Positive intravenous line tip cultures as predictors of bacteraemia

Intravenous line tip cultures provide valuable information when taken in conjunction with blood culture, but in practice are often performed in isolation. This retrospective study has evaluated: (1) the frequency of isolated line tip culture; and (2) whether the species of microorganism isolated from line tip culture, using the Maki semi-quantitative culture method, is predictive of bacteraemia. Of 2753 line tip culture episodes in 1659 patients between May 1993 and August 1995, 2230 were performed in isolation (81%). Evaluation of 792 positive line tip culture episodes in 654 patients where blood cultures were performed in the period from 48 h before, to 24 h after tip culture, identified 825 line tip isolates. Of these, 194 were associated with a blood culture positive for the same species. The rate of positive blood culture, according to species, ranged from 10-72%. The highest rate was seen for methicillin-susceptible Staphylococcus aureus where 70 of 97 line tip episodes (72%) were associated with positive blood culture. This compared with a rate of 17% for coagulase-negative staphylococci (P<0.0001). Patients with line tip cultures positive for S. aureus should be considered to be at high risk of bacteraemia.