858Evaluation of Current Methods for the Diagnosis of Catheter-Related Blood Stream Infections (CRBSI) at the Hospital for Sick Children
Bibliographic record
Abstract
Background. Central-line associated blood stream infections (CLABSI) are a significant cause of morbidity and mortality for critically ill and immunocompromised patients. The diagnosis can be challenging in children, as prophylactic antibiotics are often started prior to cultures. The purpose of this study was to review the value of catheter tip cultures in diagnosing CLABSI in children and to determine whether alternative laboratory methods of diagnosis might be indicated. Methods. We performed a retrospective review of all semi-quantitative catheter tip cultures from 2010–11. All blood culture data in the preceding two weeks were reviewed to determine their predictive value for CLABSI. Central lines that had a second culture (peripheral or other central line culture) taken within 24h of each other were analyzed separately as a pair. A survey of HCP (physicians and nurse practitioners) on the diagnosis of CLABSI in children with central lines was conducted. Results. A total of 274 catheter tips were cultured from 237 patients. The majority of patients had cultures performed in the preceding two weeks (87%). Positive tips cultures were obtained in 13% (n = 35); 28 (80%) had a preceding blood culture with the same organism. Of those patients, 86% (n = 24) had a set of paired cultures sent. Analysis of tip cultures is outlined in the figure, and paired cultures are described further in the table. The survey was distributed to 300 people, with a 25% response rate. Respondents felt line removal had significant clinical impact. Respondents were generally in agreement with IDSA guidelines on indications for line removal. Analysis of tip cultures, and paired cultures. Analysis of positive line tips and negative line tips Conclusion. Our current methods of diagnosis are not adequate for the diagnosis of CLABSI, further research is needed to assess other techniques (i.e., differential time to positivity). Disclosures. All authors: No reported disclosures.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.012 | 0.036 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.004 | 0.002 |
| Science and technology studies | 0.000 | 0.001 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.004 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".