Improving diagnosis of central venous catheter-related bloodstream infection by using differential time to positivity as a hospital-wide approach at a cancer hospital.
OBJECTIVE
Considering the difficulty of diagnosing catheter-related bloodstream infection (CRBSI), Koo Foundation Sun Yat-Sen Cancer Center uses differential time to positivity (DTP) as a hospital-wide approach to improve the diagnosis of CRBSI in febrile patients with indwelling central venous catheters (CVCs). This study describes the result of a hospital-wide use of DTP in a real practice setting.


METHODS
During January 2003-August 2007, 142 positive paired blood cultures from 125 patients without infection focus other than CVC were included. These were evaluated by DTP and semi-quantitative catheter culture (SQCC) to confirm the diagnosis of CRBSI, and were further divided into two groups: confirmed (either by DTP or SQCC) and non-confirmed CRBSI (neither DTP nor SQCC positive).


RESULTS
Fifty-nine point two percent (84/142) of episodes were confirmed as CRBSI, of which DTP was positive in 83.3% (n=70). Non-confirmed CRBSI was associated with hematologic malignancy, neutropenia status, previous antibiotics exposure and a lower CVC removal rate.


CONCLUSIONS
A hospital-wide approach of DTP was practical and feasible in improving the diagnosis of CRBSI in a real practice setting.
Chen
Wei-Ting
WT
Division of Infectious Diseases, Koo Foundation Sun Yat-Sen Cancer Center, No.125 Lih-Der Road, Beitou, Taipei, Taiwan.
Liu
Ting-Mei
TM
Wu
Shih-Hsuan
SH
Tan
Tran-Der
TD
Tseng
Hsiu-Chin
HC
Shih
Chiang-Ching
CC
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016470:Bacteremia / Q000175:diagnosis*; D002173:Cancer Care Facilities; D055499:Catheter-Related Infections / Q000175:diagnosis*; D002405:Catheterization, Central Venous / Q000009:adverse effects*; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015397:Program Evaluation; D055815:Young Adult