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Seidelman JL, Moehring R, Gettler E, Krishnan J, McGugan L, Jordan R, Murphy M, Pena H, Polage CR, Alame D, Lewis S, Smith B, Anderson D, Mehdiratta N. Implementation of a diagnostic stewardship intervention to improve blood-culture utilization in 2 surgical ICUs: Time for a blood-culture change. Infect Control Hosp Epidemiol 2024; 45:452-458. [PMID: 38073558 PMCID: PMC11007355 DOI: 10.1017/ice.2023.249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Revised: 09/25/2023] [Accepted: 10/11/2023] [Indexed: 04/10/2024]
Abstract
OBJECTIVE We compared the number of blood-culture events before and after the introduction of a blood-culture algorithm and provider feedback. Secondary objectives were the comparison of blood-culture positivity and negative safety signals before and after the intervention. DESIGN Prospective cohort design. SETTING Two surgical intensive care units (ICUs): general and trauma surgery and cardiothoracic surgery. PATIENTS Patients aged ≥18 years and admitted to the ICU at the time of the blood-culture event. METHODS We used an interrupted time series to compare rates of blood-culture events (ie, blood-culture events per 1,000 patient days) before and after the algorithm implementation with weekly provider feedback. RESULTS The blood-culture event rate decreased from 100 to 55 blood-culture events per 1,000 patient days in the general surgery and trauma ICU (72% reduction; incidence rate ratio [IRR], 0.38; 95% confidence interval [CI], 0.32-0.46; P < .01) and from 102 to 77 blood-culture events per 1,000 patient days in the cardiothoracic surgery ICU (55% reduction; IRR, 0.45; 95% CI, 0.39-0.52; P < .01). We did not observe any differences in average monthly antibiotic days of therapy, mortality, or readmissions between the pre- and postintervention periods. CONCLUSIONS We implemented a blood-culture algorithm with data feedback in 2 surgical ICUs, and we observed significant decreases in the rates of blood-culture events without an increase in negative safety signals, including ICU length of stay, mortality, antibiotic use, or readmissions.
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Affiliation(s)
- Jessica L. Seidelman
- Duke Center for Antimicrobial Stewardship and Infection Prevention Durham, North Carolina
- Division of Infectious Diseases, Department of Medicine, Duke University, Durham, North Carolina
| | - Rebekah Moehring
- Division of Infectious Diseases, Department of Medicine, Duke University, Durham, North Carolina
| | - Erin Gettler
- Duke Center for Antimicrobial Stewardship and Infection Prevention Durham, North Carolina
- Division of Infectious Diseases, Department of Medicine, Duke University, Durham, North Carolina
| | - Jay Krishnan
- Duke Center for Antimicrobial Stewardship and Infection Prevention Durham, North Carolina
- Division of Infectious Diseases, Department of Medicine, Duke University, Durham, North Carolina
| | - Lynn McGugan
- Department of Surgery, Duke University Medical Center, Durham, North Carolina
| | - Rachel Jordan
- Department of Surgery, Duke University Medical Center, Durham, North Carolina
| | - Margaret Murphy
- Department of Surgery, Duke University Medical Center, Durham, North Carolina
| | - Heather Pena
- Department of Surgery, Duke University Medical Center, Durham, North Carolina
| | | | - Diana Alame
- Department of Pathology, Duke University School of Medicine, Durham, North Carolina
| | - Sarah Lewis
- Duke Center for Antimicrobial Stewardship and Infection Prevention Durham, North Carolina
- Division of Infectious Diseases, Department of Medicine, Duke University, Durham, North Carolina
| | - Becky Smith
- Duke Center for Antimicrobial Stewardship and Infection Prevention Durham, North Carolina
- Division of Infectious Diseases, Department of Medicine, Duke University, Durham, North Carolina
| | - Deverick Anderson
- Duke Center for Antimicrobial Stewardship and Infection Prevention Durham, North Carolina
- Division of Infectious Diseases, Department of Medicine, Duke University, Durham, North Carolina
| | - Nitin Mehdiratta
- Department of Anesthesiology, Division of Anesthesia Critical Care and GVT, Duke University School of Medicine, Durham, North Carolina
