Catheter Bloodstream Infection
Meta-analysis of diagnostic techniques (Ann Intern Med 2005;142:451-466)
Differential Time to Positivity
Take cultures from line and peripherally within 10 minutes from each other. If both are positive and cath cultures turned positive >2 hours earlier, then it is cath infection.
Quantitative segment culture
segment immersed in broth, any growth is positive
>103 is positive
Semi-Quantitative culture
roll catheter piece in agar
>15 CFU is positive or semi
if same organism in blood cultures from cath and peripheral, need 5-10 times greater number of colonies in cath. sample in order to call it line sepsis
In short term devices, use quant or semi-quant segment culture combined with one perc and one line blood cx
in long term devices, use paired quant blood cx or differential time to Positivity
Catheter-related Infections
Protocol for not pulling in mild to moderate symptomotology
Intensive Care Medicine Issue: Volume 30, Number 6 June 2004
coag-neg staph can be treated by device removal alone if you give antibiotics, then the device does not need to be removed, though 1/5 of the patients will have a recurrence s. aureus should get a minimum of 7-10 days
SR of central line infections show SC better than IJ better than Femoral (Critical Care 2005, 9:R631-R635)
Coag neg staph-remove catheter and 5-7 days of Rx
S. Aureus-2 weeks and consider echo
Candida-2 weeks from time of negative culture
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