EVALUATION OF A NOVEL ENDOLUMINAL BRUSH METHOD FOR IN-SITU DIAGNOSIS OF CATHETER-RELATED SEPSIS

Aims-To determine the accuracy of a novel endoluminal brush method for the diagnosis of catheter related sepsis (CRS), which is performed in situ and hence does not require line sacrifice. Methods-230 central v enous catheters in 216 patients were examined prospectively for eviden ce of CRS or colonisation using an endoluminal brush method in conjunc tion with peripheral blood cultures. The results were compared with th ose obtained using methods that require line sacrifice: extraluminal s ampling (Maki roll) or endoluminal sampling (modified Cleri flush) of microorganisms. Results-Only 16% of 128 patients suspected clinically of having line associated infection were confirmed as having CRS. In a ddition, 2 of 102 patients not suspected of having line associated inf ection had CRS. Line colonisation was apparent in approximately twice as many catheters using the Maki roll criteria (92%) compared with eit her the endoluminal brush (43%) or Cleri flush (43%). Furthermore, col onised catheters sampled using the Maki roll technique yielded mixed g rowth twice as often as when examined by endoluminal methods (17 and 8 cases, respectively). It was rare to detect either only endoluminal ( 4 of 22 episodes) or extraluminal (1 of 22 episodes) microorganisms in cases of CRS. In contrast, catheters defined as being colonised most frequently (59% of episodes) yielded only significant extraluminal gro wth. Only one case of CRS (5%) would have been ''missed'' if lines yie lding a negative result from endoluminal brush sampling had been left in situ. Conversely, four episodes of CRS (18%) would not have been di agnosed by relying on extraluminal sampling alone. Conclusions-Diagnos is of CRS by the endoluminal brush method can be achieved without line sacrifice and is more sensitive (95%) and specific (84%) than extralu minal sampling of the catheter tip by the Maki roll technique (82% and 66%, respectively).