PDF(Pubmed)
Abstract：
UNASSIGNED: Nosocomial bloodstream infections associated with intravascular catheters pose significant financial burden, morbidity, and mortality. There is much debate about whether or not blood cultures should be drawn through central venous catheters, and while guidelines advocate for catheter-drawn cultures when catheter infection is suspected, there is variable practice in this regard.
UNASSIGNED: We performed a retrospective cohort study assessing episodes of positive catheter-drawn blood cultures with concomitant negative percutaneously-drawn cultures in tertiary care hospitals in the United States and Spain.
UNASSIGNED: We identified 143 episodes in 122 patients meeting inclusion criteria. Thirty percent of such episodes revealed growth of potential pathogens such as Staphylococcus aureus. Overall, 21% of follow-up percutaneously-drawn blood cultures obtained within 48 hours revealed growth of the same microbe after an episode of positive catheter-drawn blood cultures with negative concomitant percutaneously-drawn cultures (33% when potential pathogens were isolated; 16% when common skin contaminants were isolated). Patients with cultures growing pathogenic organisms were more likely to receive targeted antimicrobial therapy and have their catheters removed sooner.
UNASSIGNED: Many episodes of positive catheter-drawn blood cultures with concomitant negative percutaneously-drawn cultures lead to growth from percutaneously-drawn follow-up blood cultures. Thus, such initial discordant results should not be disregarded. Our findings advocate for a nuanced approach to blood culture interpretation, emphasizing the value of catheter-drawn blood cultures in clinical decision making and management.
UNASSIGNED: We performed a retrospective cohort study assessing episodes of positive catheter-drawn blood cultures with concomitant negative percutaneously-drawn cultures in tertiary care hospitals in the United States and Spain.
UNASSIGNED: We identified 143 episodes in 122 patients meeting inclusion criteria. Thirty percent of such episodes revealed growth of potential pathogens such as Staphylococcus aureus. Overall, 21% of follow-up percutaneously-drawn blood cultures obtained within 48 hours revealed growth of the same microbe after an episode of positive catheter-drawn blood cultures with negative concomitant percutaneously-drawn cultures (33% when potential pathogens were isolated; 16% when common skin contaminants were isolated). Patients with cultures growing pathogenic organisms were more likely to receive targeted antimicrobial therapy and have their catheters removed sooner.
UNASSIGNED: Many episodes of positive catheter-drawn blood cultures with concomitant negative percutaneously-drawn cultures lead to growth from percutaneously-drawn follow-up blood cultures. Thus, such initial discordant results should not be disregarded. Our findings advocate for a nuanced approach to blood culture interpretation, emphasizing the value of catheter-drawn blood cultures in clinical decision making and management.
摘要：
■与血管内导管相关的医院血流感染造成重大经济负担，发病率，和死亡率。关于是否应该通过中心静脉导管抽取血液培养物存在很多争论，虽然指南提倡在怀疑导管感染时进行导管培养，在这方面有不同的做法。
我们进行了一项回顾性队列研究，评估了美国和西班牙三级医院导管抽取血培养阳性和经皮抽取血培养阴性的事件。
■我们确定122例符合纳入标准的患者中有143例发作。30%的此类事件显示潜在病原体如金黄色葡萄球菌的生长。总的来说,在48小时内获得的经皮穿刺血液培养物中，有21％的随访显示，在导管穿刺血液培养阳性和经皮穿刺培养阴性后，同一微生物的生长（分离出潜在病原体时为33％；分离出常见皮肤污染物时为16％）。培养出病原微生物的患者更有可能接受靶向抗菌治疗，并更快地拔除导管。
■许多导管抽取的血培养阳性和伴随的经皮抽取的血培养阴性的事件导致经皮抽取的后续血培养物的生长。因此，这种最初不一致的结果不应该被忽视。我们的发现主张对血液文化的解释采取微妙的方法，强调导管抽取血培养在临床决策和管理中的价值。
我们进行了一项回顾性队列研究，评估了美国和西班牙三级医院导管抽取血培养阳性和经皮抽取血培养阴性的事件。
■我们确定122例符合纳入标准的患者中有143例发作。30%的此类事件显示潜在病原体如金黄色葡萄球菌的生长。总的来说,在48小时内获得的经皮穿刺血液培养物中，有21％的随访显示，在导管穿刺血液培养阳性和经皮穿刺培养阴性后，同一微生物的生长（分离出潜在病原体时为33％；分离出常见皮肤污染物时为16％）。培养出病原微生物的患者更有可能接受靶向抗菌治疗，并更快地拔除导管。
■许多导管抽取的血培养阳性和伴随的经皮抽取的血培养阴性的事件导致经皮抽取的后续血培养物的生长。因此，这种最初不一致的结果不应该被忽视。我们的发现主张对血液文化的解释采取微妙的方法，强调导管抽取血培养在临床决策和管理中的价值。