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Hirosawa T, Sakamoto T, Hanai S, Harada Y, Shimizu T. Effect of Prior Antibiotic Treatment on Blood Culture in an Outpatient Department of General Internal Medicine: A Retrospective Case-Control Analysis. Int J Gen Med 2023; 16:2709-2717. [PMID: 37408849 PMCID: PMC10317762 DOI: 10.2147/ijgm.s416235] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Accepted: 06/23/2023] [Indexed: 07/07/2023] Open
Abstract
Purpose The effect of antibiotics administered before blood cultures performed in general internal medicine outpatient settings is not well known. Patients and Methods We conducted a retrospective case-control study including adult patients who underwent blood cultures in the general internal medicine outpatient department of a Japanese university hospital between 2016 and 2022. Patients with positive blood cultures were included as cases and matched patients with negative blood cultures were included as controls. Univariable and multivariable logistic regression analyses were performed. Results A total of 200 patients and 200 controls were included. Antibiotics were administered prior to blood culture in 20% of patients (79/400). Oral antibiotics were prescribed to 69.6% of the prior antibiotics (55/79). Prior antibiotic use was significantly lower among patients with positive than negative blood cultures (13.5% vs 26.0%, p = 0.002) and was an independent predictive factor in univariable (odds ratio, 0.44; 95% confidence interval, 0.26-0.73; p = 0.002) and multivariable (adjusted odds ratio, 0.31; 95% confidence interval, 0.15-0.63; p = 0.002) logistic regression models for positive blood culture. The area under the receiver operating characteristic (AUROC) curve of the multivariable model for predicting positive blood cultures was 0.86. Conclusion There was a negative correlation between prior antibiotic use and positive blood cultures in the general internal medicine outpatient department. Therefore, physicians should interpret the negative results of blood cultures performed after the administration of antibiotics with care.
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Affiliation(s)
- Takanobu Hirosawa
- Department of Diagnostic and Generalist Medicine, Dokkyo Medical University, Shimotsuga, Tochigi, Japan
| | - Tetsu Sakamoto
- Department of Diagnostic and Generalist Medicine, Dokkyo Medical University, Shimotsuga, Tochigi, Japan
| | - Shogo Hanai
- Departments of Microbiology and Infectious Diseases, Fujita Health University School of Medicine, Aichi, Japan
| | - Yukinori Harada
- Department of Diagnostic and Generalist Medicine, Dokkyo Medical University, Shimotsuga, Tochigi, Japan
| | - Taro Shimizu
- Department of Diagnostic and Generalist Medicine, Dokkyo Medical University, Shimotsuga, Tochigi, Japan
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Siev A, Levy E, Chen JT, Gendlina I, Saline A, Mendapara P, Gong MN, Moskowitz A. Assessing a standardized decision-making algorithm for blood culture collection in the intensive care unit. J Crit Care 2023; 75:154255. [PMID: 36773367 PMCID: PMC10548340 DOI: 10.1016/j.jcrc.2023.154255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Revised: 01/07/2023] [Accepted: 01/08/2023] [Indexed: 02/11/2023]
Abstract
PURPOSE Blood cultures are commonly ordered for patients with low risk of bacteremia. Indications for obtaining blood cultures are often broad and ill defined, and decision algorithms for appropriate blood cultures have not been comprehensively evaluated in critically-ill populations. METHODS We conducted a retrospective analysis to assess the frequency of inappropriate blood cultures in the ICUs at Montefiore Medical Center based on an evidence-based guidance algorithm. Blood cultures were reviewed against this algorithm to determine their appropriateness. We calculated the prevalence of inappropriate blood culture and explored the reasons for these collected cultures. RESULTS 300 patients were randomly selected from an initial cohort of 3370 patients. 294 patients were included and of these, 167 patients had at least 1 blood culture drawn. 125 patients had one or more inappropriate blood culture. 61.4% of blood cultures drawn were assessed to be inappropriate. The most common reason for inappropriate cultures was a culture drawn as a result of isolated fever or leukocytosis. CONCLUSION In a cohort of critically-ill patients, inappropriate blood cultures were common. The indications for blood cultures are often not evidence-based, and evidence-based algorithms to guide the collection of blood cultures may offer a way to decrease inappropriate culture orders.
