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Semiquantitative Culture of Subcutaneous Segment for Conservative Diagnosis of Intravascular Catheter-Related InfectionInfectious Diseases and Clinical Microbiology Department, Alcalá de Henares University, Ramón y Cajal Hospital, Madrid, Spain, jesus.fortun{at}tyt.eurociber.es
Infectious Diseases and Clinical Microbiology Department, Alcalá de Henares University, Ramón y Cajal Hospital, Madrid, Spain
Preventive Medicine Department, Alcalá de Henares University, Ramón y Cajal Hospital, Madrid, Spain
Infectious Diseases and Clinical Microbiology Department, Alcalá de Henares University, Ramón y Cajal Hospital, Madrid, Spain
Infectious Diseases and Clinical Microbiology Department, Alcalá de Henares University, Ramón y Cajal Hospital, Madrid, Spain
Infectious Diseases and Clinical Microbiology Department, Alcalá de Henares University, Ramón y Cajal Hospital, Madrid, Spain
Infectious Diseases and Clinical Microbiology Department, Alcalá de Henares University, Ramón y Cajal Hospital, Madrid, Spain
Infectious Diseases and Clinical Microbiology Department, Alcalá de Henares University, Ramón y Cajal Hospital, Madrid, Spain
Background: Sensitivity and negative predictive values of combined surface cultures (skin and hub) are high in the presumptive diagnosis of catheter-related infection, but specificity and PPVs are poor. The purpose of the study was to evaluate the yield of the semiquantitative culture of the subcutaneous segment in the diagnosis of colonization of the catheter tip without removal of the catheter. Methods: A prospective study was performed in 124 nontunneled central venous catheters that were removed because of suspected infection or the end of therapy. Catheter colonization was considered if >15 colony-forming units (CFU) in the roll procedure or > 1000 CFU in the quantitative Cleri procedure were recovered from the tip cultures ("gold standard"). Before removing the catheter, a semiquantitative culture of skin surrounding the point of insertion, a semiquantitative culture of the subcutaneous segment (after removing the catheter only 2 cm), a semiquantitative cultures of the hub, and a pareated quantitative blood culture were performed. Receiver operating characteristic curves were calculated to estimate the cutoff points, and a culture was considered positive when CFUs were
Journal of Parenteral and Enteral Nutrition, Vol. 24, No. 4,
210-214 (2000) This article has been cited by other articles:
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61%; however, specificity and positive predictive values (PPVs) of subcutaneous segment cultures were significantly higher than skin cultures (94% and 88.5% us 71.6% (p = .001) and 62% (p = .014), respectively). Sensitivity of the combined skin and hub cultures and of the combined subcutaneous segment and hub cultures were similar: 86.2% and 84.3%, respectively; however, specificity and PPVs of this latter combination were significantly higher than former: 82% and 78.1% us 59.7% (p = .008) and 61.9% (p = .07), respectively. The likelihood ratio of a positive test for the combined subcutaneous segment and hub culture was 4.68, and only 2.13 for the combined skin and hub culture. Conclusions: These results indicate that the combined subcutaneous segment and hub culture constitutes an easy, effective procedure for the conservative diagnosis of catheter colonization. ( Journal of Parenteral and Enteral Nutrition 24:210-214, 2000) 
