Evaluation of a Quantitative Sonication Method of Catheter Tip Culture for Diagnosis of Catheter-Related Bloodstream Infection

Soo-Kyung Kim; Hyun-Ki Kim; Young Jin Ko; Heungsup Sung; Mi-Na Kim

doi:10.5145/ACM.2015.18.1.7

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Kim, Kim, Ko, Sung, and Kim: Evaluation of a Quantitative Sonication Method of Catheter Tip Culture for Diagnosis of Catheter-Related Bloodstream Infection

Original Article

Ann Clin Microbiol 2015;18(1):7-13.

Published online: 5 March 2015

DOI: https://doi.org/10.5145/ACM.2015.18.1.7

Evaluation of a Quantitative Sonication Method of Catheter Tip Culture for Diagnosis of Catheter-Related Bloodstream Infection

Soo-Kyung Kim, Hyun-Ki Kim, Young Jin Ko, Heungsup Sung, Mi-Na Kim

Department of Laboratory Medicine, University of Ulsan College of Medicine and Asan Medical Center, Seoul, Korea

Correspondence: Mi-Na Kim, Department of Laboratory Medicine, University of Ulsan College of Medicine and Asan Medical Center, 88, Olympic-ro 43-gil, Songpa-gu, Seoul 138-736, Korea. (Tel) 82-2-3010-4511, (Fax) 82-2-478-0884, (E-mail) mnkim@amc.seoul.kr

Received 16 October 201412 December 2014 Accepted 13 December 2014

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

초록

Background

The diagnosis of catheter-related bloodstream infection (CRBSI) should demonstrate catheter colonization of the same organism as the isolate from peripheral blood cultures, by catheter tip culture or by differential time to positivity (DTP) of catheter- drawn blood cultures versus peripheral blood cultures. The purpose of this study was to compare the sonication and the roll-plate methods of catheter tip culture.

Methods

One hundred and sixty-one catheter tips from 122 patients were submitted for catheter tip culture. Distal segments of the catheter were first inoculated using a roll-plate, and then inoculated by sonication. Sonication was performed using a BactoSonic device (Bandelin GmbH, Germany). A total of 1,018 sets of blood cultures from 7 days before to 1 day after catheter removal were analyzed for isolated or-ganisms and DTP. Cutoffs of catheter colonization were ≥15 CFU for the roll-plate method, ≥100 CFU for sonication, and ≥2 h for DTP.

Results

Twenty-four catheter tips (14.9%) showed colonization with at least one of the two methods: 21 (13.0%) with the roll-plate method and 22 (13.7%) with sonication. The positivity rates for the two methods showed no significant difference, and the con-cordance rate for the two methods was 96.9% (k=0.866, P＜0.001). Blood culture was positive in 56 episodes in 44 patients, and 14 episodes of CRBSI were diagnosed in 12 patients: 10 by tip culture (two by sonication only) and 8 by DTP. Of the 122 specimens that were negative according to both methods, 4 were from the episodes of CRBSI diagnosed by DTP.

Conclusion

Roll-plate and sonication methods are comparable in diagnostic sensitivity for catheter colonization. The roll-plate and sonication catheter tip culture methods and DTP are complementary for diagnosis of CRBSI.

Keywords: Central venous catheter, Quantitative catheter tip culture, Semi-quantitative roll plate, Sonication

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Table 1.

Detection of catheter colonization and catheter-related bloodstream infections according to the diagnostic method employed

Sonication method		Roll-plate method (No. of CRBSIs/No. of CRBSIs diagnosed by DTP)
		Colonization∗	No colonization
		Colonization∗	Mixed growth	Insignificant growth	No growth	Total
Colonization†		19 (9/4)	1 (0/0)	0	2 (1/0)	22 (10/4)
No colonization	Mixed growth	0	1 (0/0)	0	2 (0/0)	3 (0/0)
	Insignificant growth	1 (0/0)	0	2 (0/0)	3 (0/0)	6 (0/0)
	No growth	1 (0/0)	0	7 (0/0)	122 (4/4)	130 (4/4)
	Total	21 (9/4)	2 (0/0)	9 (0/0)	129 (5/4)	161 (14/8)

^∗ The cut-off used for the detection of colonization was ≥15 CFU for the roll-plate method;

^† The cut-off used for detection of colonization was ≥100 CFU for the sonication method; Correlation of colonization detection between roll-plate and sonication method was significant (P＜0.001, Chi square test).

Abbreviations: CRBSI, catheter-related bloodstream infection; DTP, differential time to positivity.

Table 2.

Quantitative comparison of CFU for the sonication and roll-plate methods

Quantification by the roll-plate method (CFU)	Quantification by sonication method (CFU)
Quantification by the roll-plate method (CFU)	0	1-99	100-999	≥1,000	Total
0	122	3	4	0	129
1-14	7	2	0	1	10
15-99	1	2	2	0	5
≥100	0	1	3	13	17
Total	130	8	9	14	161

Correlation of quantification between roll-plate method and sonication method was significant (P＜0.001, linear-by-linear asssociation).

Table 3.

Species distribution of the isolates from catheter tip cultures in combinations of roll-plate and sonication method

Microorganism	RP+/SO+ (n=22)	RP+/SO− (n=2)	RP−/SO+ (n=4)	Total (n=28)
CNS	3	1	3	7 (25.0%)
Staphylococcus epidermidis	2	1	1	4
Staphylococcus haemolyticus	1	0	1	2
Staphylococcus capitis	0	0	1	1
Staphylococcus aureus	6	0	0	6 (21.4%)
Corynebacterium spp.	1	0	0	1 (3.6%)
Gram-negative bacteria	5	0	1	6 (21.4%)
Acinetobacter baumannii	3	0	0	3
Klebsiella oxytoca	1	0	0	1
Klebsiella pneumoniae	1	0	0	1
Acinetobacter lwoffii	0	0	1	1
Candida spp.	7	1	0	8 (28.6%)

Abbreviations: CNS, coagulase-negative staphylococci; RP, semiquantitative roll-plate method; SO, quantitative sonication method.

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