title: Microbiological screening for earlier detection of central venous catheter-related bloodstream infections.
abstract: BACKGROUND
  Catheter-related bloodstream infections (CRBSIs) are currently detected with a reactive diagnostic policy, that is, application of tests to patients with clinically suspected CRBSI. The aim of our study was to evaluate whether CRBSIs could be anticipated in an earlier stage by microbiological screening using peptide nucleic acid fluorescence in situ hybridization (PNA FISH) with universal hybridization probes or acridine-orange leucocyte cytospin (AOLC) tests in haemodialysis and haematological patients with CVCs in situ compared with routine test.
  
  
  METHODS
  Peptide nucleic acid fluorescence in situ hybridization (PNA FISH) and AOLC tests using blood samples from both CVC lines in patients undergoing haemodialysis were performed three times a week and from one CVC line in haematological patients were performed daily. Results were compared with those obtained from routinely performed CRBSI diagnostic tests.
  
  
  RESULTS
  One hundred fifteen patients with 139 catheter periods were investigated. The mean observation time per catheter period was 25 days (IQR 13.5-43.5), resulting in 5615 CVC days with a total of 4839 tested blood samples. Five CRBSI cases were detected by routine measures resulting in a CRBSI rate of 0.9/1000 catheter days. Four of five CRBSIs could be anticipated by positive PNA FISH and AOLC tests 2-8 days before the diagnosis was established with routine measures.
  
  
  CONCLUSIONS
  The proactive anticipative strategy using microscopic examination of CVC blood samples to anticipate CRBSI in an earlier stage compared with routine measures is a new diagnostic approach in patients with CVCs and a high risk of developing CRBSI.
authors.affiliation: Section of Infectious Diseases and Tropical Medicine, Department of Internal Medicine, Medical University of Graz, Austria.
authors.forename: Jasmin
authors.initials: J
authors.lastname: Wagner
authors.forename: Gernot
authors.initials: G
authors.lastname: Schilcher
authors.forename: Ines
authors.initials: I
authors.lastname: Zollner-Schwetz
authors.forename: Martin
authors.initials: M
authors.lastname: Hoenigl
authors.forename: Thomas
authors.initials: T
authors.lastname: Valentin
authors.forename: Werner
authors.initials: W
authors.lastname: Ribitsch
authors.forename: Joerg
authors.initials: J
authors.lastname: Horina
authors.forename: Alexander R
authors.initials: AR
authors.lastname: Rosenkranz
authors.forename: Andrea
authors.initials: A
authors.lastname: Grisold
authors.forename: Matthias
authors.initials: M
authors.lastname: Unteregger
authors.forename: Katharina
authors.initials: K
authors.lastname: Troppan
authors.forename: Angelika
authors.initials: A
authors.lastname: Valentin
authors.forename: Peter
authors.initials: P
authors.lastname: Neumeister
authors.forename: Robert
authors.initials: R
authors.lastname: Krause
mesh_terms: D000165:Acridine Orange; D000328:Adult; D000368:Aged; D055499:Catheter-Related Infections / Q000175:diagnosis*; D062905:Central Venous Catheters; D042241:Early Diagnosis; D005456:Fluorescent Dyes; D019337:Hematologic Neoplasms / Q000628:therapy; D018380:Hematopoietic Stem Cell Transplantation; D006801:Humans; D017404:In Situ Hybridization, Fluorescence / Q000379:methods; D008828:Microbiological Techniques; D008875:Middle Aged; D020135:Peptide Nucleic Acids / Q000378:metabolism; D011446:Prospective Studies; D006435:Renal Dialysis; D055815:Young Adult
chemical_list: D005456:Fluorescent Dyes; D020135:Peptide Nucleic Acids; D000165:Acridine Orange
keywords: AOLC; CVC; PNA FISH; catheter-related blood stream infection; haemodialysis; screening