Diagnosis of catheter-related bloodstream infection in neonates: A study on the value of differential time to positivity of paired blood cultures
- 1 September 2007
- journal article
- neonatal intensive-care
- Published by Ovid Technologies (Wolters Kluwer Health) in Pediatric Critical Care Medicine
- Vol. 8 (5), 470-475
- https://doi.org/10.1097/01.pcc.0000282156.44533.d1
Abstract
Objective: Diagnosis of neonatal catheter-related bloodstream infection (CRBSI) is currently based on isolation of identical bacterial species from bloodstream and catheter tip cultures. This requires removal of the catheter followed by the insertion of a new catheter. The objective of this study was to investigate whether differential time to positivity (DTP) of blood cultures drawn from paired peripheral vein and central vascular catheter is useful for diagnosing neonatal CRBSI, avoiding removal of the catheter. Design: Retrospective observational study. Setting: Neonatal intensive care unit, University Hospital of Antwerp, Belgium. Patients: Neonates with probable and definite nosocomial bloodstream infection. Interventions: All episodes of nosocomial bloodstream infection (NBSI) in an approximately 7.5-yr period were identified retrospectively. Definite NBSI episodes in which paired blood cultures were obtained were retained to calculate DTP, to determine the optimal DTP cutoff for the diagnosis of CRBSI, and to assess the validity of DTP for the diagnosis of CRBSI. Measurements and Main Results: Of 32 NBSI episodes included in the study, 16 were CRBSI, seven were non-CRBSI, and nine were classified as “diagnosis uncertain.” In CRBSI, blood cultures drawn from a central vascular catheter were positive earlier than those drawn from a peripheral vein (median 9.67 hrs vs. 21.58 hrs, p < .01). Median DTP was 10.42 hrs in CRBSI and −0.33 hrs in non-CRBSI (p = .01). The optimal DTP cutoff for the diagnosis of CRBSI was ≥1 hr (area under the receiver operating characteristic curve = 0.84 ± 0.11), with a sensitivity of 94%, a specificity of 71%, a positive predictive value of 88%, and a negative predictive value of 83%. Conclusions: Differential time to positivity of paired blood cultures may have some potential in the diagnosis of catheter-related infections in neonatal intensive care unit patients and should be subjected to a prospective study.Keywords
This publication has 27 references indexed in Scilit:
- Qualitative versus quantitative blood cultures in the diagnosis of catheter-related bloodstream infections in children with malignancyPediatric Blood & Cancer, 2005
- Identification of central venous catheter-related infections in infants and childrenPediatric Critical Care Medicine, 2005
- Differential quantitative blood cultures for the diagnosis of catheter-related bloodstream infections associated with short- and long-term catheters: A prospective studyDiagnostic Microbiology and Infectious Disease, 2004
- Difference in Time to Detection: A Simple Method to Differentiate Catheter-Related from Non—Catheter-Related Bloodstream Infection in Immunocompromised Pediatric PatientsClinical Infectious Diseases, 2003
- Clinical Utility of Blood Cultures Drawn From Central Vein Catheters and Peripheral Venipuncture in Critically Ill Medical PatientsSocial psychiatry. Sozialpsychiatrie. Psychiatrie sociale, 2003
- Time to positivity of neonatal blood culturesArchives of Disease in Childhood: Fetal & Neonatal, 2001
- Comparison of the BacT/Alert PF Pediatric FAN Blood Culture Bottle with the Standard Pediatric Blood Culture Bottle, the Pedi-BacTJournal of Clinical Microbiology, 2001
- Validity of Earlier Positivity of Central Venous Blood Cultures in Comparison with Peripheral Blood Cultures for Diagnosing Catheter-Related Bacteremia in Cancer PatientsJournal of Clinical Microbiology, 2001
- Prediction of nosocomial sepsis in neonates by means of a computer-weighted bedside scoring system (NOSEP score)Critical Care Medicine, 2000
- Prolongation of hospital stay and extra costs due to hospital-acquired infection in a neonatal unitJournal of Hospital Infection, 1997