Assessing Patients for Potential Catheter-Related Bloodstream Infections
Hi, I'm Dr. William Jarvis, President of Jason and Jarvis Associates and Medscape Infectious Disease Expert Advisor.
Today I'd like to talk about the appropriate assessment of a patient for potential catheter-related bloodstream infection.
Have you often wondered in patients who have multilumen catheters, how many of those lumens should be cultured? Indeed, the Infectious Disease Society of America's (IDSA) recent guidelines for clinical practice left this as an unresolved issue. However, a recent article in Clinical Infectious Diseases by Guembe and associates addressed this issue. If you look at the IDSA clinical practice guidelines, the recommendation for working a patient up for a catheter-related bloodstream infection, is to obtain a culture from the catheter and a peripheral stick, at least 10 cc of blood inoculated from each, and then culture them, look at time to positivity, and look at colony counts.
In this study, a large number of patients who had diagnosed catheter-related bloodstream infections were retrospectively assessed. They had all been cultured according to the clinical practice guideline of IDSA. What was found was that if 1 lumen of a double lumen catheter had not been cultured, approximately 30% of catheter-related bloodstream infections would be missed. If 1 lumen of a triple lumen catheter had been eliminated, about 15% of catheter-related bloodstream infections would have been missed. If 2 lumens of a triple lumen catheter had been eliminated, over 37% of catheter-related bloodstream infections would have been missed.
The bottom line of this study is, if you have a patient where you are considering catheter-related bloodstream infection as a potential diagnosis, then culturing all of the lumens of that catheter at the same time that you obtain a peripheral blood culture, and then looking at time to positivity and colony counts at 2 hours, as well as the result of the blood culture itself, can better detect catheter-related bloodstream infections in these patients. It may be more costly, but it also is much more likely to give you the right diagnosis.
Until next time, this is Dr. William Jarvis. Thank you.
Hi, I'm Dr. William Jarvis, President of Jason and Jarvis Associates and Medscape Infectious Disease Expert Advisor.
Today I'd like to talk about the appropriate assessment of a patient for potential catheter-related bloodstream infection.
Have you often wondered in patients who have multilumen catheters, how many of those lumens should be cultured? Indeed, the Infectious Disease Society of America's (IDSA) recent guidelines for clinical practice left this as an unresolved issue. However, a recent article in Clinical Infectious Diseases by Guembe and associates addressed this issue. If you look at the IDSA clinical practice guidelines, the recommendation for working a patient up for a catheter-related bloodstream infection, is to obtain a culture from the catheter and a peripheral stick, at least 10 cc of blood inoculated from each, and then culture them, look at time to positivity, and look at colony counts.
In this study, a large number of patients who had diagnosed catheter-related bloodstream infections were retrospectively assessed. They had all been cultured according to the clinical practice guideline of IDSA. What was found was that if 1 lumen of a double lumen catheter had not been cultured, approximately 30% of catheter-related bloodstream infections would be missed. If 1 lumen of a triple lumen catheter had been eliminated, about 15% of catheter-related bloodstream infections would have been missed. If 2 lumens of a triple lumen catheter had been eliminated, over 37% of catheter-related bloodstream infections would have been missed.
The bottom line of this study is, if you have a patient where you are considering catheter-related bloodstream infection as a potential diagnosis, then culturing all of the lumens of that catheter at the same time that you obtain a peripheral blood culture, and then looking at time to positivity and colony counts at 2 hours, as well as the result of the blood culture itself, can better detect catheter-related bloodstream infections in these patients. It may be more costly, but it also is much more likely to give you the right diagnosis.
Until next time, this is Dr. William Jarvis. Thank you.
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