Evaluation of Dif
Evaluation of Different methods for Diagnosis of Catheter Related Blood Stream Infection
Yasser M. Ismail and Sahar M. Fayed
Clinical & Chemical Pathology Department, Benha Faculty of Medicine
Abstract: Introduction: Intravascular catheters are crucial in modern medical practice, particularly in intensive care units (ICUs). However, vascular catheter-related bloodstream infections (CRBSIs) have become a leading cause of health-care-associated bloodstream infections and are associated with substantial morbidity and mortality. Aim of the work: to determine whether the Gram stain-acridine orange leucocyte cytospin (AOLC) test could offer accuracy comparable to other methods for the diagnosis of catheter-related blood stream infection and to avoid inconvenient, unnecessary and costly central venous catheter removal. Material and methods: This study included 36 patients with central venous catheterization. All patients with CVC were clinically suspected to have CR-BSI, as suggested by their physicians. They were 24 males and 12 females with their ages ranging between 20 years and 68 years with the mean age 51.3 ± 14.9 years. The samples were subjected to two major diagnostic strategies: the first implemented catheter sparing approach, while the other strategy required catheter removal. Catheter sparing diagnostic methods included paired quantitative blood cultures, pour-plate technique and acridine orange leukocyte cytospin/Gram test (AOLC/G test), while methods that required device removal were semiquantitative catheter segment culture (roll- plate method) and quantitative catheter segment culture (tip-flush method). Results: Taking the roll- plate technique as the reference method, there was fair agreement (66.7%) between the results of pour plate and roll plate techniques (kappa=0.226), there was moderate agreement between the results of paired quantitative blood culture (83.3%), tip flush method (83.3%) and AOLC / G (80.6%) and the reference method (kappa=0.429, 0.429 ,0.40 respectively). The diagnostic validity tests for AOLC showed that the specificity of AOLC was 100% and the sensitivity was 78.8%. Conclusion: From this study, it was concluded that the Gram stain-AOLC test is a simple, rapid, sensitive and specific test that could be used as a first line screening test for the in situ diagnosis of CRBSI. This policy can prevent the unnecessary removal of uninfected catheters and significantly extends the life span of catheters and lowers the risks and costs of mechanical complications associated with new catheter placement.
[Yasser M. Ismail and Sahar M. Fayed. Evaluation of Different methods for Diagnosis of Catheter Related Blood Stream Infection. Life Sci J 2013;10(1):1915-1923] (ISSN:1097-8135). http://www.lifesciencesite.com.
Keyword: Catheter related blood stream infection; CRBSI; cytospin; AOLC.