Comparison of semi-quantitative and quantitative methods for diagnosis of catheter-related blood stream infections: a systematic review and meta-analysis of diagnostic accuracy studies.

Yan Zhang,Linlin Wu,Li Yang,Yanmei Chu

doi:10.1017/s0950268820001673

Yan Zhang, Linlin Wu + Show 2 more

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https://doi.org/10.1017/s0950268820001673

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Journal: Epidemiology and Infection	Publication Date: Jan 1, 2020
Citations: 2	License type: CC BY 4.0

Affiliation: Zaozhuang Municipal Hospital

Abstract

Catheter-related blood-stream infections (CRBSIs) are the most common healthcare-associated blood-stream infections. They can be diagnosed by either semi-quantitative or quantitative methods, which may differ in diagnostic accuracy. A meta-analysis was undertaken to compare the diagnostic accuracy of semi-quantitative and quantitative methods for CRBSI. A systematic search of Medline, Scopus, Cochrane and Embase databases up to January 2020 was performed and subjected to a QUADAS (quality assessment of diagnostic accuracy studies 2) tool to evaluate the risk of bias among studies. The pooled sensitivity and specificity of the methods were determined and heterogeneity was evaluated using the χ2 test and I2. Publication bias was assessed using a Funnel plot and the Egger's test. In total, 45 studies were analysed with data from 11 232 patients. The pooled sensitivity and specificity of semi-quantitative methods were 85% (95% CI 79-90%) and 84% (95% CI 79-88%), respectively; and for quantitative methods were 85% (95% CI 79-90%) and 95% (95% CI 91-97%). Considerable heterogeneity was statistically evident (P < 0.001) by both methods with a correspondingly symmetrical Funnel plot that was confirmed by a non-significant Deek's test. We conclude that both semi-quantitative and quantitative methods are highly useful for screening for CRBSI in patients and display high sensitivity and specificity. Quantitative methods, particularly paired quantitative cultures, had the highest sensitivity and specificity and can be used to identify CRBSI cases with a high degree of certainty.

Highlights

Central venous or peripheral artery catheters are used for managing critically-ill or emergency patients admitted to intensive care units (ICUs) or emergency units of tertiary care centres
The most common complication associated with their use is catheter-related blood-stream infection (CRBSI) [1, 2], which constitute a major part of healthcare-associated bacteraemia and are associated with significant morbidity, mortality and excess economic burden to the hospitals [3, 4]
Participants were patients suspected of having a CRBSI in medical, surgical or neonatal ICUs of a tertiary care hospital, irrespective of their age groups or comorbid status

Summary

Introduction

Central venous or peripheral artery catheters are used for managing critically-ill or emergency patients admitted to intensive care units (ICUs) or emergency units of tertiary care centres. The most common complication associated with their use is catheter-related blood-stream infection (CRBSI) [1, 2], which constitute a major part of healthcare-associated bacteraemia and are associated with significant morbidity, mortality and excess economic burden to the hospitals [3, 4]. A semiquantitative diagnostic technique was first recommended in 1977 by Maki et al [6] in which, a catheter tip segment was cultured on the surface of a blood agar plate to detect bacterial contamination This became the benchmark method and is widely used as a reference standard against which other diagnostic methods for CRBSIs are compared.

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