Introduction: Intravascular catheters are crucial in modern medical practice, particularly in intensive
care units (ICUs). However, vascular catheter-related bloodstream infections (CRBSIs) have become a leading cause
of health-care-associated bloodstream infections and are associated with substantial morbidity and mortality. Aim of
the work: to determine whether the Gram stain-acridine orange leucocyte cytospin (AOLC) test could offer
accuracy comparable to other methods for the diagnosis of catheter-related blood stream infection and to avoid
inconvenient, unnecessary and costly central venous catheter removal. Material and methods: This study included
36 patients with central venous catheterization. All patients with CVC were clinically suspected to have CR-BSI, as
suggested by their physicians. They were 24 males and 12 females with their ages ranging between 20 years and 68
years with the mean age 51.3 ± 14.9 years. The samples were subjected to two major diagnostic strategies: the first
implemented catheter sparing approach, while the other strategy required catheter removal. Catheter sparing
diagnostic methods included paired quantitative blood cultures, pour-plate technique and acridine orange leukocyte
cytospin/Gram test (AOLC/G test), while methods that required device removal were semiquantitative catheter
segment culture (roll- plate method) and quantitative catheter segment culture (tip-flush method). Results: Taking
the roll- plate technique as the reference method, there was fair agreement (66.7%) between the results of pour plate
and roll plate techniques (kappa=0.226), there was moderate agreement between the results of paired quantitative
blood culture (83.3%), tip flush method (83.3%) and AOLC / G (80.6%) and the reference method (kappa=0.429,
0.429 ,0.40 respectively). The diagnostic validity tests for AOLC showed that the specificity of AOLC was 100%
and the sensitivity was 78.8%. Conclusion: From this study, it was concluded that the Gram stain-AOLC test is a
simple, rapid, sensitive and specific test that could be used as a first line screening test for the in situ diagnosis of
CRBSI. This policy can prevent the unnecessary removal of uninfected catheters and significantly extends the life
span of catheters and lowers the risks and costs of mechanical complications associated with new catheter
placement.
[Yasser M. Ismail and Sahar M. Fayed. Evaluation of Different methods for Diagnosis of Catheter Related
Blood Stream Infection. Life Sci J 2013;10(1):1915-1923] (ISSN:1097-8135). http://www.lifesciencesite.com. 275 |
