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Differential Time to Positivity: A Useful Method for Diagnosing Catheter-Related Bloodstream Infections

Issam Raad, MD; Hend A. Hanna, MD, MPH; Badie Alakech, MD; Ioannis Chatzinikolaou, MD; Marcella M. Johnson, MS; and Jeffrey Tarrand, MD
[+] Article and Author Information

From University of Texas M.D. Anderson Cancer Center, Houston, and Texas Tech University Medical School, Lubbock, Texas.


Acknowledgment: The authors thank Dr. Lyle David Broemeling, Professor, Department of Biostatistics, University of Texas M.D. Anderson Cancer Center, Houston, Texas, for statistical help and expertise.

Potential Financial Conflicts of Interest: None disclosed.

Requests for Single Reprints: Hend Hanna, MD, Department of Infectious Diseases, Infection Control and Employee Health, University of Texas M. D. Anderson Cancer Center, 1515 Holcombe Boulevard (Unit 402), Houston, TX 77030; e-mail, hhanna@mdanderson.org.

Current Author Addresses: Drs. Raad, Hanna, Alakech, Chatzinikolaou, and Tarrand and Ms. Johnson: Department of Infectious Diseases, Infection Control and Employee Health, University of Texas M. D. Anderson Cancer Center, 1515 Holcombe Boulevard (Unit 402), Houston, TX 77030.

Author Contributions: Conception and design: I. Raad, H.A. Hanna.

Analysis and interpretation of the data: I. Raad, H.A. Hanna.

Drafting of the article: I. Raad, H.A. Hanna.

Critical revision of the article for important intellectual content: I. Raad, H.A. Hanna.

Final approval of the article: I. Raad, H.A. Hanna, B. Alakech, I. Chatzinikolaou, M.M. Johnson, J. Tarrand.

Provision of study materials or patients: J. Tarrand.

Statistical expertise: H.A. Hanna, M.M. Johnson.

Collection and assembly of data: H.A. Hanna, B. Alakech, I. Chatzinikolaou.


Ann Intern Med. 2004;140(1):18-25. doi:10.7326/0003-4819-140-1-200401060-00007
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Between September 1999 and November 2000, we analyzed 6138 pairs of simultaneously drawn blood cultures. Of these, 5128 pairs (83.5%) had negative central venous catheter blood cultures and peripheral vein blood cultures, 603 pairs (9.8%) had positive central venous catheter blood cultures and negative peripheral vein blood cultures, and 191 pairs (3.1%) had negative central venous catheter blood cultures and positive peripheral vein blood cultures. We excluded these 5922 pairs of cultures from the analysis because the study's objective was to evaluate differential time to positivity when both cultures were positive. Another 216 pairs of cultures (3.5%) had positive results on both the central venous catheter blood cultures and peripheral vein blood cultures. Of these, we excluded 25 pairs because the central venous catheter blood cultures and peripheral vein blood cultures had different organisms. We included in the analysis the remaining 191 pairs, which were positive simultaneous blood cultures that grew the same organism (Figure 1).

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Figures

Grahic Jump Location
Figure 1.
Flow diagram of blood cultures during the study period.

CBC = central blood culture; DTP = differential time to positivity; PBC = percutaneous blood culture.

Grahic Jump Location
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Figure 2.
A receiver-operating characteristic curve showing the accuracy of differential time to positivity of 120 minutes or more as a diagnostic test for catheter-related bloodstream infection.
Grahic Jump Location

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Summary for Patients

Diagnosing Catheter-Related Bloodstream Infections

The summary below is from the full report titled “Differential Time to Positivity: A Useful Method for Diagnosing Catheter-Related Bloodstream Infections.” It is in the 6 January 2004 issue of Annals of Internal Medicine (volume 140, pages 18-25). The authors are I. Raad, H.A. Hanna, B. Alakech, I. Chatzinikolaou, M.M. Johnson, and J. Tarrand.

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