• Medicina intensiva · Apr 2015

    Randomized Controlled Trial Comparative Study

    Blood culture differential time to positivity enables safe catheter retention in suspected catheter-related bloodstream infection: a randomized controlled trial.

    • Caroline Sabatier, Xaime García, Ricard Ferrer, Montserrat Duarte, Montserrat Colomina, Dolores Alcaráz, Dionisia Fontanals, and Jordi Vallés.
    • Service de Réanimation, Centre Hospitalier de Mont-de-Marsan, France. Electronic address: sabatier.caroline@gmail.com.
    • Med Intensiva. 2015 Apr 1; 39 (3): 135-41.

    ObjectiveTo evaluate the clinical usefulness and safety of the differential-time-to-positivity (DTP) method for managing the suspicion of catheter-related bloodstream infection (CR-BSI) in comparison with a standard method that includes catheter removal in critically ill patients.Methods DesignA prospective randomized study was carried out.SettingA 16-bed clinical-surgical ICU (July 2007-February 2009).InterventionsPatients were randomly assigned to one of two groups at the time CR-BSI was suspected. In the standard group, a standard strategy requiring catheter withdrawal was used to confirm or rule out CR-BSI. In the DTP group, DTP without catheter withdrawal was used to confirm or rule out CR-BSI.Measurementsclinical and microbiological data, CR-BSI rates, unnecessary catheter removals, and complications due to new puncture or to delays in catheter removal.ResultsTwenty-six patients were analyzed in each group. In the standard group, 6 of 37 suspected episodes of CR-BSI were confirmed and 5 colonizations were diagnosed. In the DTP group, 5 of 26 suspected episodes of CR-BSI were confirmed and four colonizations were diagnosed. In the standard group, all catheters (58/58, 100%) were removed at the time CR-BSA was suspected, whereas in the DTP group, only 13 catheters (13/41, 32%) were removed at diagnosis, and 10 due to persistent septic signs (10/41, 24%). In cases of confirmed CR-BSI, there were no differences between the two groups in the evolution of inflammatory parameters during the 48hours following the suspicion of CR-BSI.ConclusionsIn critically ill patients with suspected CR-BSI, the DTP method makes it possible to keep the central venous catheter in place safely.Copyright © 2013 Elsevier España, S.L.U. and SEMICYUC. All rights reserved.

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