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Interventional Diagnostic Procedure: A Practical Guide for the Assessment of Coronary Vascular Function
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Rapid diagnosis of central-venous-catheter-related bloodstream infection without catheter removal

P Kite1, B M Dobbins, M H Wilcox

  • 1Department of Microbiology, General Infirmary, University of Leeds, UK.

Lancet (London, England)
|November 7, 1999
PubMed
Abstract

Insights

The rapid gram stain and acridine-orange leucocyte cytospin test (AOLC) accurately diagnoses bloodstream infections related to central venous catheters (CVC), avoiding unnecessary catheter removal and enabling timely treatment.

Area of Science:

  • Medical Diagnostics
  • Infectious Diseases
  • Microbiology

Background:

  • Current methods for diagnosing central venous catheter (CVC)-related bloodstream infections are slow and often necessitate catheter removal.
  • Unnecessary CVC removal increases patient risks associated with reinsertion, especially when infections are not present.

Purpose of the Study:

  • To evaluate the efficacy of the gram stain and acridine-orange leucocyte cytospin test (AOLC) for rapid diagnosis of CVC-related bloodstream infections.
  • To compare the AOLC test's performance against methods requiring catheter removal and an in situ technique.

Main Methods:

  • Assessed the gram stain and AOLC test on CVC blood samples (100 microL) using light and ultraviolet microscopy.
  • Compared AOLC test results with tip roll, tip flush, and endoluminal brush methods, alongside peripheral blood cultures.
  • Evaluated 128 suspected cases in 124 adult surgical patients with a median CVC dwell time of 16 days.

Main Results:

  • The gram stain and AOLC test demonstrated high sensitivity (96%) and specificity (92%) for diagnosing CVC-related bloodstream infections.
  • Positive and negative predictive values for the AOLC test were 91% and 97%, respectively.
  • Compared to other methods, AOLC showed superior specificity (92%) versus tip-roll (55%) and tip-flush (76%).

Conclusions:

  • The gram stain and AOLC test is a rapid, simple, and effective method for diagnosing CVC-related bloodstream infections.
  • This technique offers comparable or superior performance to existing methods, especially those requiring catheter removal.
  • Early and accurate diagnosis with AOLC facilitates targeted antimicrobial therapy, improving patient outcomes.

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