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Abstract
Catheter-related bloodstream infections represent the main cause of hospital-acquired bacteremia. The mortality attributable to CR-BSIs is around 10%, mostly due to endocarditis, septic
shock, metastatic lung infection, and septic thrombophlebitis.
The diagnostic approach to CR-BSI consists of clinical evaluation and microbiologic confirmation.
The clinical features are often non-specific and up to 85% of those catheters removed on clinical grounds alone are subsequently proven to be sterile.
The methods for the in-situ diagnosis of CR-BSIs are expensive, time-consuming, and relay on microbiologic culture techniques that require 24 to 48hours for in-vitro culture to
confirm the diagnosis of CR-BSI.
In the present thesis, we assessed the accuracy of the Gram stain-acridine orange leucocyte cytospin (AOLC) test as a rapid, simple and feasible tool for the detection of CR-BSI in ICU patients combined with peripheral blood cultures,in comparison to routine
semi-quantitative catheter culture method.
The results of our study showed AOLC to have a sensitivity of 96%, a specificity of 63%, a PPV of 69%,a NPV of 94% and a diagnostic accuracy of 78%The addition of the Gram stain to the
AOLC for the diagnosis of CR-BSI improved the specificity and the PPV of the test to be 85%, and 78%; respectively.
Nevertheless,the sensitivity was lowered to 61%, the NPV 72%, and the
diagnostic accuracy 74%.
The incidence of CR-BSI/1000 catheterization days was found to be 21.5 and the most commonly isolated organism causing CR-BSI among the randomly selected cases was methicillin resistant Staph. aureus (MRSA).
Among the risk factors that were found to be significantly associated with CR-BSI were duration of catheterization and the site of catheter insertion. Other factors such as age, sex, ASA
score, TPN and number of lumens were not found to be significantly associated with CR-BSI.