1887

Abstract

Blood cultures are sometimes obtained from intravascular catheters for convenience. However, there is controversy regarding this practice. The authors compared the diagnostic test characteristics of blood cultures obtained from intravascular catheters and peripheral veins. Relevant studies for inclusion in this review were identified through PubMed (January 1970–October 2005) and the Cochrane Central Register of Controlled Trials. Studies that reported clear definitions of true bacteraemia were included in the analysis. Two reviewers independently extracted the data. Six studies were included in the analysis, providing data for 2677 pairs of blood cultures obtained from an intravascular catheter and a peripheral venipuncture. A culture obtained from an intravascular catheter was found to be a diagnostic test for bacteraemia with better sensitivity (OR 1.85, 95 % CI 1.14–2.99, fixed effects model) and better negative predictive value (almost with statistical significance) (OR 1.55, 95 % CI 0.999−2.39, fixed effects model) but with less specificity (OR 0.33, 95 % CI 0.18–0.59, random effects model) and lower positive predictive value (OR 0.41, 95 % CI 0.23–0.76, random effects model) compared to a culture taken by peripheral venipuncture. In a group of 1000 patients, eight additional patients with true bacteraemia would be identified and 59 falsely diagnosed as having bacteraemia by a blood culture obtained from an intravascular catheter compared to results of the peripheral blood culture. Given the consequences of undertreating patients with bacteraemia, the authors believe that, based on the available evidence, at least one blood culture should be obtained from the intravascular catheter.

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2008-01-01
2019-11-14
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References

