Skip to main content Accessibility help

Diagnosing and Reporting of Central Line–Associated Bloodstream Infections

  • Susan E. Beekmann (a1), Daniel J. Diekema (a1), W. Charles Huskins (a2), Loreen Herwaldt (a1), John M. Boyce (a3), Robert J. Sherertz (a4), Philip M. Polgreen (a1) (a5) and on behalf of the Infectious Diseases Society of America Emerging Infections Network...



The diagnosis of central line-associated bloodstream infections (CLABSIs) is often controversial, and existing guidelines differ in important ways.


To determine both the range of practices involved in obtaining blood culture samples and how central line-associated infections are diagnosed and to obtain members' opinions regarding the process of designating bloodstream infections as publicly reportable CLABSIs.


Electronic and paper 11-question survey of infectious-diseases physician members of the Infectious Diseases Society of America Emerging Infections Network (IDSA EIN).


All 1,364 IDSA EIN members were invited to participate.


692 (51%) members responded; 52% of respondents with adult practices reported that more than half of the blood culture samples for intensive care unit (ICU) patients with central lines were drawn through existing lines. A sizable majority of respondents used time to positivity, differential time to positivity when paired blood cultures are used, and quantitative culture of catheter tips when diagnosing CLABSI or determining the source of that bacteremia. When determining whether a bacteremia met the reportable CLABSI definition, a majority used a decision method that involved clinical judgment.


Our survey documents a strong preference for drawing 1 set of blood culture samples from a peripheral line and 1 from the central line when evaluating fever in an ICU patient, as recommended by IDSA guidelines and in contrast to current Centers for Disease Control and Prevention recommendations. Our data show substantial variability when infectious-diseases physicians were asked to determine whether bloodstream infections were primary bacteremias, and therefore subject to public reporting by National Healthcare Safety Network guidelines, or secondary bacteremias, which are not reportable.


Corresponding author

Department of Internal Medicine, SW34J General Hospital, 200 Hawkins Drive, Iowa City, IA 52242 (


