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

Gowardman, John R., Jeffries, Paula, Lassig-Smith, Melissa, Stuart, Janine, Jarrett, Paul, Deans, Renae, McGrail, Matthew, George, Narelle M., Nimmo, Graeme R. and Rickard, Claire M. (2013) A comparative assessment of two conservative methods for the diagnosis of catheter-related infection in critically ill patients. Intensive Care Medicine, 39 1: 109-116.

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Author Gowardman, John R.
Jeffries, Paula
Lassig-Smith, Melissa
Stuart, Janine
Jarrett, Paul
Deans, Renae
McGrail, Matthew
George, Narelle M.
Nimmo, Graeme R.
Rickard, Claire M.
Title A comparative assessment of two conservative methods for the diagnosis of catheter-related infection in critically ill patients
Journal name Intensive Care Medicine  (ERA 2012 Listed)    (ERA 2010 Rank A)   Check publisher's open access policy
Publication date 2013-01
Sub-type Article
Year available 2012
DOI 10.1007/s00134-012-2689-7
Volume number 39
Issue number 1
ISSN 0342-4642; 1432-1238
Start page 109
End page 116
Total pages 8
Place of publication Heidelberg, Germany
Publisher Springer
Collection year 2013
Language eng
Formatted 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.
Keyword Catheter-related bloodstream infection
Central venous catheter
Arterial catheter
Intensive care unit
Q-Index Code C1
Q-Index Status Confirmed Code
Institutional Status UQ
Additional Notes Published online: 26 September 2012

Document type: Journal Article
Sub-type: Article
Collections: Official 2013 Collection
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Created: Wed, 05 Dec 2012, 17:35:55 EST by Sia Athanasas on behalf of Anaesthesiology and Critical Care - RBWH