Blot, F., Nitenberg, G. & Brun-Buisson, C. (2000). New tools in diagnosing catheter related infections. Support Care Cancer, 8(4), 287-292.
Calfee, D. & Farr, B. (1999). Catheter-related bloodstream infection. Current Infectious Disease Reports. 1, 238-244.
Dobbins, B.M., Kite, P., Wilcox, M.H., et al (1997). Economic evaluation of the use of endoluminal brushes in the diagnosis of catheter related sepsis (CRS) in a surgical unit. Clinical Nutrition, 97(2), 77.
This study assesses 104 episodes of suspected CRS over 12 months [70 triple-lumen, 25 single-lumen and 9 Hickman catheters]. Total material costs of removing and replacing all suspected catheters was £3726.78 compared to £2772.32 for brushing all catheters and removing and replacing only the infected ones. Authors conclude: "A policy of in-situ endoluminal brushing of CVCs suspected of causing CRS and removing and replacing only positive cultured catheters is cost-effective and prevents needless sacrifice of the majority of CVC".
Dobbins, B.M., Kite, P., Wilcox, M.H., et al (1997). Clinical safety of the endoluminal brush technique for in-situ diagnosis of catheter related sepsis 37th ICAAC J-189, 323-324.
In this study, 226 patients, of whom 34 had CRS, were assessed for bacteremia. Pre-[PB], immediately post- [IPB] and one hour [HPB] after brushing. The mean difference between PB and IPB was 7cfu/ml. The mean difference between PB and HPB was 1cfu/ml. The authors conclude "The brush technique is clinically safe and is rarely associated with a transient bacteremia".
Dobbins, B.M. & Kite, P. (1999). Endoluminal brushing in catheter-related sepsis: A sweeping statement [Editorial] Nutrition, 15,66-67.
This study summarizes all of the clinical work conducted at The General Infirmary, Leeds UK. Since all the data in this publication is relevant it is difficult to provide a synopsis. The paper should be read in its entirety.
Elliott, T. & Tebbs, S. (1998). Prevention of central venous catheter-related infection. Journal of Hospital Infection, 40, 193-201.
Johnson, A. & Oppenheim, B. (1992). Vascular catheter-related sepsis: diagnosis & prevention. Journal of Hospital Infection, 20, 67-78.
Kite P., Dobbins B.M., Wilcox M.H., et al (1997). Evaluation of a novel endoluminal brush for in situ diagnosis of catheter-related sepsis Journal of Clinical Pathology 50, 276-282.
This large study of 230 CVC in 216 surgical patients had 128 catheters removed on suspicion of infection and 102 removed electively without suspicion. All catheters were subject to “FACTS” Endoluminal Brush culture [EB], the Maki Roll [MR] and the Cleri flush [CF]. CRS was confirmed by the same organism being isolated from both blood and the catheter [by any of the three techniques]. Colonization was defined as growth from any catheter surface by any technique in the absence of a blood isolate. 22 cases of CRS were confirmed: 21 positive by EB (Sensitivity = 93%), 18 by MR (Sensitivity = 82%), and 15 by CF(Sensitivity = 75%), [CF was not conducted on 2 CRS positive catheters]. Colonization (n=76) was detected as 43% by EB, 92% by MR and 43% by CF: 41% of colonized catheters were colonized extraluminally only, 7% endoluminally only and 53% on both surfaces. Colonization rates were similar for both suspected and non-suspected groups - 32% and 34% respectively. Two of the 22 cases of CRS were not suspected, and 52% of suspected and 64% of non-suspected catheters was sterile. [Specificity EB 84%, MR 66%, CF 84%]. The CRS Endoluminal Brush was found to be the most sensitive and specific of the three techniques for the diagnosis of CRS. CRS was predictably higher in the suspected group [16%] than in the non-suspected group [2%]. However, on this evidence, when clinical parameters are used to select catheters thought to be infected, the majority [84%] of such lines yield no significant growth. No patient experienced adverse effects from brushing. The authors conclude "The endoluminal brush method is a cost-effective approach to sampling lines suspected of CRS".
Markus, S. & Buday, S. (1989). Culturing indwelling central venous catheters in-situ. Infections in Surgery, 8 157-162.
Tighe, M.J., Kite P., Thomas D., et al (1996). An endoluminal brush to detect the infected central venous catheter in situ: a pilot study. British Medical Journal, 313, 1528-1529.
This pilot study examined 115 catheters from 112 surgical patients receiving TPN. 44 catheters were removed at the end of therapy and 71 were removed on suspicion of infection. The Brush [EB] was positive in 14 of 15 (93%) of cases of CRS: the Maki Roll [MR] in 10 of 15 (67%). 16 of 24 colonized catheters were EB positive versus 19 of 24 by MR. All sterile [66] catheters were negative by both techniques but 10 contaminated catheters were all positive by MR but all negative by EB. EB accurately identified 11.4% of patients having unsuspected infection.
Worthington, T., Lambert, P. & Elliott, T. (2000). A novel serological test for the laboratory diagnosis of central venous catheter-associated sepsis. Journal of Antimicrobial Chemotherapy. 46, 513-519.
