Reviewed by Cindy Noyes, MD, University of Vermont Medical Center, Burlington, VT
When pathogenic organisms are recovered, positive central line cultures may predict subsequent bacteremia in a significant minority of patients.
Outcomes of patients with concurrent positive central line cultures and negative percutaneous cultures were evaluated at 2 institutions in 2 countries. The primary aim was to identify if the positive central line cultures became clinically significant, suggesting that central line cultures could allow for earlier intervention. This was a retrospective cohort including patients from a hospital in the US and Spain. Inclusion criteria included adults hospitalized between January 2010 through December 2022, who had at least 1 positive central line culture and negative peripheral culture within 12 hours of one another (if more than one instance, counted as distinct episodes). One hundred and forty-three episodes were identified in 122 patients. At the time of collection, 65% of patients were reported to have fever and 26% met SIRS criteria. Twenty-one percent of peripheral cultures drawn within 48 hours of initial central line positive and peripheral culture negative revealed growth of the same organism, though this was higher (33%) when pathogenic organisms were recovered. Patients with isolation of pathogenic organism were more likely to have their central line removed, receive targeted systemic antibiotics, antibiotic lock treatment and Infectious Disease consults. The authors suggest this supports the theory that luminal colonization of a central line may be followed by seeding the blood stream. More importantly, positive central line cultures which recover pathogenic organisms may be clinically relevant even with discordant negative peripheral cultures and could offer an earlier opportunity for intervention.
Reference:
Wales, R et al. Impact of catheter-drawn blood cultures on patient management: A multicenter, retrospective cohort study. OFID. June 2024.