Catheters, Microbes, Time, and Gold Standards
Authors: Barry M. Farr
Journal: Annals of Internal Medicine (2004)

Editorials6 January 2004Catheters, Microbes, Time, and Gold StandardsBarry M. Farr, MD, MScBarry M. Farr, MD, MScFrom University of Virginia Health System; Charlottesville, VA 22908.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-140-1-200401060-00014 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail Vascular catheters became integral to medical care in the 1940s, and soon thereafter catheter-related bloodstream infection (CRBSI) became an important cause of morbidity and mortality. Catheter removal was considered imperative for diagnosis and therapy of CRBSI until a quarter century ago when Wing and colleagues proposed drawing paired quantitative blood cultures to diagnose CRBSI—1 set through the catheter and another from a peripheral vein (1). They reported a patient with a 400-fold higher concentration of 2 gram-negative bacilli (Enterobacter cloacae and Citrobacter freundii) in catheter-drawn blood and reasoned that the difference must mean that the catheter was the source of ...References1. Wing EJ, Norden CW, Shadduck RK, Winkelstein A. Use of quantitative bacteriologic techniques to diagnose catheter-related sepsis. Arch Intern Med. 1979;139:482-3. [PMID: 107870] CrossrefMedlineGoogle Scholar2. Flynn PM, Shenep JL, Stokes DC, Barrett FF. In situ management of confirmed central venous catheter-related bacteremia. Pediatr Infect Dis J. 1987;6:729-34. [PMID: 3670937] CrossrefMedlineGoogle Scholar3. Siegman-Igra Y, Anglim AM, Shapiro DE, Adal KA, Strain BA, Farr BM. Diagnosis of vascular catheter-related bloodstream infection: a meta-analysis. J Clin Microbiol. 1997;35:928-36. [PMID: 9157155] CrossrefMedlineGoogle Scholar4. Blot F, Schmidt E, Nitenberg G, Tancrede C, Leclercq B, Laplanche A, et al . 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Validity of earlier positivity of central venous blood cultures in comparison with peripheral blood cultures for diagnosing catheter-related bacteremia in cancer patients. J Clin Microbiol. 2001;39:274-8. [PMID: 11136783] CrossrefMedlineGoogle Scholar8. Sherertz RJ, Heard SO, Raad II. Diagnosis of triple-lumen catheter infection: comparison of roll plate, sonication, and flushing methodologies. J Clin Microbiol. 1997;35:641-6. [PMID: 9041404] CrossrefMedlineGoogle Scholar9. Mermel LA, Josephson S, Binns L. Diagnosis of catheter related bloodstream infection (CRBSI) by differential growth rates of catheter-drawn and percutaneously drawn blood cultures [Abstract]. In: Abstracts of the 38th Interscience Conference on Antimicrobial Agents and Chemotherapy, San Diego, CA, 24–27 September 1998. Abstract no. K-5, p. 500. Google Scholar10. Seifert H, Cornely O, Seggewiss K, Decker M, Stefanik D, Wisplinghoff H, et al . Bloodstream infection in neutropenic cancer patients related to short-term nontunnelled catheters determined by quantitative blood cultures, differential time to positivity, and molecular epidemiological typing with pulsed-field gel electrophoresis. J Clin Microbiol. 2003;41:118-23. [PMID: 12517836] CrossrefMedlineGoogle Scholar11. Rijnders BJ, Verwaest C, Peetermans WE, Wilmer A, Vandecasteele S, Van Eldere J, et al . Difference in time to positivity of hub-blood versus nonhub-blood cultures is not useful for the diagnosis of catheter-related bloodstream infection in critically ill patients. Crit Care Med. 2001;29:1399-403. [PMID: 11445695] CrossrefMedlineGoogle Scholar12. Raad I, Hanna HA, Alakech B, Chatzinikolaou I, Johnson MM, Tarrand J. Differential time to positivity: a useful method for diagnosing catheter-related bloodstream infections. Ann Intern Med. 2004;140:18-25. LinkGoogle Scholar13. Cobb DK, High KP, Sawyer RG, Sable CA, Adams RB, Lindley DA, et al . A controlled trial of scheduled replacement of central venous and pulmonary-artery catheters. N Engl J Med. 1992;327:1062-8. [PMID: 1522842] CrossrefMedlineGoogle Scholar14. Mermel LA, Farr BM, Sherertz RJ, Raad O, 'Grady N, Harris JS, et al . Guidelines for the management of intravascular catheter-related infections. Clin Infect Dis. 2001;32:1249-72. [PMID: 11303260] CrossrefMedlineGoogle Scholar15. Seo SK, Venkataraman L, DeGirolami PC, Samore MH. Molecular typing of coagulase-negative staphylococci from blood cultures does not correlate with clinical criteria for true bacteremia. Am J Med. 2000;109:697-704. [PMID: 11137484] CrossrefMedlineGoogle Scholar16. Khatib R, Riederer KM, Clark JA, Khatib S, Briski LE, Wilson FM. Coagulase-negative staphylococci in multiple blood cultures: strain relatedness and determinants of same-strain bacteremia. J Clin Microbiol. 1995;33:816-20. [PMID: 7790443] CrossrefMedlineGoogle Scholar17. Kim SD, McDonald LC, Jarvis WR, McAllister SK, Jerris R, Carson LA, et al . Determining the significance of coagulase-negative staphylococci isolated from blood cultures at a community hospital: a role for species and strain identification. Infect Control Hosp Epidemiol. 2000;21:213-7. [PMID: 10738993] CrossrefMedlineGoogle Scholar Author, Article, and Disclosure InformationAuthors: Barry M. Farr, MD, MScAffiliations: From University of Virginia Health System; Charlottesville, VA 22908.Disclosures: None disclosed.Corresponding Author: Barry M. Farr, MD, MSc, P.O. Box 800473, University of Virginia Health System, Charlottesville, VA 22908. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoDifferential Time to Positivity: A Useful Method for Diagnosing Catheter-Related Bloodstream Infections Issam Raad , Hend A. Hanna , Badie Alakech , Ioannis Chatzinikolaou , Marcella M. Johnson , and Jeffrey Tarrand Metrics Cited byA comparative assessment of two conservative methods for the diagnosis of catheter-related infection in critically ill patientsQuantitative Cultures for Diagnosing Ventilator-Associated Pneumonia: A Critique 6 January 2004Volume 140, Issue 1Page: 62-64KeywordsAntibioticsAttentionBacteremiaBloodCathetersHematologic testsNosocomial infectionsSafety studiesSpecificityVeins ePublished: 6 January 2004 Issue Published: 6 January 2004 Copyright & PermissionsCopyright © 2004 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...