Medizinische Universität Graz Austria/Österreich - Forschungsportal - Medical University of Graz
Gewählte Publikation:
Rabensteiner, J.
Biphasic peptide nucleic acid fluorescence in situ hybridization and acridine orange leucocyte cytospin staining for anticipative diagnosis of central venous catheter related bloodstream infections
Doktoratsstudium der Medizinischen Wissenschaft; Humanmedizin; [ Dissertation ] Medical University of Graz; 2014. pp.
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- Autor*innen der Med Uni Graz:
- Rabensteiner Jasmin
- Betreuer*innen:
- Kessler Harald
- Krause Robert
- Raggam Reinhard Bernd
- Altmetrics:
- Abstract:
- Background and objectives: Currently, routine diagnostics for detection of catheter-related bloodstream infection (CRBSI) is performed only in patients with clinical signs of infection. This prospective trial was undertaken to evaluate a possible value of screening for CRBSI in hemodialysis (HD) and hematooncological (HO) patients with central venous catheters (CVCs) in situ. Methods: In this study, 237 patients (55 HD, 182 HO) with 402 (60 HD, 342 HO) catheter periods were investigated. Three times per week EDTA blood was drawn from both lumina in HD patients and daily from the distal catheter lumen in HO patients prior to connection to hemodialysis (HD) or routine blood sampling (HO). Screening for CRBSI was performed with the universal PNA FISH test and compared to the AOLC stain. Additionally, blood samples were cultured quantitatively on chocolate agar. If CRBSI was clinically suspected, routine investigations were performed. Attending physicians were blinded to the screening results. Results: Twenty CRBSI cases (2 HD; 17 HO) were detected by routine investigations resulting in a CRBSI rate of 1.9/1000 catheter days (HD 0.5/1000; HO 2.6/1000). In both of the HD CRBSI patients, infection could be anticipated 7 and 8 days before routine diagnosis by positive universal PNA FISH test and AOLC stain. In the HO patients, 2 CRBSIs could be anticipated by positive universal PNA FISH test and 5 by AOLC stain 2 days prior to routine diagnosis. Ten patients showed positive screening results but no clinical signs of CRBSI. The sensitivity and specificity of the universal PNA FISH test were 100% HD/12% HO and 95% HD/98% HO, the PPV and NPV were 40% HD/22% HO and 100% HD/95% HO, respectively. The sensitivity and specificity of the AOLC screening were 100% HD/29% HO and 96% HD/97% HO, the PPV and NPV were 50% HD/33% HO and 100% HD/97% HO, respectively. Conclusion: Screening for CRBSI in HD patients seems to be useful but due to the small number of CRBSIs, further studies are needed. In HO patients, screening for CRBSI does not appear to be a useful and cost-efficient tool. Reasons for false negative results might include origin of CRBSIs from other lumina not sampled for screening. False positive results might origin from catheter colonization without subsequent spread of microorganisms into the peripheral bloodstream.