Differential time to positivity of blood cultures: a valid method for diagnosing catheter-related bloodstream infections in the intensive care unit

Abstract

Purpose: The validation in critical patients with short-term catheters of a method for diagnosing catheter-related bloodstream infection (CR-BSI), based on the differential time to positivity (DTP) of blood cultures.

Methods: Patients suspected of having CR-BSI were included. Two peripheral vein blood cultures and a catheter hub blood culture were simultaneously carried out. The responsible catheter was removed and tip cultured. Times to positivity of all blood cultures were automatically registered. CR-BSI was diagnosed when all the cultures were positive for the same microorganism and DTP≥120 min. This diagnosis was compared with the one obtained using the standard method.

Results: 226 cases suspected of CR-BSI were analyzed during a 20-month period. A total of 19 removed catheters were associated with CR-BSI. Seven cases of polymicrobial cultures (4 with CR-BSI) were discarded from the final analysis due to the impossibility of determining the time to positivity for each individual microorganism. Using the DTP method, 12 out of 15 CR-BSI cases were diagnosed (sensitivity 80%, specificity 99%, PPV 92%, NPV 98%). In a ROC curve, we found a cut-off value of 17.7 h in positivity of hub blood cultures that may be useful for diagnosing CR-BSI.

Conclusion: DTP can be a valid method for CR-BSI diagnosis in critically ill patients, avoiding unnecessary catheter withdrawal.