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Journal of Clinical Microbiology, July 2008, p. 2222-2226, Vol. 46, No. 7
0095-1137/08/$08.00+0     doi:10.1128/JCM.00214-08
Copyright © 2008, American Society for Microbiology. All Rights Reserved.

Time to Blood Culture Positivity as a Marker for Catheter-Related Candidemia{triangledown}

Ronen Ben-Ami,1,5* Miriam Weinberger,3,5 Ruth Orni-Wasserlauff,1,2,5 David Schwartz,2 Avraham Itzhaki,3 Tzipora Lazarovitch,4 Edna Bash,2 Yuval Aharoni,2 Irina Moroz,1 and Michael Giladi1,2,5

Infectious Diseases Unit,1 Microbiology Laboratory, Tel Aviv Sourasky Medical Center, Tel Aviv,2 Infectious Diseases Unit,3 Microbiology Laboratory, Assaf Harofeh Medical Center, Zerifin,4 Sackler School of Medicine, Tel Aviv University, Ramat Aviv, Israel5

Received 2 February 2008/ Returned for modification 24 March 2008/ Accepted 5 May 2008

Candida spp. are important causes of nosocomial bloodstream infections. Around 80% of patients with candidemia have an indwelling central venous catheter (CVC). Determining whether the CVC is the source of candidemia has implications for patient management. We assessed whether the time to detection of Candida species in peripheral blood (time to positivity [TTP]) can serve as a marker for catheter-related candidemia. Prospective surveillance of Candida bloodstream infection was conducted in two medical centers. TTP was recorded by the BacT/Alert automated system. Sixty-four candidemia episodes were included. Fifty patients (78%) had an indwelling CVC. Thirteen patients (20.3%) had definite catheter-related candidemia. TTP was shorter for definite catheter-related candidemia (17.3 ± 2 h) than that for candidemia from other sources (38.2 ± 3 h; P < 0.001). A TTP cutoff of 30 h was 100% sensitive and 51.4% specific for catheter-related candidemia (area under the receiver-operator characteristic curve of 0.76). We conclude that TTP in peripheral blood is a sensitive but nonspecific marker for catheter-related candidemia and that a TTP of more than 30 h can help exclude an intravascular catheter as the possible source of candidemia.

* Corresponding author. Present address: Infectious Disease Unit, MD Anderson Cancer Center, 1515 Holcombe Blvd., Box 1460, Houston, TX 77030. Phone: (713) 745-1371. Fax: (713) 745-6839. E-mail: rbenami{at}mdanderson.org

{triangledown} Published ahead of print on 14 May 2008.

Journal of Clinical Microbiology, July 2008, p. 2222-2226, Vol. 46, No. 7
0095-1137/08/$08.00+0     doi:10.1128/JCM.00214-08
Copyright © 2008, American Society for Microbiology. All Rights Reserved.





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