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Affiliation(s)
- Alana Siev
- Memorial Sloan Kettering Cancer Center, Department of Medicine, USA; Montefiore Medical Center, Department of Medicine, USA.
| | - Elana Levy
- Montefiore Medical Center, Department of Medicine, USA
| | - Jen-Ting Chen
- Montefiore Medical Center, Department of Critical Care Medicine, USA; University of California San Francisco, Department of Medicine, Division of Pulmonary and Critical Care Medicine, USA
| | - Inessa Gendlina
- Montefiore Medical Center, Department of Infectious Diseases, USA
| | - Austin Saline
- Montefiore Medical Center, Department of Neurology, USA
| | | | - Michelle Ng Gong
- Montefiore Medical Center, Department of Critical Care Medicine, USA
| | - Ari Moskowitz
- Montefiore Medical Center, Department of Critical Care Medicine, USA
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4
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Fabre V, Carroll KC, Cosgrove SE. Blood Culture Utilization in the Hospital Setting: a Call for Diagnostic Stewardship. J Clin Microbiol 2022; 60:e0100521. [PMID: 34260274 PMCID: PMC8925908 DOI: 10.1128/jcm.01005-21] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
There has been significant progress in detection of bloodstream pathogens in recent decades with the development of more sensitive automated blood culture detection systems and the availability of rapid molecular tests for faster organism identification and detection of resistance genes. However, most blood cultures in clinical practice do not grow organisms, suggesting that suboptimal blood culture collection practices (e.g., suboptimal blood volume) or suboptimal selection of patients to culture (i.e., blood cultures ordered for patients with low likelihood of bacteremia) may be occurring. A national blood culture utilization benchmark does not exist, nor do specific guidelines on when blood cultures are appropriate or when blood cultures are of low value and waste resources. Studies evaluating the potential harm associated with excessive blood cultures have focused on blood culture contamination, which has been associated with significant increases in health care costs and negative consequences for patients related to exposure to unnecessary antibiotics and additional testing. Optimizing blood culture performance is important to ensure bloodstream infections (BSIs) are diagnosed while minimizing adverse events from overuse. In this review, we discuss key factors that influence blood culture performance, with a focus on the preanalytical phase, including technical aspects of the blood culture collection process and blood culture indications. We highlight areas for improvement and make recommendations to improve current blood culture practices among hospitalized patients.
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Affiliation(s)
- Valeria Fabre
- Department of Medicine, Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- Department of Antimicrobial Stewardship, The Johns Hopkins Hospital, Baltimore, Maryland, USA
| | - Karen C. Carroll
- Department of Pathology, Division of Medical Microbiology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Sara E. Cosgrove
- Department of Medicine, Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- Department of Antimicrobial Stewardship, The Johns Hopkins Hospital, Baltimore, Maryland, USA
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The Role of Mid-Regional Proadrenomedullin in the Differential Diagnosis between Culture-Negative and Culture-Positive Sepsis at Emergency Department Admission. Biomedicines 2022; 10:biomedicines10020357. [PMID: 35203566 PMCID: PMC8962368 DOI: 10.3390/biomedicines10020357] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2021] [Revised: 01/20/2022] [Accepted: 01/27/2022] [Indexed: 12/21/2022] Open
Abstract
Background: The host response in culture-negative sepsis (CnS) has been marginally explored upon emergency department (ED) admission. It would be of paramount importance to create a clinical prediction rule to support the emergency department physician in identifying septic patients who can be treated with antibiotics immediately without waiting time to draw cultures if they are unlikely to provide useful diagnostic information. Methods: A multivariable logistic regression analysis was applied to identify the independent clinical variables and serum biomarkers of the culture-negative status among 773 undifferentiated septic patients. Those predictors were combined to build a nomogram predictive of CnS. Results: The serum concentrations of six biomarkers, among the eight biomarkers assayed in this study, were significantly lower in the patients with CnS (449) than in those with culture-positive sepsis (324). After correction for co-variates, only mid-regional proadrenomedullin (MR-proADM) was found to be independently correlated with culture-negative status. Absence of diabetes, hemoglobin concentrations, and respiratory source of infection were the other independent clinical variables integrated into the nomogram—its sensitivity and specificity for CnS were 0.80 and 0.79, respectively. Conclusions: Low concentrations of MR-proADM were independently associated with culture-negative sepsis. Our nomogram, based on the MR-proADM levels, did not predict culture-negative status with reasonable certainty in patients with a definitive diagnosis of sepsis at ED admission.
