Titre du document / Document title

Rapid diagnosis of central-venous-catheter-related bloodstream infection without catheter removal

Auteur(s) / Author(s)

KITE P. ⁽¹⁾ ; DOBBINS B. M. ⁽²⁾ ; WILCOX M. H. ⁽¹⁾ ; MCMAHON M. J. ⁽²⁾ ;

Affiliation(s) du ou des auteurs / Author(s) Affiliation(s)

⁽¹⁾ Department of Microbiology, General Infirmary, University of Leeds, Leeds, ROYAUME-UNI
⁽²⁾ Academic Unit of Surgery, General Infirmary, Leeds, ROYAUME-UNI

Résumé / Abstract

Background Current methods for the diagnosis of bloodstream infection related to central venous catheters (CVC) are slow and in many cases require catheter removal. Since most CVC that are removed on suspicion of causing infection prove not to be infected, removal of catheters unnecessarily exposes patients to the risks associated with reinsertion. Methods The gram stain and acridine-orange leucocyte cytospin test (AOLC) is rapid (30 min), inexpensive, and requires only 100 μL catheter blood (treated with edetic acid) and the use of light and ultraviolet microscopy. We assessed the gram stain and AOLC test in suspected cases of catheter-related bloodstream infection, in comparison with two methods requiring catheter removal (tip roll and tip flush), and a third technique, done in situ (endoluminal brush) in conjunction with quantitative peripheral-blood cultures. Findings 128 cases of suspected catheter-related bloodstream infection were assessed in 124 adult surgical patients (median duration of CVC placement was 16 days). In 112 (88%) cases CVC blood was obtainable. Catheter-related bloodstream infection was diagnosed in 50 cases (culture of the same organism from the catheter, in significant numbers, and from peripheral-blood culture). The sensitivity of the gram stain and AOLC test was 96% and the specificity was 92%, with a positive predictive value of 91% and a negative predictive value of 97%. By comparison, the tip-roll, tip-flush, and endoluminal-brush methods had sensitivities of 90%, 95%, and 92%, and specificities of 55%, 76%, and 98%, respectively. Interpretation The gram stain and AOLC test is a simple, and rapid method for the diagnosis of catheter-related bloodstream infection. This diagnostic method compares favourably with other diagnostic methods, particularly those that require the removal of the catheter, and can permit early targeted antimicrobial therapy.

Revue / Journal Title

Lancet   ISSN 0140-6736   CODEN LANCAO 

Source / Source

1999, vol. 354, n^o9189, pp. 1504-1507 (28 ref.)

Langue / Language

Anglais

Editeur / Publisher

Lancet, London, ROYAUME-UNI  (1823) (Revue)

Mots-clés anglais / English Keywords

Central vein ; Catheter ; Association ; Infection ; Blood stream form ; Accuracy ; Gram staining ; Diagnosis ; Human ; Surgery ; Methodology ; Cardiovascular disease ; Venous disease ; Instrumentation therapy ;

Mots-clés français / French Keywords

Veine centrale ; Cathéter ; Association ; Infection ; Forme sanguine ; Précision ; Coloration Gram ; Diagnostic ; Homme ; Chirurgie ; Méthodologie ; Appareil circulatoire pathologie ; Veine pathologie ; Traitement instrumental ;

Mots-clés espagnols / Spanish Keywords

Vena central ; Catéter ; Asociación ; Infección ; Forma sanguínea ; Precisión ; Coloración Gram ; Diagnóstico ; Hombre ; Cirugía ; Metodología ; Aparato circulatorio patología ; Vena patología ; Tratamiento instrumental ;

Localisation / Location

INIST-CNRS, Cote INIST : 5004, 35400008001563.0100