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Time to and differential time to blood culture positivity for assessing catheter-related yeast fungaemia: A longitudinal, 7-year study in a single university hospital.
Mycoses 2019M

Abstract

BACKGROUND

Time to positivity (TTP) and differential time to positivity (DTTP) between central and peripheral blood cultures are commonly used for bacteraemia to evaluate the likelihood of central venous catheter (CVC)-related bloodstream infection. Few studies have addressed these approaches to yeast fungaemia.

OBJECTIVES

This study aimed to evaluate TTP and DTTP to assess CVC-related yeast fungaemia (CVC-RYF).

PATIENTS/METHODS

We retrospectively analysed the results from 105 adult patients with incident fungaemia, with CVC removed and cultured, collected from 2010 to 2017. The bottles were incubated in a BioMérieux BacT/ALERT 3D and kept for at least 5 days.

RESULTS

Of the 105 patients included, most were oncology patients (85.7%) and had of long-term CVC (79.6%); 32 (30.5%) had a culture-positive CVC (defined as CVC-RYF) with the same species as in blood culture, and 69.5% had culture-negative CVC (defined as non-CVC-RYF, NCVC-RYF). Candida albicans represented 46% of the episodes. The median TTP was statistically different between CVC-RYF and NCVC-RYF (16.8 hours interquartile range (IQR) [9.7-28.6] vs 29.4 hours [IQR 20.7-41.3]; P = .001). A TTP <10 hours had the best positive likelihood ratio (21.5) for CVC-RYF, although the sensitivity was only 28%. DTTP was available for 52 patients. A DTTP >5 hours had a sensitivity of 100% and a specificity of 71% for CVC-RYF.

CONCLUSIONS

Since the median TTP was 17 hours and the most performing DTTP >5 hours, these delays are too long to take a decision in the same operational day. More rapid methods for detecting infected catheters should be tested to avoid unnecessary CVC withdrawal.

Authors+Show Affiliations

Parasitology-Mycology Laboratory, Lariboisière Saint-Louis Fernand Widal Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France. Paris-Diderot, Sorbonne Paris Cité University, Paris, France. Molecular Mycology Unit, Institut Pasteur, Reference National Center of Invasive Mycoses and Antifungals, CNRS UMR2000, Paris, France.Anesthesiology Department, Lariboisière Saint-Louis Fernand Widal Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France.Parasitology-Mycology Laboratory, Lariboisière Saint-Louis Fernand Widal Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France.Microbiology Department, Lariboisière Saint-Louis Fernand Widal Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France. Paris-Diderot, IAME UMR-1137, Sorbonne Paris Cité University, Paris, France.Microbiology Department, Lariboisière Saint-Louis Fernand Widal Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France.Tropical and Infectious Diseases Department, Lariboisière Saint-Louis Fernand Widal Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France.Parasitology-Mycology Laboratory, Lariboisière Saint-Louis Fernand Widal Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France.Parasitology-Mycology Laboratory, Lariboisière Saint-Louis Fernand Widal Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France. Paris-Diderot, Sorbonne Paris Cité University, Paris, France. Molecular Mycology Unit, Institut Pasteur, Reference National Center of Invasive Mycoses and Antifungals, CNRS UMR2000, Paris, France.Parasitology-Mycology Laboratory, Lariboisière Saint-Louis Fernand Widal Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France. Paris-Diderot, Sorbonne Paris Cité University, Paris, France. Molecular Mycology Unit, Institut Pasteur, Reference National Center of Invasive Mycoses and Antifungals, CNRS UMR2000, Paris, France.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

31630462

Citation

Gits-Muselli, Maud, et al. "Time to and Differential Time to Blood Culture Positivity for Assessing Catheter-related Yeast Fungaemia: a Longitudinal, 7-year Study in a Single University Hospital." Mycoses, 2019.
Gits-Muselli M, Villiers S, Hamane S, et al. Time to and differential time to blood culture positivity for assessing catheter-related yeast fungaemia: A longitudinal, 7-year study in a single university hospital. Mycoses. 2019.
Gits-Muselli, M., Villiers, S., Hamane, S., Berçot, B., Donay, J. L., Denis, B., ... Bretagne, S. (2019). Time to and differential time to blood culture positivity for assessing catheter-related yeast fungaemia: A longitudinal, 7-year study in a single university hospital. Mycoses, doi:10.1111/myc.13024.
Gits-Muselli M, et al. Time to and Differential Time to Blood Culture Positivity for Assessing Catheter-related Yeast Fungaemia: a Longitudinal, 7-year Study in a Single University Hospital. Mycoses. 2019 Oct 19; PubMed PMID: 31630462.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Time to and differential time to blood culture positivity for assessing catheter-related yeast fungaemia: A longitudinal, 7-year study in a single university hospital. AU - Gits-Muselli,Maud, AU - Villiers,Stéphane, AU - Hamane,Samia, AU - Berçot,Béatrice, AU - Donay,Jean-Luc, AU - Denis,Blandine, AU - Guigue,Nicolas, AU - Alanio,Alexandre, AU - Bretagne,Stéphane, Y1 - 2019/10/19/ PY - 2019/04/24/received PY - 2019/10/04/revised PY - 2019/10/10/accepted PY - 2019/10/21/pubmed PY - 2019/10/21/medline PY - 2019/10/21/entrez KW - blood cultures KW - candidaemia KW - central venous catheter KW - diagnosis KW - differential time to positivity KW - time to positivity KW - yeast fungaemia JF - Mycoses JO - Mycoses N2 - BACKGROUND: Time to positivity (TTP) and differential time to positivity (DTTP) between central and peripheral blood cultures are commonly used for bacteraemia to evaluate the likelihood of central venous catheter (CVC)-related bloodstream infection. Few studies have addressed these approaches to yeast fungaemia. OBJECTIVES: This study aimed to evaluate TTP and DTTP to assess CVC-related yeast fungaemia (CVC-RYF). PATIENTS/METHODS: We retrospectively analysed the results from 105 adult patients with incident fungaemia, with CVC removed and cultured, collected from 2010 to 2017. The bottles were incubated in a BioMérieux BacT/ALERT 3D and kept for at least 5 days. RESULTS: Of the 105 patients included, most were oncology patients (85.7%) and had of long-term CVC (79.6%); 32 (30.5%) had a culture-positive CVC (defined as CVC-RYF) with the same species as in blood culture, and 69.5% had culture-negative CVC (defined as non-CVC-RYF, NCVC-RYF). Candida albicans represented 46% of the episodes. The median TTP was statistically different between CVC-RYF and NCVC-RYF (16.8 hours interquartile range (IQR) [9.7-28.6] vs 29.4 hours [IQR 20.7-41.3]; P = .001). A TTP <10 hours had the best positive likelihood ratio (21.5) for CVC-RYF, although the sensitivity was only 28%. DTTP was available for 52 patients. A DTTP >5 hours had a sensitivity of 100% and a specificity of 71% for CVC-RYF. CONCLUSIONS: Since the median TTP was 17 hours and the most performing DTTP >5 hours, these delays are too long to take a decision in the same operational day. More rapid methods for detecting infected catheters should be tested to avoid unnecessary CVC withdrawal. SN - 1439-0507 UR - https://www.unboundmedicine.com/medline/citation/31630462/Time_to_and_differential_time_to_blood_culture_positivity_for_assessing_catheter-related_yeast_fungaemia:_A_longitudinal,_7-year_study_in_a_single_university_hospital L2 - https://doi.org/10.1111/myc.13024 DB - PRIME DP - Unbound Medicine ER -