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Diagnostic usefulness of differential time to positivity for catheter-related candidemia.

ABSTRACT: A differential time to positivity (DTP) of ? 120 min is useful for diagnosing catheter-related bacteremia, but data on diagnosing catheter-related candidemia (CRC) in this way are limited. We wished to evaluate the usefulness of the DTP for diagnosing CRC. All adult patients who had the same Candida species isolated from blood cultures drawn simultaneously from a central venous catheter (CVC) and a peripheral vein were included at a tertiary care hospital over an 18-month period. A total of 105 patients with candidemia who had positive simultaneous CVC and peripheral vein blood cultures were included in our study. Sixty-one patients (58%) had CRC (47 definite and 14 probable), and 38 (36%) had candidemia from another source (non-CRC). The remaining 6 patients (6%) with indeterminate candidemia were excluded from the final analysis. The overall sensitivity and specificity of a DTP of ? 120 min for diagnosing CRC were 85% (95% confidence interval [CI], 74% to 93%) and 82% (95% CI, 66% to 92%), respectively, and for neutropenic patients, they were 75% (95% CI, 19% to 99%) and 100% (95% CI, 75% to 100%), respectively. For Candida glabrata infections, the optimal DTP cutoff was ? 6 h, with a sensitivity of 63% (95% CI, 35% to 85%) and a specificity of 75% (95% CI, 35% to 97%). In summary, DTP is useful for diagnosing CRC, and a DTP of ? 120 min appears to be the optimal cutoff except for CRC caused by C. glabrata. For neutropenic patients, DTP may be useful as an adjunct test to rule in CRC and to decide whether a catheter should be removed.

SUBMITTER: Park KH

PROVIDER: S-EPMC4097682 | biostudies-literature | 2014 Jul

REPOSITORIES: biostudies-literature

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Diagnostic usefulness of differential time to positivity for catheter-related candidemia.

Park Ki-Ho KH Lee Mi Suk MS Lee Sang-Oh SO Choi Sang-Ho SH Sung Heungsup H Kim Mi-Na MN Kim Yang Soo YS Woo Jun Hee JH Kim Sung-Han SH

Journal of clinical microbiology 20140514 7

A differential time to positivity (DTP) of ≥ 120 min is useful for diagnosing catheter-related bacteremia, but data on diagnosing catheter-related candidemia (CRC) in this way are limited. We wished to evaluate the usefulness of the DTP for diagnosing CRC. All adult patients who had the same Candida species isolated from blood cultures drawn simultaneously from a central venous catheter (CVC) and a peripheral vein were included at a tertiary care hospital over an 18-month period. A total of 105 ...[more]

PMID: 24829236

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Project description:Background and Purpose:Catheter-related blood circulation infection is the most dangerous and serious side-effects of vascular catheters, which leads to the enhancement of the costs, mortality, and hospital stay duration, especially in the Intensive Care Unit. Regarding this, the aim of the current study was to identify the prevalence of catheter-induced candidemia in the Tehran Heart Center, a heart hospital in Tehran, Iran. Materials and Methods:This study was conducted on patients admitted to Tehran Heart Center for a minimum of 7 days during 18 months. To detect the fungal elements, blood culture and catheter culture were performed in the patients receiving central or peripheral venous catheter. Then, the polymerase chain reaction (PCR) was applied to determine the possible diagnosis. Results:The investigation of 223 samples led to the identification of a total of 15 (6.7%) yeast isolates obtained from 9 (60%), 4 (26.6 %), and 2 (13.4%) catheter, blood, and skin (of the catheter insertion areas) cultures, respectively. Out of nine Candida isolates obtained from the catheter samples, 1 (11.1%), 1 (11.1%), 2 (22.2%), and 5 (55.6%) cases were identified as C. tropicalis, C. membranifaciens, C. glabrata, and C. albicans, respectively, using the internal transcribed spacer region sequencing. Furthermore, the four yeasts isolated from the blood culture included C. tropicalis, C. carpophila, C. membranifaciens, and Cryptococcus albidus. Additionally, one case of C. glabrata and one case of C. albicans were isolated from the skin culture of the catheter insertion areas in patients with positive catheter culture. We reported two cases of catheter-related candidemia caused by C. membranifaciens and C. tropicalis on the basis of the genetic similarity of the species isolated from the blood and catheter. These cases were treated successfully with intravenous fluconazole and catheter removal. Conclusion:There is some evidence indicating the growing prevalence of non-albicans Candida infections. Many risk factors, including prior antibiotic therapy, use of a central venous catheter, surgery, and parenteral nutrition, are considered to be associated with candidemia in hospitalized heart failure patients. The identification of the route of infection in candidemia is difficult. In the current study, the positive blood and catheter cultures for Candida isolates and the similarity of the ITS region of ribosomal DNA sequence of Candida isolated from two patients confirmed the diagnosis of intravenous catheter-related candidemia.

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Diagnostic usefulness of differential time to positivity for catheter-related candidemia.

Publications

Diagnostic usefulness of differential time to positivity for catheter-related candidemia.

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