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.
Puravankara Projects Ltd is a leading real estate developer in India. Puravankara developers are involved with all sorts of commercial and residential properties.
Puravankara Projects Ltd is a leading real estate developer in India. Puravankara developers are involved with all sorts of commercial and residential properties.
It is important to realize that guidelines cannot always account for individual
variation among patients. They are not intended to supplant physician judgment
with respect to particular patients or special clinical situations. The IDSA considers
adherence to these guidelines to be voluntary, with the ultimate determination
regarding their application to be made by the physician in the light of each patient’s
individual circumstances.
Central nervous system (CNS) infections are extremely serious group of diseases.
The cerebral cortex and spinal cord are confined within the restricted boundaries of the skull and bony spinal canal.
Infection, inflammation and oedema therefore have serious consequences, often leading to tissue infarction that in turn results in permanent neurologic damage or death.
Therefor, early diagnosis and prompt treatment is very important
It is important to realize that guidelines cannot always account for individual
variation among patients. They are not intended to supplant physician judgment
with respect to particular patients or special clinical situations. The IDSA considers
adherence to these guidelines to be voluntary, with the ultimate determination
regarding their application to be made by the physician in the light of each patient’s
individual circumstances.
Central nervous system (CNS) infections are extremely serious group of diseases.
The cerebral cortex and spinal cord are confined within the restricted boundaries of the skull and bony spinal canal.
Infection, inflammation and oedema therefore have serious consequences, often leading to tissue infarction that in turn results in permanent neurologic damage or death.
Therefor, early diagnosis and prompt treatment is very important
Puravankara Projects Ltd is a leading real estate developer in India. Puravankara developers are involved with all sorts of commercial and residential Properties.
1. Typically we begin to 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 points about 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 positive CRBSI 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 culture from 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?
6. Main point of this 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 of this 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.