title: Blood culture differential time to positivity enables safe catheter retention in suspected catheter-related bloodstream infection: a randomized controlled trial.
abstract: OBJECTIVE
  To evaluate the clinical usefulness and safety of the differential-time-to-positivity (DTP) method for managing the suspicion of catheter-related bloodstream infection (CR-BSI) in comparison with a standard method that includes catheter removal in critically ill patients.
  A prospective randomized study was carried out.
  
  
  METHODS
  A 16-bed clinical-surgical ICU (July 2007-February 2009).
  
  
  METHODS
  Patients were randomly assigned to one of two groups at the time CR-BSI was suspected. In the standard group, a standard strategy requiring catheter withdrawal was used to confirm or rule out CR-BSI. In the DTP group, DTP without catheter withdrawal was used to confirm or rule out CR-BSI.
  
  
  METHODS
  clinical and microbiological data, CR-BSI rates, unnecessary catheter removals, and complications due to new puncture or to delays in catheter removal.
  
  
  RESULTS
  Twenty-six patients were analyzed in each group. In the standard group, 6 of 37 suspected episodes of CR-BSI were confirmed and 5 colonizations were diagnosed. In the DTP group, 5 of 26 suspected episodes of CR-BSI were confirmed and four colonizations were diagnosed. In the standard group, all catheters (58/58, 100%) were removed at the time CR-BSA was suspected, whereas in the DTP group, only 13 catheters (13/41, 32%) were removed at diagnosis, and 10 due to persistent septic signs (10/41, 24%). In cases of confirmed CR-BSI, there were no differences between the two groups in the evolution of inflammatory parameters during the 48hours following the suspicion of CR-BSI.
  
  
  CONCLUSIONS
  In critically ill patients with suspected CR-BSI, the DTP method makes it possible to keep the central venous catheter in place safely.
authors.affiliation: Service de Réanimation, Centre Hospitalier de Mont-de-Marsan, France. Electronic address: sabatier.caroline@gmail.com.
authors.forename: Caroline
authors.initials: C
authors.lastname: Sabatier
authors.affiliation: Centro de Críticos, Hospital de Sabadell, Corporació Sanitària Parc Taulí. Institut Universitari Parc Taulí-UAB, Universitat Autònoma de Barcelona, Campus d́Excel·lència International. CIBER Enfermedades Respiratorias, France.
authors.forename: Xaime
authors.initials: X
authors.lastname: García
authors.affiliation: Servei de Medicina Intensiva UCI-SEMICRITICS, Hospital Universitari Mútua Terrassa, France.
authors.forename: Ricard
authors.initials: R
authors.lastname: Ferrer
authors.affiliation: Centro de Críticos, Hospital de Sabadell, Corporació Sanitària Parc Taulí. Institut Universitari Parc Taulí-UAB, Universitat Autònoma de Barcelona, Campus d́Excel·lència International. CIBER Enfermedades Respiratorias, France.
authors.forename: Montserrat
authors.initials: M
authors.lastname: Duarte
authors.affiliation: Centro de Críticos, Hospital de Sabadell, Corporació Sanitària Parc Taulí. Institut Universitari Parc Taulí-UAB, Universitat Autònoma de Barcelona, Campus d́Excel·lència International. CIBER Enfermedades Respiratorias, France.
authors.forename: Montserrat
authors.initials: M
authors.lastname: Colomina
authors.affiliation: Centro de Críticos, Hospital de Sabadell, Corporació Sanitària Parc Taulí. Institut Universitari Parc Taulí-UAB, Universitat Autònoma de Barcelona, Campus d́Excel·lència International. CIBER Enfermedades Respiratorias, France.
authors.forename: Dolores
authors.initials: D
authors.lastname: Alcaráz
authors.affiliation: Microbiology Laboratory, UDIAT Centre Diagnòstic, Corporació Sanitària Parc Taulí. Institut Universitari Parc Taulí-UAB. Universitat Autònoma de Barcelona, Campus d́Excel·lència International, France.
authors.forename: Dionisia
authors.initials: D
authors.lastname: Fontanals
authors.affiliation: Centro de Críticos, Hospital de Sabadell, Corporació Sanitària Parc Taulí. Institut Universitari Parc Taulí-UAB, Universitat Autònoma de Barcelona, Campus d́Excel·lència International. CIBER Enfermedades Respiratorias, France.
authors.forename: Jordi
authors.initials: J
authors.lastname: Vallés
mesh_terms: D000328:Adult; D000368:Aged; D001431:Bacteriological Techniques; D001769:Blood / Q000382:microbiology*; D055499:Catheter-Related Infections / Q000097:blood / Q000175:diagnosis* / Q000382:microbiology; D002405:Catheterization, Central Venous / Q000009:adverse effects*; D002408:Catheters, Indwelling / Q000382:microbiology*; D020878:Device Removal; D016972:Enterobacter cloacae / Q000302:isolation & purification; D004756:Enterobacteriaceae Infections / Q000175:diagnosis / Q000209:etiology / Q000382:microbiology; D005260:Female; D006801:Humans; D007362:Intensive Care Units; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D055624:Methicillin-Resistant Staphylococcus aureus / Q000302:isolation & purification; D008875:Middle Aged; D011446:Prospective Studies; D011552:Pseudomonas Infections / Q000175:diagnosis / Q000209:etiology / Q000382:microbiology; D013203:Staphylococcal Infections / Q000175:diagnosis / Q000209:etiology / Q000382:microbiology; D013997:Time Factors; D016896:Treatment Outcome; D019564:Unnecessary Procedures
keywords: Bacteriemia asociada a catéter; Catheter-related infections; Catéter venoso central; Central venous catheter; Critical care; Cuidados intensivos; Diagnosis; Diagnóstico