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Clinical Utility of Blood Cultures Drawn from Indwelling Central Venous Catheters in Hospitalized Patients with Cancer

Jeffrey A. DesJardin, MD; Matthew E. Falagas, MD, MSc; Robin Ruthazer, MPH; John Griffith, PhD; Dorothy Wawrose, MD; David Schenkein, MD; Kenneth Miller, MD; and David R. Snydman, MD
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From New England Medical Center and Tufts University School of Medicine, Boston, Massachusetts.

Presented in part at the 37th Interscience Conference on Antimicrobial Agents and Chemotherapy, September 1997, Toronto, Canada.

Grant Support: In part by National Research Service Award T32-AI07329 from the National Institutes of Health.

Acknowledgments: The authors thank Roselia Martinez for assistance with manuscript preparation.

Requests for Reprints: David R. Snydman, MD, Box 238, New England Medical Center, 750 Washington Street, Boston, MA 02111; e-mail, david.snydman@es.nemc.org. For reprint orders in quantities exceeding 100, please contact the Reprints Coordinator; phone, 215-351-2657; e-mail, reprints@mail.acponline.org.

Current Author Addresses: Dr. DesJardin: Western Infectious Disease Consultants, 7760 West 38th Avenue, Suite 290, Wheat Ridge, CO 80033.

Dr. Falagas: Vas. Sofias Avenue 105-107, Athens 11521, Greece.

Ms. Ruthazer and Dr. Griffith: New England Medical Center, 750 Washington Street, Box 063, Boston, MA 02111.

Dr. Wawrose: 2115 Portland Avenue, #312, Nashville, TN 37212.

Dr. Schenkein: New England Medical Center, 750 Washington Street, Box 245, Boston, MA 02111.

Dr. Miller; New England Medical Center, 750 Washington Street, Box 542, Boston, MA 02111

Dr. Snydman: New England Medical Center 750 Washington Street, Box 238, Boston, MA 02111.

Ann Intern Med. 1999;131(9):641-647. doi:10.7326/0003-4819-131-9-199911020-00002
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Long-term, indwelling central venous catheters are indispensable in the management of patients with cancer. Common indications for the placement of these catheters in patients with cancer include poor peripheral access; frequent need to administer blood products or antibiotics or to draw blood; continuous infusion of chemotherapeutic agents; a prolonged treatment course; and use of vesicant drugs (1). The convenience of these catheters makes them an obvious choice for frequent blood draws, and the reliability of routine laboratory data obtained from blood drawn through central venous catheters has been demonstrated (2). However, the American College of Physicians guidelines (3) and expert opinion (4) discourage the use of intravascular devices to obtain blood for culture. Such statements have evolved because of concern that contamination rates will increase (that is, specificity will decrease) when blood cultures are obtained through intravascular devices, leading to prolonged hospitalization and increased cost (5), and concern about possible line contamination. Results from studies supporting (67) or refuting (811) such concerns have been inconsistent. Furthermore, none of these studies were blinded, and all lacked a clear “gold standard” definition of true bacteremia.

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Grahic Jump Location
Comparison of positive (squares) and negative (circles) predictive value of blood drawn for culture by peripheral venipuncture (white squares) or through an indwelling central venous catheter (black circles) using sensitivity and specificity for each test result over a prevalence range of bacteremia.

The vertical line represents the prevalence of 8% observed in the study.

Grahic Jump Location




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Summary for Patients

Are Blood Tests for Infection Accurate If They are Taken from Patients' Intravenous Lines?

The summary below is from the full report titled “Clinical Utility of Blood Cultures Drawn from Indwelling Central Venous Catheters in Hospitalized Patients with Cancer.” It is in the 2 November 1999 issue of Annals of Internal Medicine (volume 131, pages 641-647). The authors are J.A. DesJardin, M.E. Falagas, R. Ruthazer, J. Griffith, D. Wawrose, D. Schenkein, K. Miller, and D.R. Snydman.


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