1. Catheter-related blood stream infections

2. Objectives 1.Catheter-related blood stream infections - Present scenario 2.Methods of diagnosing CRBSI 3.Importance of Differential Time to Positivity method by automated system 4.Interpret DTP result to diagnose CRBSI XIII National Workshop on Diagnostic Methods in Clinical Microbiology, JIPMER 25-Nov-15

3. Catheter-related blood stream infections(CRBSI) Bacteremia/ fungemia in a patient with an intravascular catheter, associated with clinical manifestations of infections (i.e., fever, chills, and/or hypotension), and no apparent source for the BSI except the catheter Local signs of inflammation – absent in 70% of cases of CRBSI XIII National Workshop on Diagnostic Methods in Clinical Microbiology, JIPMER 25-Nov-15

4. Diagnosis XIII National Workshop on Diagnostic Methods in Clinical Microbiology, JIPMER 25-Nov-15

5. XIII National Workshop on Diagnostic Methods in Clinical Microbiology, JIPMER (for bacteria) ≥25 CFU/ml (for fungal) 25-Nov-15

6. XIII National Workshop on Diagnostic Methods in Clinical Microbiology, JIPMER (Maki method) (Endoluminal flush culture) 25-Nov-15

7. Procedure – Differential time to positivity XIII National Workshop on Diagnostic Methods in Clinical Microbiology, JIPMER 25-Nov-15

8. Requirements: Automated blood culture system- BACTEC 9120 Bactec blood culture bottles (Paediatric and/or adult – Aerobic) XIII National Workshop on Diagnostic Methods in Clinical Microbiology, JIPMER 25-Nov-15

9. Procedure 1 Two sets of blood collected simultaneously from the catheter hub of the CVC and from a peripheral site 2 8-10 ml blood drawn aseptically 3 Inoculated into Bactec blood culture bottles which will be incubated in an automatic blood culture detection system 4 The time required for the bottles to become positive is recorded(TTP) 5 The differential time to positivity (DTP) is calculated XIII National Workshop on Diagnostic Methods in Clinical Microbiology, JIPMER 25-Nov-15

10. XIII National Workshop on Diagnostic Methods in Clinical Microbiology, JIPMER Collection time Positive signal Entry in BACTEC Arrival at Lab Identification and AST report Transport timeTime to positivity(TTP) Time to reporting TTP of catheter sample(TTP C ) TTP of peripheral sample(TTP P ) 25-Nov-15

11. XIII National Workshop on Diagnostic Methods in Clinical Microbiology, JIPMER Peripheral Central CRBSI Negative ≥2 hours Same organism Positive Negative Different organisms Calculate DTP(TTP P -TTP C ) No Yes ????? Interpretation Excluded DTP cannot be measured Possible Contamination Local colonization 25-Nov-15

12. THANK YOU 25-Nov-15 XIII National Workshop on Diagnostic Methods in Clinical Microbiology, JIPMER