title: Time to blood culture positivity as a marker for catheter-related candidemia.
abstract: Candida spp. are important causes of nosocomial bloodstream infections. Around 80% of patients with candidemia have an indwelling central venous catheter (CVC). Determining whether the CVC is the source of candidemia has implications for patient management. We assessed whether the time to detection of Candida species in peripheral blood (time to positivity [TTP]) can serve as a marker for catheter-related candidemia. Prospective surveillance of Candida bloodstream infection was conducted in two medical centers. TTP was recorded by the BacT/Alert automated system. Sixty-four candidemia episodes were included. Fifty patients (78%) had an indwelling CVC. Thirteen patients (20.3%) had definite catheter-related candidemia. TTP was shorter for definite catheter-related candidemia (17.3 +/- 2 h) than that for candidemia from other sources (38.2 +/- 3 h; P < 0.001). A TTP cutoff of 30 h was 100% sensitive and 51.4% specific for catheter-related candidemia (area under the receiver-operator characteristic curve of 0.76). We conclude that TTP in peripheral blood is a sensitive but nonspecific marker for catheter-related candidemia and that a TTP of more than 30 h can help exclude an intravascular catheter as the possible source of candidemia.
authors.affiliation: Infectious Disease Unit, Microbiology Laboratory, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel. rbenami@mdanderson.org
authors.forename: Ronen
authors.initials: R
authors.lastname: Ben-Ami
authors.forename: Miriam
authors.initials: M
authors.lastname: Weinberger
authors.forename: Ruth
authors.initials: R
authors.lastname: Orni-Wasserlauff
authors.forename: David
authors.initials: D
authors.lastname: Schwartz
authors.forename: Avraham
authors.initials: A
authors.lastname: Itzhaki
authors.forename: Tzipora
authors.initials: T
authors.lastname: Lazarovitch
authors.forename: Edna
authors.initials: E
authors.lastname: Bash
authors.forename: Yuval
authors.initials: Y
authors.lastname: Aharoni
authors.forename: Irina
authors.initials: I
authors.lastname: Moroz
authors.forename: Michael
authors.initials: M
authors.lastname: Giladi
mesh_terms: D000046:Academic Medical Centers; D000368:Aged; D000369:Aged, 80 and over; D001769:Blood / Q000382:microbiology*; D002175:Candida / Q000302:isolation & purification*; D002177:Candidiasis / Q000175:diagnosis*; D002408:Catheters, Indwelling / Q000009:adverse effects*; D003428:Cross Infection / Q000382:microbiology*; D005260:Female; D016469:Fungemia / Q000175:diagnosis*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009172:Mycology / Q000379:methods*; D011446:Prospective Studies; D012680:Sensitivity and Specificity; D013997:Time Factors