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6
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Fatemi Y, Bergl PA. Diagnostic Stewardship: Appropriate Testing and Judicious Treatments. Crit Care Clin 2021; 38:69-87. [PMID: 34794632 DOI: 10.1016/j.ccc.2021.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Diagnostic stewardship encompasses the entire diagnosis-to-treatment paradigm in the intensive care unit (ICU). Initially born of the antimicrobial stewardship movement, contemporary diagnostic stewardship aims to promote timely and appropriate diagnostic testing that directly links to management decisions. In the stewardship framework, excessive diagnostic testing in low probability cases is discouraged due to its tendency to generate false-positive results, which have their own downstream consequences. Though the evidence basis for diagnostic stewardship initiatives in the ICU is nascent and largely limited to retrospective analyses, available literature generally suggests that these initiatives are safe, feasible, and associated with similar patient outcomes. As diagnostic testing of critically ill patients becomes increasingly sophisticated in the ensuing decade, a stewardship mindset will aid bedside clinicians in interpreting and incorporating new diagnostic strategies in the ICU.
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Affiliation(s)
- Yasaman Fatemi
- Division of Infectious Diseases, Children's Hospital of Philadelphia, 3401 Civic Center Boulevard, Philadelphia, PA 19104, USA.
| | - Paul A Bergl
- Department of Critical Care, Gundersen Lutheran Medical Center, 1900 South Avenue, Mail Stop LM3-001, La Crosse, WI 54601, USA; Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
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7
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Anteneh DA, Kifle ZD, Mersha GB, Ayele TT. Appropriateness of Antibiotics Use and Associated Factors in Hospitalized Patients at University of Gondar Specialized Hospital, Amhara, Ethiopia: Prospective Follow-up Study. INQUIRY: THE JOURNAL OF HEALTH CARE ORGANIZATION, PROVISION, AND FINANCING 2021; 58:469580211060744. [PMID: 34873941 PMCID: PMC8661117 DOI: 10.1177/00469580211060744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background: Appropriate antibiotic use means that the patient receives the appropriate drug at adequate doses and duration for a susceptible pathogen. This improves the effectiveness of antibiotic therapy and prevents the emergence of resistant pathogens. Thus, this study aimed to assess the appropriateness of antibiotics use and associated factors among hospitalized patients. Methods: A hospital-based prospective follow-up study was conducted in internal medicine. Data were collected by chart review and interview of prescribers and patients using a pre-tested questionnaire derived from RAND modified Delphi method. Appropriate antibiotic use means that the patient receives the drug based on culture result at the right time in adequate doses and duration. Frequencies and percentage distribution of dependent variables were analyzed. Moreover, bivariate and multivariate analyses were used to assess the factors influencing factors. Result: Of the 303 study participants, the mean age was44.36 ± 1.07 years and the majority 173 (57.1%) of the participants were females. The appropriateness of antibiotics use among hospitalized patients was 26 (8.6%). Males have used antibiotics more appropriately than females [5.99 (Adjusted odd ration (AOR) 95% CI 2.00-7.98)], while employed study participants were used antibiotics more appropriately than nonemployees [7.29 (AOR 95% CI 1.34-9.58)]. Moreover, patients who received antibiotics after blood culture [2.74 (AOR 95% CI 1.09-8.37)] and cerebrospinal fluid culture [5.82 (AOR 95% CI 1.84-5.63)] were used antibiotics more appropriately than patients who received antibiotics without culture. In addition, patients who believe that the prescribed antibiotics prevent complication of the disease [4.21 (AOR 95% CI 1.33-7.35)] were used antibiotics more appropriately than those who didn’t understand the use of antibiotics. Conclusion: The appropriateness of antibiotics use was very low in the study area. Patient gender, ethnicity, source of income, patient’s belief in antibiotics, and specimen cultures were significantly associated with the appropriateness of antibiotics use.
