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Difference in time to detection: a simple method to differentiate catheter-related from non-catheter-related
Aditya H Gaur1, Patricia M Flynn, Mary Anne Giannini
1Department of Infectious Diseases, St. Jude Children's Research Hospital, University of Tennessee Health Science Center, Memphis, TN 38105-2794, USA.
Abstract:
Current methods for diagnosis of catheter-related infection (CRI) are cumbersome and may require removal of the central venous catheter (CVC). A prospective study was conducted to validate the difference in time to detection (DTD) of cultures of blood samples obtained simultaneously from a peripheral vein (PV) and from the CVC for differentiation of CRI and non-CRI. During a 15-month period, 9 episodes were categorized as CRI and 24 as non-CRI. The median DTD for patients with CRI was significantly higher than that for patients with non-CRI (457 vs. -4 min; P<.001). The optimum cutoff point for diagnosis of CRI was a DTD of > or =120 min (sensitivity, 88.9%; specificity, 100%). With pretest probability of CRI ranging from 28% to 54%, the positive predictive value of a DTD of > or =120 min for the diagnosis of CRI was 100%; the negative predictive value was 89%-96%. On the basis of findings from this study, which is the largest, to date, to involve pediatric patients with tunneled CVCs and the first to use paired quantitative blood cultures as a "criterion standard," DTD was found to be a simple, reliable tool for diagnosis of CRI in hospitals that use continuously read blood culture systems.
Insights
Diagnosing catheter-related infections (CRI) is simpler with time to detection (DTD) blood cultures. A DTD of 120 minutes or more reliably identifies CRI, avoiding catheter removal.
Area of Science:
- Infectious Diseases
- Clinical Microbiology
- Pediatric Medicine
Background:
- Catheter-related infections (CRI) pose diagnostic challenges, often necessitating central venous catheter (CVC) removal.
- Current diagnostic methods for CRI can be time-consuming and invasive.
Purpose of the Study:
- To validate the utility of time to detection (DTD) in differentiating CRI from non-CRI.
- To assess DTD as a diagnostic tool for CRI in pediatric patients with tunneled CVCs.
Main Methods:
- Prospective study comparing blood culture DTD from peripheral veins (PV) and CVCs.
- Paired quantitative blood cultures used as a criterion standard.
- Analysis of 33 episodes (9 CRI, 24 non-CRI) over 15 months.
Main Results:
- Median DTD was significantly higher for CRI (457 min) versus non-CRI (-4 min).
- A DTD cutoff of ≥120 minutes demonstrated 88.9% sensitivity and 100% specificity for CRI.
- Positive predictive value was 100% and negative predictive value ranged from 89%-96%.
Conclusions:
- DTD is a simple and reliable method for diagnosing CRI in healthcare settings with continuously read blood culture systems.
- This study, involving pediatric patients with tunneled CVCs, supports DTD as an effective diagnostic biomarker for CRI.
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