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Journal of Clinical Microbiology, January 2003, p. 118-123, Vol. 41, No. 1
0095-1137/03/$08.00+0     DOI: 10.1128/JCM.41.1.118-123.2003
Copyright © 2003, American Society for Microbiology. All Rights Reserved.

Bloodstream Infection in Neutropenic Cancer Patients Related to Short-Term Nontunnelled Catheters Determined by Quantitative Blood Cultures, Differential Time to Positivity, and Molecular Epidemiological Typing with Pulsed-Field Gel Electrophoresis

Harald Seifert,1* Oliver Cornely,2 Kerstin Seggewiss,1 Mathias Decker,1 Danuta Stefanik,1 Hilmar Wisplinghoff,1 and Gerd Fätkenheuer2

Institute of Medical Microbiology, Immunology and Hygiene,1 Department of Internal Medicine, University of Cologne, Cologne, Germany2

Received 26 August 2002/ Returned for modification 24 September 2002/ Accepted 9 October 2002

To determine the rate of catheter-related bloodstream infection (CRBSI) among cases of primary bloodstream infection (BSI) in febrile neutropenic cancer patients with short-term nontunnelled catheters, quantitative paired blood cultures (Isolator) from the central venous catheter (CVC) and peripheral vein were obtained between November 1999 and January 2001. Bactec blood culture bottles were obtained to determine the differential time to positivity (DTP). CRBSI was defined as a quantitative blood culture ratio of >5:1 (CVC versus peripheral) with proven identity of isolates from positive peripheral and CVC blood cultures as confirmed by pulsed-field gel electrophoresis. Forty-nine episodes of primary BSI were detected among 235 cancer patients with febrile neutropenia. Of these, 18 episodes (37%) were CRBSI and 31 (63%) were BSI with an unknown portal of entry. Coagulase-negative staphylococci were present in nine cases of CRBSI (50%). The identity of isolates from peripheral and CVC blood cultures was confirmed in all cases. Earlier positivity (>2 h) of CVC-drawn versus peripheral blood cultures was observed in 18 of 22 CRBSI-associated blood cultures (sensitivity, 82%; specificity, 88%; positive predictive value, 75%; negative predictive value, 92%). In summary, CRBSI accounted for 37% of cases of primary BSI in this population of neutropenic cancer patients. DTP compares favourably with quantitative blood cultures for the diagnosis of CRBSI and may be particularly useful for patients in whom catheter salvage is highly desirable.

* Corresponding author. Mailing address: Institute of Medical Microbiology, Immunology and Hygiene, University of Cologne, Goldenfelsstr. 19-21, 50935 Cologne, Germany. Phone: 0049 221 4783009. Fax: 0049 221 4783067. E-mail: harald.seifert{at}uni-koeln.de.

Journal of Clinical Microbiology, January 2003, p. 118-123, Vol. 41, No. 1
0095-1137/03/$08.00+0     DOI: 10.1128/JCM.41.1.118-123.2003
Copyright © 2003, American Society for Microbiology. All Rights Reserved.



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