Impact of inappropriate central line blood cultures
Abstract:
A 57-year-old man with end-stage kidney disease who was receiving hemodialysis through a tunneled central venous catheter presented to the emergency department with severe hyperkalemia that prompted admission for emergent hemodialysis. He was also found to have community-acquired pneumonia, as diagnosed by a left upper lobar alveolar infiltrate and acute hypoxemic respiratory failure. An initial infectious workup included 2 peripheral blood cultures, and treatment with ceftriaxone and azithromycin was initiated. He then became febrile (temperature, 38.1 °C), and blood culture specimens were collected from the central venous catheter and a peripheral source. After 1 day, the blood culture specimen from his central line grew coagulase-negative Staphylococcus via blood culture multiplex polymerase chain reaction, and vancomycin was added. The next day, 2 additional peripheral blood culture specimens were collected. The infectious diseases service was consulted for possible catheter related bloodstream infection (CRBSI). The consultant determined that the risk of CRBSI was low because the tunneled line was nontender without surrounding erythema or drainage, and the patient had a known alternative source of infection. They recommended discontinuation of vancomycin and completion of the 5-day course of antibiotic therapy for pneumonia. Initial and repeated peripheral culture results remained negative, his fever and hypoxia resolved, and the patient was successfully discharged.
Reference:
Fuher AN, Young H, Mikkelsen ME. The Harm of Inappropriate Central Line Blood Cultures in Clinical Practice. JAMA Intern Med. 2024 Oct 21. doi: 10.1001/jamainternmed.2024.5344. Epub ahead of print. PMID: 39432314.