Department of Experimental Medicine and Surgery, "Tor Vergata" University of Rome, Via Montpellier 1, 00133, Rome, Italy.
Eur J Clin Microbiol Infect Dis. 2012 Nov;31(11):3139-44. doi: 10.1007/s10096-012-1676-9. Epub 2012 Jun 27.
The diagnosis of catheter-related bloodstream infections (CRBSIs) in febrile patients with indwelling central venous catheters (CVCs) needs improvement. To diagnose CRBSIs more efficiently, we have developed a novel culture approach using the catheter tips removed from febrile patients. CVCs and blood cultures from 1,070 patients with only CVC-related infections were obtained over a period of 3 years (January 2009 to December 2011). The CVCs were evaluated by a semi-quantitative catheter culture method according to Maki's method and by our novel method, which is based on the use of the HB&L UROQUATTRO™ system (Alifax, Padova, Italy). Using our new method, 571 (571/1,070) of the infections were confirmed as CRBSIs. The remaining 487 patients had infections that were associated with hematologic malignancies, neutropenia, prior exposure to antibiotics, and a decreased CVC removal rate. Twelve samples were identified as false-positives. The percentage of patients with CRBSIs confirmed using the HB&L UROQUATTRO™ system was 53.36 % versus 34.95 % (p-value 0.004) using Maki's method (374/1,070 CVC Maki-positive samples). Our results indicate that our new culture method allows for an improved CRBSI diagnosis rate. A significant number of tip cultures (18.41 %) tested positive for CRBSIs using our system but were negative when tested using Maki's method. Moreover, the use of the HB&L UROQUATTRO™ system allowed us to significantly reduce diagnosis time; a negative CRBSI diagnosis could be made within 6 h and a positive diagnosis could be made within 22-28 h.
对于留置中心静脉导管（CVC）的发热患者，导管相关性血流感染（CRBSI）的诊断需要改进。为了更有效地诊断 CRBSI，我们开发了一种新的培养方法，使用从发热患者中取出的导管尖端。在 3 年期间（2009 年 1 月至 2011 年 12 月），共获得了 1070 例仅与 CVC 相关感染的患者的 CVC 和血液培养物。CVC 按照 Maki 方法和我们的新方法（基于使用 HB&L UROQUATTRO™系统（意大利帕多瓦 Alifax））进行半定量导管培养评估。使用我们的新方法，571 例（571/1070）感染被确认为 CRBSI。其余 487 例患者的感染与血液恶性肿瘤、中性粒细胞减少、先前接触抗生素和 CVC 清除率降低有关。12 个样本被鉴定为假阳性。使用 HB&L UROQUATTRO™系统确认的 CRBSI 患者比例为 53.36%，而使用 Maki 方法（1070 例 CVC Maki 阳性样本中 374 例）为 34.95%（p 值<0.004）。我们的结果表明，我们的新培养方法可以提高 CRBSI 的诊断率。使用我们的系统，大量尖端培养物（18.41%）对 CRBSI 呈阳性，但使用 Maki 方法检测时呈阴性。此外，使用 HB&L UROQUATTRO™系统还使我们能够显著缩短诊断时间；阴性 CRBSI 诊断可在 6 小时内做出，阳性诊断可在 22-28 小时内做出。
