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A comparative assessment of two conservative methods for the diagnosis of catheter-related infection in critically ill patients

John R. Gowardman| Paula Jeffries| Melissa Lassig-Smith| Janine Stuart| Paul Jarrett| Renae Deans| Matthew McGrail| Narelle M. George| Graeme R. Nimmo| Claire M. Rickard
Original
Volume 39, Issue 1 / January , 2013

Pages 109 - 116

Abstract

Purpose

To assess the utility of two in situ techniques, differential time to positivity (DTP) and semiquantitative superficial cultures (SQSC) for diagnosing catheter-related bloodstream infection (CR-BSI) in critically ill adults.

Methods

This was a prospective cohort study in patients with suspected CR-BSI arising from a short-term arterial catheter (AC) or a central venous catheter (CVC). On suspicion of CR-BSI, devices were removed. Blood, skin, catheter tip and hub cultures were taken. Infection rates were compared against the diagnosis of CR-BSI using matched tip and blood cultures.

Results

Of 120 episodes of clinically suspected CR-BSI in 101 patients examined, 9 (7.5 %) were confirmed as CR-BSI. Validity values (95 % CI) for the diagnosis of CR-BSI arising from both AC and CVC for DTP were: sensitivity 44 % (15–77 %), specificity 98 % (93–100 %), positive predictive value (PPV) 67 % (24–94 %), negative predictive value (NPV) 96 % (90–98 %), positive likelihood ratio (LR+) 25 (5–117), negative likelihood ratio (LR−) 0.6 (0.3–1.0), diagnostic odds ratio (DOR) 44 (7–258), and accuracy 94 % (92–98 %). Validity values (95 % CI) for SQSC were: sensitivity 78 % (41–96 %), specificity 60 % (50–69 %), PPV 14 % (6–26 %), NPV 97 % (89–99 %), LR+ 1.9 (1.0–2.3), LR− 0.4 (0.1–1.3), DOR 5.1 (1.1–19), and accuracy 61 % (51–69 %). DTP combined with SQSC improved sensitivity and NPV to 100 % whilst the DOR increased to 25.8 (95 % CI 3–454).

Conclusions

CR-BSI can be ruled out by undertaking DTP and SQSC concurrently for both ACs and CVCs with 100 % sensitivity and NPV.

Keywords

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