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Olumide adeola pidan c
This document discusses the diagnosis of catheter-related bloodstream infections (CRBSIs). Clinical findings alone are unreliable for diagnosis as fever has poor specificity and inflammation at the insertion site has low sensitivity. Blood cultures that grow Staphylococcus aureus, coagulase-negative Staphs, Candida species, or skin microorganisms in a recently inserted catheter may indicate CRBSI. Differential time to positivity compares blood culture growth from the catheter and peripheral vein, and if the catheter sample is positive at least two hours earlier, it confirms CRBSI. Any complicated infection scenarios require catheter removal.
Olumide adeola pidan c
- 1. Typically we beginto suspect that the patient may have a catheter related blood stream infection when there is fever that has been unaccounted for and that they may have had a catheter in place for some time or it may be unclear whether pt may have a CRBSI and thus it is left in. Therefore, will first talk about the diagnosis of catheter related blood stream infection through blood cultures as opposed to diagnosing after the catheter has been pulled and that the tip is cultured.
- 2. Some important pointsabout diagnosis of CRBSI: -Clinical findings are unreliable poor sensitivity and specificity -Most sensitive is fever, but has poor specificity -Inflammation or pururlence around insertion site has greater specificity but poor sensitivity -In general blood cultures positive for the following species should make you more suspicious of CRBSI: - S. aureus - Coag-neg staph - Candida species - Recently inserted catheter (i.e. one that had ben indwelling < 14 days) is commonly colonized from skin microorganisms along the
- 3. Definition of positiveCRBSI via Differential time to positivity is comparing the catheter to the peripheral vein to see which sample grows out first. -Monitoring for growth is based on radiometric methods -So the theory is that the greater the inoculum of microbes inoculated into blood cultures bottles, the shorter the incubation required to detect microbial growth, one would expect the catheter to have the greater inoculum. -85-89% sensitivity and 81-83% specificity in meta-analysis of 8 studies
- 4. Obtain blood culturefrom peripheral vein and from the central line. If the blood culture from the central line becomes positive at least two hours before that of the peripheral line, then diagnosis of CRBSI. How do you proceed from here if positive CRBSI?
- 5. Other treatment modalitiesnot discussed: Salvage Exchange Antibiotic lock therapy
- 6. Main point ofthis slide is to say that these are “COMPLICATED” infection scenarios that require catheter removal. You’ll see this reiterated in the flow diagram towards the end of this presentation. Anything that falls under “complicated” means you need to remove the catheter.
- 7. Main point ofthis slide is to say that these are “COMPLICATED” infection scenarios that require catheter removal. You’ll see this reiterated in the flow diagram towards the end of this presentation. Anything that falls under “complicated” means you need to remove the catheter.