Performing Gram stain directly on catheter tips: assessment of the quality of the observation process

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• 作者：M. Guembe ; M. J. Pérez-Granda ; M. L. Rivera…
• 刊名：European Journal of Clinical Microbiology & Infectious Diseases
• 出版年：2015
• 出版时间：June 2015
• 年：2015
• 卷：34
• 期：6
• 页码：1091-1095
• 全文大小：112 KB
• 参考文献：1.Bouza E, Alvarado N, Alcalá L, Mu?oz P, Rabadán PM, Rodríguez-Créixems M (2006) An instant procedure to demonstrate catheter-tip colonization may help clinicians. Diagn Microbiol Infect Dis 56(3):255-60View Article PubMed
  2.Collignon P, Chan R, Munro R (1987) Rapid diagnosis of intravascular catheter-related sepsis. Arch Intern Med 147(9):1609-612View Article PubMed
  3.Cooper GL, Hopkins CC (1985) Rapid diagnosis of intravascular catheter-associated infection by direct Gram staining of catheter segments. N Engl J Med 312(18):1142-147View Article PubMed
  4.Coutlée F, Lemieux C, Paradis JF (1988) Value of direct catheter staining in the diagnosis of intravascular-catheter-related infection. J Clin Microbiol 26(6):1088-090PubMed Central PubMed
  5.Hendrickson DA (1985) Reagents and stains. In: Lennette EH, Balows A, Hausler WJ Jr, Shadomy HJ (eds) Manual of clinical microbiology, 4th edn. American Society for Microbiology, Washington, DC, pp 1102-103
  6.Maki DG, Weise CE, Sarafin HW (1977) A semiquantitative culture method for identifying intravenous-catheter-related infection. N Engl J Med 296(23):1305-309View Article PubMed
  7.Mermel LA, Allon M, Bouza E, Craven DE, Flynn P, O’Grady NP, Raad II, Rijnders BJ, Sherertz RJ, Warren DK (2009) Clinical practice guidelines for the diagnosis and management of intravascular catheter-related infection: 2009 Update by the Infectious Diseases Society of America. Clin Infect Dis 49(1):1-5View Article PubMed Central PubMed
  
• 作者单位：M. Guembe (1) (5)
  M. J. Pérez-Granda (3) (4)
  M. L. Rivera (1)
  P. Martín-Rabadán (1) (2) (3)
  E. Bouza (1) (2) (3)
  
  1. Department of Clinical Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Mara?ón, Madrid, Spain
  5. Servicio de Microbiología Clínica y Enfermedades Infecciosas, Hospital General Universitario “Gregorio Mara?ón- C/. Dr. Esquerdo, 46, 28007, Madrid, Spain
  3. CIBER Enfermedades Respiratorias—CIBERES (CB06/06/0058), Madrid, Spain
  4. Cardiac Surgery Postoperative Care Unit, Hospital General Universitario Gregorio Mara?ón, Madrid, Spain
  2. Medicine Department, School of Medicine, Universidad Complutense de Madrid, Madrid, Spain
  
• 刊物类别：Biomedical and Life Sciences
• 刊物主题：Biomedicine
  Medical Microbiology
  Internal Medicine
  
• 出版者：Springer Berlin / Heidelberg
• ISSN：1435-4373

文摘

A previous study performed in our institution showed that catheter tip (CT) staining by combining acridine orange and Gram stain (GS) before culture anticipated catheter colonization with exhaustive and careful observation by a highly trained technician. Our objective was to assess the validity values of GS without acridine orange on an external smear of CT for predicting catheter colonization and catheter-related bloodstream infection (C-RBSI). We compared different periods of observation and the results of two technicians with different levels of professional experience. Over a 5-month period, the roll-plate technique was preceded by direct GS of all CTs sent to the microbiology laboratory. The reading was taken at ×100 by two observers with different skill levels. Each observer performed a routine examination (3?min along three longitudinal lines) and an exhaustive examination (5?min along five longitudinal lines). The presence of at least one cell was considered positive. All slides were read before culture results were known. We included a total of 271 CTs from 209 patients. The prevalence of catheter colonization and C-RBSI was 16.2?% and 5.1?%, respectively. Routine and exhaustive examinations revealed only 29.5?% and 40.9?% of colonized catheters, respectively (p-lt;-.001). In contrast, they revealed high negative predictive values for C-RBSI (96.5?% and 96.3?%, respectively). Our study shows that the yield of GS performed directly on CTs is greater when staining is performed exhaustively. However, the decision to implement this approach in daily routine will depend on the prevalence rate of catheter colonization at each institution.