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Affiliation(s)
- Demssie Ayalew Anteneh
- Department of Hospital clinical Pharmacy, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Zemene Demelash Kifle
- Department of Pharmacology, School of Pharmacy, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Gizeaddis Belay Mersha
- Department of hospital microbiology, university of Gondar comprehensive specialized hospital, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
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A Diagnostic Stewardship Intervention To Improve Blood Culture Use among Adult Nonneutropenic Inpatients: the DISTRIBUTE Study. J Clin Microbiol 2020; 58:JCM.01053-20. [PMID: 32759354 DOI: 10.1128/jcm.01053-20] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Accepted: 07/25/2020] [Indexed: 12/18/2022] Open
Abstract
Interventions to optimize blood culture (BCx) practices in adult inpatients are limited. We conducted a before-after study evaluating the impact of a diagnostic stewardship program that aimed to optimize BCx use in a medical intensive care unit (MICU) and five medicine units at a large academic center. The program included implementation of an evidence-based algorithm detailing indications for BCx use and education and feedback to providers about BCx rates and indication inappropriateness. Neutropenic patients were excluded. BCx rates from contemporary control units were obtained for comparison. The primary outcome was the change in BCxs ordered with the intervention. Secondary outcomes included proportion of inappropriate BCx, solitary BCx, and positive BCx. Balancing metrics included compliance with the Centers for Medicare and Medicaid Services (CMS) SEP-1 BCx component, 30-day readmission, and all-cause in-hospital and 30-day mortality. After the intervention, BCx rates decreased from 27.7 to 22.8 BCx/100 patient-days (PDs) in the MICU (P = 0.001) and from 10.9 to 7.7 BCx/100 PD for the 5 medicine units combined (P < 0.001). BCx rates in the control units did not decrease significantly (surgical intensive care unit [ICU], P = 0.06; surgical units, P = 0.15). The proportion of inappropriate BCxs did not significantly change with the intervention (30% in the MICU and 50% in medicine units). BCx positivity increased in the MICU (from 8% to 11%, P < 0.001). Solitary BCxs decreased by 21% in the medicine units (P < 0.001). Balancing metrics were similar before and after the intervention. BCx use can be optimized with clinician education and practice guidance without affecting sepsis quality metrics or mortality.
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9
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Santos SB, Cunha AP, Macedo M, Nogueira CL, Brandão A, Costa SP, Melo LDR, Azeredo J, Carvalho CM. Bacteriophage‐receptor binding proteins for multiplex detection of
Staphylococcus
and
Enterococcus
in blood. Biotechnol Bioeng 2020; 117:3286-3298. [DOI: 10.1002/bit.27489] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 06/23/2020] [Accepted: 07/10/2020] [Indexed: 02/06/2023]
Affiliation(s)
- Sílvio B. Santos
- Centre of Biological Engineering University of Minho Braga Portugal
| | | | - Mariana Macedo
- Centre of Biological Engineering University of Minho Braga Portugal
| | - Catarina L. Nogueira
- International Iberian Nanotechnology Laboratory Braga Portugal
- Instituto de Engenharia de Sistemas e Computadores – Microsistemas e Nanotecnologias (INESC MN) and IN – Institute of Nanoscience and Nanotechnolnology Lisbon Portugal
| | - Ana Brandão
- Centre of Biological Engineering University of Minho Braga Portugal
| | - Susana P. Costa
- Centre of Biological Engineering University of Minho Braga Portugal
- International Iberian Nanotechnology Laboratory Braga Portugal
- Instituto de Engenharia de Sistemas e Computadores – Microsistemas e Nanotecnologias (INESC MN) and IN – Institute of Nanoscience and Nanotechnolnology Lisbon Portugal
| | - Luís D. R. Melo
- Centre of Biological Engineering University of Minho Braga Portugal
| | - Joana Azeredo
- Centre of Biological Engineering University of Minho Braga Portugal
| | - Carla M. Carvalho
- Centre of Biological Engineering University of Minho Braga Portugal
- International Iberian Nanotechnology Laboratory Braga Portugal
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10
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Baron HR, Phalen DN, Silvanose CD, Binoy A, Azmanis PN. Multicentric Septic Osteomyelitis and Arthritis Caused by Staphylococcus aureus in a Gyrfalcon ( Falco rusticolus). J Avian Med Surg 2020; 33:406-412. [PMID: 31833309 DOI: 10.1647/2018-408] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
An adult female gyrfalcon (Falco rusticolus) was presented with a right-wing droop and weight loss. Radiographic images revealed osteolysis and osseous proliferation of the right shoulder and the mobile vertebra between the notarium and synsacrum. The tentative diagnosis was vertebral osteomyelitis secondary to septic arthritis. The bird did not respond to antibiotic and anti-inflammatory therapy and represented 10 days later, with feathers soiled with feces, an impacted, dilated cloaca, and an inability to stand due to spastic paralysis of the hind legs. The bird's condition did not improve with 24 hours of supportive care and its quality of life was considered poor; therefore, the patient was euthanatized and submitted for postmortem examination. Multicentric septic osteomyelitis and arthritis were confirmed in the mobile vertebra between the notarium and synsacrum and the right shoulder. Despite 10 days of antibiotic therapy, Staphylococcus aureus was isolated from within the 2 locations in which septic osteomyelitis and arthritis were identified. This report describes the clinical features, diagnosis, and pathologic findings of septic osteomyelitis and arthritis caused by S aureus in a falcon.