Hide All
1. Srinivasan, A, Wise, M, Bell, M, et al. Vital signs: central line-associated blood stream infections—United States, 2001, 2008, and 2009. MMWR Morb Mortal Wkly Rep 2011;60(8):243248.
2. Wisplinghoff, H, Bischoff, T, Tallent, SM, Seifert, H, Wenzel, RP, Edmond, MB. Nosocomial bloodstream infections in US hospitals: analysis of 24,179 cases from a prospective nationwide surveillance study. Clin Infect Dis 2004;39(3):309317.
3. Diekema, DJ, Beekmann, SE, Chapin, KC, Morel, KA, Munson, EL, Doern, GV. Epidemiology and outcome of nosocomial and community-onset bloodstream infection. J Clin Microbiol 2003;41(8):36553660.
4. Weinstein, MP, Towns, ML, Quartey, SM, et al. The clinical significance of positive blood cultures in the 1990s: a prospective comprehensive evaluation of the microbiology, epidemiology, and outcome of bacteremia and fungemia in adults. Clin Infect Dis 1997;24(4):584602.
5. Umscheid, CA, Mitchell, MD, Doshi, JA, Agarwal, R, Williams, K, Brennan, PJ. Estimating the proportion of healthcare-associated infections that are reasonably preventable and the related mortality and costs. Infect Control Hosp Epidemiol 2011;32(2): 101114.
6. Mermel, LA, Allon, M, Bouza, E, et al. Clinical practice guidelines for the diagnosis and management of intravascular catheter-related infection: 2009 update by the Infectious Diseases Society of America. Clin Infect Dis 2009;49(1):145.
7. Dudeck, MA, Horan, TC, Peterson, KD, et al. National Healthcare Safety Network (NHSN) report, data summary for 2010, device-associated module. Am J Infect Control 2011;39(10):798816.
8. Fridkin, SK, Olmsted, RN. Meaningful measure of performance: a foundation built on valid, reproducible findings from surveillance of health care-associated infections. Am J Infect Control 2011;39(2):8790.
9. Reagan, J, Hacker, C. Laws pertaining to healthcare-associated infections: a review of 3 legal requirements. Infect Control Hosp Epidemiol 2012;33(1):7580.
10. Fraser, TG, Gordon, SM. CLABSI rates in immunocompromised patients: a valuable patient centered outcome? Clin Infect Dis 2011;52(12):14461450.
11. Sexton, DJ, Chen, LF, Anderson, DJ. Current definitions of central line-associated bloodstream infection: is the emperor wearing clothes? Infect Control Hosp Epidemiol 2010;31(12):12861289.
12. Executive Committee of the Infectious Diseases Society of America Emerging Infections Network. The Emerging Infections Network: a new venture for the Infectious Diseases Society of America. Clin Infect Dis 1997;25(1):3436.
13. Strausbaugh, LJ, Liedtke, LA. The Emerging Infections Network electronic mail conference and web page. Clin Infect Dis 2001;32(2):270276.
14. Horan, TC, Andrus, M, Dudeck, MA. CDC/NHSN surveillance definition of health care-associated infection and criteria for specific types of infections in the acute care setting. Am J Infect Control 2008;36(5):309332.
15. Al Wohoush, I, Cairo, J, Rangaraj, G, Granwehr, B, Hachem, R, Raad, I. Comparing quantitative culture of a blood sample obtained through the catheter with differential time to positivity in establishing a diagnosis of catheter-related bloodstream infection. Infect Control Hosp Epidemiol 2010;31(10):10891091.
16. Safdar, N, Fine, JP, Maki, DG. Meta-analysis: methods for diagnosing intravascular device-related bloodstream infection. Ann Intern Med 2005;142(6):451466.
17. Catton, JA, Dobbins, BM, Kite, P, et al. In situ diagnosis of intravascular catheter-related bloodstream infection: a comparison of quantitative culture, differential time to positivity, and en-doluminal brushing. Crit Care Med 2005;33(4):787791.
18. Backman, LA, Melchreit, R, Rodriguez, R. Validation of the surveillance and reporting of central line-associated bloodstream infection data to a state health department. Am J Infect Control 2010;38(10):832838.
19. Lin, MY, Hota, B, Khan, YM, et al. Quality of traditional surveillance for public reporting of nosocomial bloodstream infection rates. JAMA 2010;304(18):20352041.
20. Niedner, MF, Frost, M, Timm, D, et al. The harder you look, the more you find: catheter-associated bloodstream infection surveillance variability. Am J Infect Control 2010;38(8):585595.
21. McBryde, ES, Brett, J, Russo, PL, Worth, LJ, Bull, AL, Richards, MJ. Validation of statewide surveillance system data on central line-associated bloodstream infection in intensive care units in Australia. Infect Control Hosp Epidemiol 2009;30(11)10451049.
22. Aswani, MS, Reagan, J, Jin, L, Pronovost, PJ, Goeschel, C. Variation in public reporting of central line-associated bloodstream infections by state. Am J Med Qual 2011;26(5):387395.
23. Martinez, JA, Desjardin, JA, Aronoff, M, Supran, S, Nasraway, SA, Snydman, DR. Clinical utility of blood cultures drawn from central venous or arterial catheters in critically ill surgical patients. Crit Care Med 2002;30(1):713.
24. Norberg, A, Christopher, NC, Ramundo, ML, Bower, JR, Berman, SA. Contamination rates of blood cultures obtained by dedicated phlebotomy vs intravenous catheter. JAMA 2003;289(6): 726729.
25. Ramsook, C, Childers, K, Cron, SG, Nirken, M. Comparison of blood-culture contamination rates in a pediatric emergency room: newly inserted intravenous catheters versus venipuncture. Infect Control Hosp Epidemiol 2000;21(10):649651.
26. Beutz, M, Sherman, G, Mayfield, J, Fraser, VJ, Kollef, MH. Clinical utility of blood cultures drawn from central vein catheters and peripheral venipuncture in critically ill medical patients. Chest 2003;123(3):854861.
27. Park, KH, Cho, OH, Lee, SO, et al. Development of subsequent bloodstream infection in patients with positive Hickman catheter blood cultures and negative peripheral blood cultures. Diagn Microbiol Infect Dis 2011;70(1):3136.
28. Freeman, JT, Chen, LF, Sexton, DJ, Anderson, DJ. Blood culture contamination with enterococci and skin organisms: implications for surveillance definitions of primary bloodstream infections. Am J Infect Control 2011;39(5):436438.


Altmetric attention score

Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed