing catheter-related bloodstream infections.
BACKGROUND
Catheter-related bloodstream infections are associated with recognized morbidity and mortality, especially in critically ill patients. Accurate diagnosis of such infections results in proper management of patients and in reducing unnecessary removal of catheters.


OBJECTIVE
To evaluate differential time to positivity as a method for diagnosing catheter-related bacteremias caused by both short-term and long-term use of central venous catheters.


METHODS
Prospective study design.


METHODS
M.D. Anderson Cancer Center, Houston, Texas, a tertiary care cancer center.


METHODS
All patients, between September 1999 and November 2000, who had the same organism isolated from blood cultures drawn simultaneously through the central venous catheter and the peripheral vein.


METHODS
Time necessary for the blood cultures from the central venous catheter and the peripheral vein to become positive, as well as other relevant patient information.


RESULTS
191 bloodstream infections with positive simultaneous central venous catheter and peripheral vein blood cultures were included. One hundred eight patients had catheter-related bacteremias, and 83 had non-catheter-related bacteremias. Catheter-related bacteremias were more frequently caused by staphylococci and less likely to be associated with underlying hematologic malignant conditions, neutropenia, and longer duration of hospitalization. As a diagnostic tool for catheter-related bacteremia (using a composite definition reference standard according to the Infectious Diseases Society of America guidelines), differential time to positivity of 120 minutes or more was associated with 81% sensitivity and 92% specificity for short-term catheters and 93% sensitivity and 75% specificity for long-term catheters.


CONCLUSIONS
Differential time to positivity of 120 minutes or more is highly sensitive and specific for catheter-related bacteremia in patients who have short- and long-term catheters.
Raad
Issam
I
Department of Infectious Diseases, Infection Control and Employee Health, University of Texas M.D. Anderson Cancer Center, Houston, Texas 77030, USA. hhanna@mdanderson.org
Hanna
Hend A
HA
Alakech
Badie
B
Chatzinikolaou
Ioannis
I
Johnson
Marcella M
MM
Tarrand
Jeffrey
J
D016470:Bacteremia / Q000175:diagnosis* / Q000209:etiology*; D001431:Bacteriological Techniques / Q000379:methods*; D002405:Catheterization, Central Venous / Q000009:adverse effects* / Q000295:instrumentation; D002408:Catheters, Indwelling / Q000009:adverse effects*; D004866:Equipment Contamination; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011446:Prospective Studies; D013997:Time Factors