Difference in Time to Detection: A Simple Method to Differentiate Catheter-Related from Non--Catheter-Related Bloodstream Infection in Immunocompromised Pediatric Patients

Gaur, Aditya H.; Flynn, Patricia M.; Giannini, Mary Anne; Shenep, Jerry L.; Hayden, Randall T.
August 2003
Clinical Infectious Diseases;8/15/2003, Vol. 37 Issue 4, p469
Academic Journal
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 ≥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 ≥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.


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