  1. Adal, K. A. & Farr, B. M. ( 1996; ). Central venous catheter-related infections: a review. Nutrition 12, 208–213.[CrossRef]
    [Google Scholar]
  2. Aronson, M. D. & Bor, D. H. ( 1987; ). Blood cultures. Ann Intern Med 106, 246–253.[CrossRef]
    [Google Scholar]
  3. Bates, D. W., Goldman, L. & Lee, T. H. ( 1991; ). Contaminant blood cultures and resource utilization. The true consequences of false-positive results. JAMA 265, 365–369.[CrossRef]
    [Google Scholar]
  4. Beutz, M., Sherman, G., Mayfield, J., Fraser, V. J. & Kollef, M. H. ( 2003; ). Clinical utility of blood cultures drawn from central vein catheters and peripheral venipuncture in critically ill medical patients. Chest 123, 854–861.[CrossRef]
    [Google Scholar]
  5. Bozzetti, F., Terno, G., Bonfanti, G. & Gallus, G. ( 1984; ). Blood culture as a guide for the diagnosis of central venous catheter sepsis. J Parenter Enteral Nutr 8, 396–398.[CrossRef]
    [Google Scholar]
  6. Bryant, J. K. & Strand, C. L. ( 1987; ). Reliability of blood cultures collected from intravascular catheter versus venipuncture. Am J Clin Pathol 88, 113–116.
    [Google Scholar]
  7. DesJardin, J. A., Falagas, M. E., Ruthazer, R., Griffith, J., Wawrose, D., Schenkein, D., Miller, K. & Snydman, D. R. ( 1999; ). Clinical utility of blood cultures drawn from indwelling central venous catheters in hospitalized patients with cancer. Ann Intern Med 131, 641–647.
    [Google Scholar]
  8. Everts, R. J., Vinson, E. N., Adholla, P. O. & Reller, L. B. ( 2001; ). Contamination of catheter-drawn blood cultures. J Clin Microbiol 39, 3393–3394.[CrossRef]
    [Google Scholar]
  9. Felices, F. J., Hernandez, J. L., Ruiz, J., Meseguer, J., Gomez, J. A. & Molina, E. ( 1979; ). Use of the central venous pressure catheter to obtain blood cultures. Crit Care Med 7, 78–79.[CrossRef]
    [Google Scholar]
  10. Juste, R. N., Hannan, M., Glendenning, A., Azadian, B. & Soni, N. ( 2000; ). Central venous blood culture: a useful test for catheter colonisation? Intensive Care Med 26, 1373–1375.[CrossRef]
    [Google Scholar]
  11. Krueger, K. E., Carrico, C. J., Detter, J. C., Raisys, V. A. & Underhill, S. L. ( 1981; ). The reliability of laboratory data from blood samples collected through pulmonary artery catheters. Arch Pathol Lab Med 105, 343–344.
    [Google Scholar]
  12. Lange, B. J., Weiman, M., Feuer, E. J., Jakobowski, D., Bilodeau, J., Stallings, V. A., Hirschl, R., Bell, L. M., Harper, J. & Cnaan, A. ( 1997; ). Impact of changes in catheter management on infectious complications among children with central venous catheters. Infect Control Hosp Epidemiol 18, 326–332.[CrossRef]
    [Google Scholar]
  13. Levin, P. D., Hersch, M., Rudensky, B. & Yinnon, A. M. ( 2000; ). The use of the arterial line as a source for blood cultures. Intensive Care Med 26, 1350–1354.[CrossRef]
    [Google Scholar]
  14. Martinez, J. A., DesJardin, J. A., Aronoff, M., Supran, S., Nasraway, S. A. & Snydman, D. R. ( 2002; ). Clinical utility of blood cultures drawn from central venous or arterial catheters in critically ill surgical patients. Crit Care Med 30, 7–13.[CrossRef]
    [Google Scholar]
  15. McBryde, E. S., Tilse, M. & McCormack, J. ( 2005; ). Comparison of contamination rates of catheter-drawn and peripheral blood cultures. J Hosp Infect 60, 118–121.[CrossRef]
    [Google Scholar]
  16. O'Grady, N. P., Alexander, M., Dellinger, E. P., Gerberding, J. L., Heard, S. O., Maki, D. G., Masur, H., McCormick, R. D., Mermel, L. A. & other authors ( 2002; ). Guidelines for the prevention of intravascular catheter-related infections. Centers for Disease Control and Prevention. MMWR Recomm Rep 51, 1–29.
    [Google Scholar]
  17. Raad, I. I. ( 1994; ). The pathogenesis and prevention of central venous catheter-related infections. Middle East J Anesthesiol 12, 381–403.
    [Google Scholar]
  18. Tabriz, M. S., Riederer, K., Baran, J., Jr & Khatib, R. ( 2004; ). Repeating blood cultures during hospital stay: practice pattern at a teaching hospital and a proposal for guidelines. Clin Microbiol Infect 10, 624–627.[CrossRef]
    [Google Scholar]
  19. Tafuro, P., Colbourn, D., Gurevich, I., Schoch, P., Wachs, H., Krystofiak, S. & Cunha, B. A. ( 1986; ). Comparison of blood cultures obtained simultaneously by venepuncture and from vascular lines. J Hosp Infect 7, 283–288.[CrossRef]
    [Google Scholar]
  20. Tokars, J. I. ( 2004; ). Predictive value of blood cultures positive for coagulase-negative staphylococci: implications for patient care and health care quality assurance. Clin Infect Dis 39, 333–341.[CrossRef]
    [Google Scholar]
  21. Tonnesen, A., Peuler, M. & Lockwood, W. R. ( 1976; ). Cultures of blood drawn by catheters vs venipuncture. JAMA 235, 1877 [CrossRef]
    [Google Scholar]
  22. Vaisanen, I. T., Michelsen, T., Valtonen, V. & Makelainen, A. ( 1985; ). Comparison of arterial and venous blood samples for the diagnosis of bacteremia in critically ill patients. Crit Care Med 13, 664–667.
    [Google Scholar]
  23. Weinstein, M. C. & Fineberg, H. V. ( 1980; ). Clinical Decision Analysis. Philadelphia, PA: W. B. Saunders.
  24. Wormser, G. P., Onorato, I. M., Preminger, T. J., Culver, D. & Martone, W. J. ( 1990; ). Sensitivity and specificity of blood cultures obtained through intravascular catheters. Crit Care Med 18, 152–156.[CrossRef]
    [Google Scholar]
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