Role of semiquantitative roll over technique and flush technique in diagnosing central line associated bloodstream infection (CLABSI) and central line related local infections (CRLI) in MICU patients: A prospective study

Dhanashree P Inamdar ,Sujata Baveja

doi:10.18231/2581-4761.2019.0011

Abstract

Abstract Introduction: Diagnosing Central line associated bloodstream infection (CLABSI) and Central line Related local infections (CRLI) involves doing central line tip culture. The routine method which is followed in every laboratory is the semiquantitative roll plate method. However, the use of a quantitative flush method will add a further advantage, as it may detect endoluminal microorganisms more easily which helps in diagnosing blood stream infections due to central line. Materials and Methods: A prospective study was carried out in MICU of tertiary care hospital. Semiquantitative roll over technique and quantitative flush technique was followed to process central line catheter in patients suspected of CRLI and CLABSI. Results: Of 210 samples processed from patients forty seven patients (47) were diagnosed with CRLI and seven (7) with CLABSI. Semiquantitative technique had superiority in diagnosing local infections whereas flush technique had superiority in diagnosing blood stream infections. Conclusion: Both Semiquantitative and flush techniques are recommended for processing central line catheters for diagnosing CRLI and CLABSI. Early CLABSI can be missed sometimes in samples from ICU patients who have associated comorbid conditions. Thus those laboratories where only semiquantitative roll over technique is followed, quantitative flush technique is recommended which aids in diagnosing CLABSI which can be missed by roll over technique. Keywords: Central line associated bloodstream infections (CLABSI), Central line related local infections (CRLI), Intensive care unit (ICU), Semiquantitative roll over, Quantitative flush technique. Introduction Central line catheter associated bloodstream infection (CLABSI) remains one of the leading causes of nosocomial acquired bacteremia in ICUs leading to increased mortality, whereas Central line related local infections (CRLI) leads to increased morbidity and hospital stay in turn increasing cos

Highlights

Diagnosing Central line associated bloodstream infection (CLABSI) and Central line Related local infections (CRLI) involves doing central line tip culture
Central line catheter associated bloodstream infection (CLABSI) remains one of the leading causes of nosocomial acquired bacteremia in Intensive care unit (ICU) leading to increased mortality, whereas Central line related local infections (CRLI) leads to increased morbidity and hospital stay in turn increasing cost burden on patient.[1,2,3,4,5]
The present study was undertaken with a purpose of diagnosing Central line associated bloodstream infection (CLABSI) and Central line Related local infections (CRLI) by semiquantitative roll over technique and flush technique in Medical Intensive Care Unit (MICU) patients on central line catheters

Summary

Introduction

Diagnosing Central line associated bloodstream infection (CLABSI) and Central line Related local infections (CRLI) involves doing central line tip culture. Semiquantitative roll over technique and quantitative flush technique was followed to process central line catheter in patients suspected of CRLI and CLABSI. CLABSI can be missed sometimes in samples from ICU patients who have associated comorbid conditions Those laboratories where only semiquantitative roll over technique is followed, quantitative flush technique is recommended which aids in diagnosing CLABSI which can be missed by roll over technique. The reference standard established was a semiquantitative technique described by Maki et al in 1977,8 with a cutoff of 15 CFU (colony forming units) to distinguish microbial contamination of catheters from significant colonization This technique which is called the roll plate method is done on distal 5 cm end of catheter tip which is rolled back and forth on an agar plate for culture. Bouza and colleagues demonstrated a cutoff of 100 CFU to be superior to one of _1,000 CFU/catheter segment.[17]

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Results

Conclusion