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Objective: To describe the frequency and correlates of concordant and discordant BC pairs (ie., central (CVC BC and peripheral BC (PBC)) among infants with a central venous catheter (CVC) during a late-onset sepsis evaluation in the neonatal intensive care unit (NICU).
Methods: We collected data on BC results, time to culture positivity, laboratory test results, antibiotic usage, and clinical outcomes from infants with a CVC who underwent sepsis evaluations.
Results: Over 15 months, 211 sepsis evaluations occurred in 94 patients; 27% (57) had positive BCs. Both CVC BC and PBC were positive in 32 (56%) culture-positive sepsis evaluations; 26/32 PBC+/CVC BC+(81%) were concordant (i.e., same organism from both cultures). Among the 32 positive culture pairs were 12 pairs of coagulase-negative staphylococci (CoNS); 8 were concordant by molecular typing. In 25 evaluations with only one positive culture, the CVC was positive in 21 and the peripheral blood in 4. All PBC+/CVC- cultures and 62% of PBC-/CVC+ cultures grew CoNS. CoNS, as compared to non-CoNS, isolates, were less likely to be concordant (25% vs. 66%; p = 0.002). Of concordant positive cultures, 55% were catheter-related bloodstream infection (CRBSI), based on differential time to positivity (DTP). Time to positivity of concordant positives was shorter than discordant positives (p = 0.005). Concordant positives were more likely to have recurrent positive BCs while on antibiotics (59% vs. 15%; p = 0.001).
Conclusions: In neonates with a CVC, analysis of positive cultures from CVC and PBC frequently show characteristics suggesting false positivity (discordant culture pairs, longer time to culture positivity and low likelihood of continued positive BC after antibiotics). These findings supports the practice of obtaining both central and peripheral cultures when infants with a CVC are evaluated for sepsis.