Objective To determine the value of differential time to positivity ( DTTP ) of blood culture for the diagnosis of catheter-related bloodstream infection ( CRBSI ) in patients with solid tumors in intensive care unit ( ICU ). Methods A retrospective study was conducted. 615 pairs of peripheral vein blood cultures and instantaneous catheter tip blood culture of 615 patients admitted to ICU of Tianjin Medical University Cancer Institute and Hospital were collected from August 2011 to March 2014. The DTTP method and ( or ) semi quantitative culture of catheter tip were compared. CRBSI was diagnosed when both cultures were positive for the same microorganism and DTTP ≥2 hours ( 120 minutes ). The result of this procedure was compared with that of organism obtained using the semi quantitative culture of blood at catheter tip with≥15 cfu. Based on the clinical diagnosis, the reliability of two kinds of laboratory examination was compared for the diagnosis of CRBSI by plotting receiver operator characteristic curve ( ROC curve ). Results The result of 615 cases suspected of having CRBSI were analyzed during the study period. Of these, 440 episodes were excluded because cultures were negative for blood obtained through peripheral vein and central vein. Eight episodes were excluded because only peripheral vein blood culture was positive and 57 episodes were excluded because of only central vein blood culture was positive, 68 pairs of blood cultures were excluded due to the presence of multiple catheters and repeated blood withdrawals. Two cases of polymicrobial cultures were excluded from the final analysis due to the difficulty in determining the time of positive result for each individual microorganism. Ten cases in 42 cases of suspected cases of CRBSI were excluded from analysis because catheter was not removed, therefore culture from catheter tip could not be obtained. Using the DTTP method, 14 out of 17 CRBSI cases were diagnosed with DTTP≥120 minutes, while 3 cases were missed;the semi quantitative catheter tip culture was positive in 13 cases, and in 4 cases it was neglected. In 2 cases of CRBSI it was missed by both methods. The area under the ROC curve ( AUC ) of DTTP, catheter tip culture and the combination method was 0.912, 0.882 and 0.941 for diagnosis of CRBSI, respectively. Validity values for the diagnosis of CRBSI for DTTP were:sensitivity 82.35%, specificity 92.31%, positive predictive value 93.33%and negative predictive value 80.00%, and they were higher than those of the catheter tip culture method only ( 76.47%, 84.62%, 86.67% and 73.33%). The specificity and positive predictive CRBSI combination of the two methods in the diagnosis value were up to 100%, the sensitivity ( 88.24%) and negative predictive value ( 86.67%) was also increased, but no significant differences were found with DTTP method (χ2=0.00, P=1.00;χ2=0.00, P=0.98;χ2=0.00, P=0.98;χ2=0.00, P=0.98 ). Conclusions DTTP can be a valid method recommended for CRBSI diagnosis in critically ill patients with acceptable sensitivity, good specificity as well as positive predictive value. DTTP combined with other clinical symptoms can not only avoid unnecessary catheter withdrawal, but it also can help obtain the optimal treatment time and strategy.

Objective To evaluate the clinical efficacy of transurethral resection of ureteral orifice invaded by advanced prostate cancer caused hydronephrosis. Methods A retrospective study was done in 15 patients who were diagnosed by advanced prostate cancer with invasion of ureteral orifice and treated by transurethral resection of ureteral orifice and maximal androgen blockade. 24 kidneys were diagnosed as hydronephrosis by ultrasound. Before the procedure, the average serum BUN was 13.2 mmol/L (8.9~28.5), the average serum Cr was 243.3 μmol/L (126.7~369.2), the average GFR evaluated by renal radionuclide imaging was 48.6 mL/min (31.1~66.2), and the upper urinary tract was obstructed in kidneys with hydronephrosis. Results All 15 patients underwent successfully transurethral resection of ureteral orifice and discharged after 4 days stay. The average procedure time was 65 min (50~100 min) and mean blood loss was 45 mL (30~65 mL) . The patients were followed up for 2~4 weeks. Hydronephrosis examined by ultrasound was ameliorated in 18 kidneys (75%) and not obviously changed in 6 kidneys (25%) in one week after procedure. Hydronephrosis examined by ultrasound was ameliorated in 20 kidneys (83.3%) and not obviously changed in 4 kidneys (16.7%) in two weeks after procedure. Within two weeks after procedure,the average serum BUN was 10.75 mmol/L (6.6~21.30 mmol/L), the average serum Cr was 187.3μmol/L (97.5~286.6 μmol/L), the average GFR evaluated by renal radionuclide imaging was 58.1 mL/min (37.8~79.2 mL/min),and upper urinary tract was unobstructed. Conclusion Upper urinary tract obstruction and renal function were ameliorated and improved in a short time by transurethral resection of ureteral orifice invaded by advanced prostate cancer which caused hydronephrosis.