DIAGNOSIS OF VASCULAR CATHETER-RELATED BLOOD-STREAM INFECTION - A METAANALYSIS

Catheter-related bloodstream infections increased in incidence during the past decade, causing significant morbidity, mortality, and excess hospital costs, Absence of inflammation at the catheter site in most c ases makes clinical diagnosis uncertain, The relative accuracy and cos t-effectiveness of different microbiologic tests for confirming that b loodstream infection is catheter related have remained unclear, A meta -analysis of published studies was conducted regarding the accuracy of diagnostic test methods using pooled sensitivity and specificity and summary receiver operating characteristic (ROC) curve analysis, The co st for each test was estimated by methods published by the College of American Pathologists. Costs of catheter replacement and antibiotic th erapy for false positive results were included in the cost per accurat e test result, Twenty-two studies evaluating six test methods met incl usion criteria for the meta-analysis. Accuracy increased in ROC analys is for catheter segment cultures with increasing quantitation (P = 0.0 3) (i.e., quantitative > semiquantitative > qualitative) largely due t o an increase in specificity. The highest Youden index (mean = 0.85) w as observed with quantitative catheter segment culture, the only metho d,vith pooled sensitivity and specificity above 90%. For blood culture methods, there was no statistically significant trend toward increase d accuracy. The unpaired quantitative catheter blood culture offered t he lowest cost per accurate test result but was only 78% sensitive, In conclusion, quantitative culture was the most accurate method for cat heter segment culture, and unpaired quantitative catheter blood cultur e was the single most cost-effective test, especially for long-term ca theters.