Diagnostic usefulness of differential time to positivity for catheter-related candidemia.
A differential time to positivity (DTP) of ≥ 120 min is useful for diagnosing catheter-related bacteremia, but data on diagnosing catheter-related candidemia (CRC) in this way are limited. We wished to evaluate the usefulness of the DTP for diagnosing CRC. All adult patients who had the same Candida species isolated from blood cultures drawn simultaneously from a central venous catheter (CVC) and a peripheral vein were included at a tertiary care hospital over an 18-month period. A total of 105 patients with candidemia who had positive simultaneous CVC and peripheral vein blood cultures were included in our study. Sixty-one patients (58%) had CRC (47 definite and 14 probable), and 38 (36%) had candidemia from another source (non-CRC). The remaining 6 patients (6%) with indeterminate candidemia were excluded from the final analysis. The overall sensitivity and specificity of a DTP of ≥ 120 min for diagnosing CRC were 85% (95% confidence interval [CI], 74% to 93%) and 82% (95% CI, 66% to 92%), respectively, and for neutropenic patients, they were 75% (95% CI, 19% to 99%) and 100% (95% CI, 75% to 100%), respectively. For Candida glabrata infections, the optimal DTP cutoff was ≥ 6 h, with a sensitivity of 63% (95% CI, 35% to 85%) and a specificity of 75% (95% CI, 35% to 97%). In summary, DTP is useful for diagnosing CRC, and a DTP of ≥ 120 min appears to be the optimal cutoff except for CRC caused by C. glabrata. For neutropenic patients, DTP may be useful as an adjunct test to rule in CRC and to decide whether a catheter should be removed.
Division of Infectious Diseases, Department of Internal Medicine, Kyung Hee University Hospital, Kyung Hee University School of Medicine, Seoul, Republic of Korea.
Ki-Ho
KH
Park
Division of Infectious Diseases, Department of Internal Medicine, Kyung Hee University Hospital, Kyung Hee University School of Medicine, Seoul, Republic of Korea.
Mi Suk
MS
Lee
Department of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
Sang-Oh
SO
Lee
Department of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
Sang-Ho
SH
Choi
Department of Laboratory Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
Heungsup
H
Sung
Department of Laboratory Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
Mi-Na
MN
Kim
Department of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
Yang Soo
YS
Kim
Department of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
Jun Hee
JH
Woo
Department of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea kimsunghanmd@hotmail.com.
Sung-Han
SH
Kim
D000328:Adult; D000368:Aged; D002175:Candida / Q000302:isolation & purification*; D058387:Candidemia / Q000175:diagnosis*; D055499:Catheter-Related Infections / Q000175:diagnosis*; D002404:Catheterization / Q000009:adverse effects; D062905:Central Venous Catheters / Q000382:microbiology; D015331:Cohort Studies; D005260:Female; D006801:Humans; D008297:Male; D008828:Microbiological Techniques / Q000379:methods*; D008875:Middle Aged; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D062606:Tertiary Care Centers; D013997:Time Factors