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Affiliation(s)
- Hamish R Baron
- Avian Reptile and Exotic Pet Hospital, Brownlow Hill, Sydney School of Veterinary Science, University of Sydney, NSW, Australia.,Dubai Falcon Hospital, Zabeel Dubai, United Arab Emirates
| | - David N Phalen
- Avian Reptile and Exotic Pet Hospital, Brownlow Hill, Sydney School of Veterinary Science, University of Sydney, NSW, Australia
| | | | - Ambily Binoy
- Dubai Falcon Hospital, Zabeel Dubai, United Arab Emirates
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11
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Mitaka H, Gomez T, Lee YI, Perlman DC. Risk Factors for Positive Follow-Up Blood Cultures in Gram-Negative Bacilli Bacteremia: Implications for Selecting Who Needs Follow-Up Blood Cultures. Open Forum Infect Dis 2020; 7:ofaa110. [PMID: 32328509 PMCID: PMC7166118 DOI: 10.1093/ofid/ofaa110] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Accepted: 03/25/2020] [Indexed: 12/31/2022] Open
Abstract
Background The value of follow-up blood cultures (FUBCs) to document clearance of bacteremia due to Gram-negative bacilli (GNB) has not been well established. Although previous studies suggested that the yield of FUBCs for GNB bacteremia is low, it remains to be elucidated for whom FUBC may be beneficial and for whom it is unnecessary. Methods A retrospective cohort study was performed at 4 acute care hospitals to identify risk factors for positive FUBCs with GNB bacteremia and to better guide clinicians’ decisions as to which patients may or may not benefit from FUBCs. Participants included adult patients with GNB bacteremia who had FUBCs and were admitted between January 2017 and December 2018. The primary outcomes were the factors associated with positive FUBCs and the yield of FUBCs with and without the factors. Results Of 306 patients with GNB bacteremia who had FUBCs, 9.2% (95% confidence interval, 6.2%–13.0%) had the same GNB in FUBCs. In the multivariate logistic regression analysis, end-stage renal disease on hemodialysis, intravascular device, and bacteremia due to extended-spectrum β-lactamase or carbapenemase-producing organism were identified as independent predictors of positive FUBCs with GNB bacteremia. Approximately 7 FUBCs and 30 FUBCs were needed for patients with ≥1 or no risk factors, respectively, to yield 1 positive result. SummaryThis multi-site retrospective cohort study found that among patients with gram-negative bacilli (GNB) bacteremia, having ESRD on hemodialysis, intravascular devices, or bacteremia due to multi-drug resistant GNB were each independently associated with having a positive follow-up blood culture. Conclusions Follow-up blood culture may not be necessary for all patients with GNB bacteremia and has the highest yield in patients with 1 or more risk factors.
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Affiliation(s)
- Hayato Mitaka
- Department of Medicine, Mount Sinai Beth Israel, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Tessa Gomez
- Division of Infectious Diseases, Department of Medicine, Mount Sinai Beth Israel, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Young Im Lee
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, Mount Sinai Beth Israel, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - David C Perlman
- Division of Infectious Diseases, Department of Medicine, Mount Sinai Beth Israel, Icahn School of Medicine at Mount Sinai, New York, New York, USA
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12
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Cheng MP, Stenstrom R, Paquette K, Stabler SN, Akhter M, Davidson AC, Gavric M, Lawandi A, Jinah R, Saeed Z, Demir K, Huang K, Mahpour A, Shamatutu C, Caya C, Troquet JM, Clark G, Yansouni CP, Sweet D. Blood Culture Results Before and After Antimicrobial Administration in Patients With Severe Manifestations of Sepsis: A Diagnostic Study. Ann Intern Med 2019; 171:547-554. [PMID: 31525774 DOI: 10.7326/m19-1696] [Citation(s) in RCA: 108] [Impact Index Per Article: 21.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Administering antimicrobial agents before obtaining blood cultures could potentially decrease time to treatment and improve outcomes, but it is unclear how this strategy affects diagnostic sensitivity. OBJECTIVE To determine the sensitivity of blood cultures obtained shortly after initiation of antimicrobial therapy in patients with severe manifestations of sepsis. DESIGN Patient-level, single-group, diagnostic study. (ClinicalTrials.gov: NCT01867905). SETTING 7 emergency departments in North America. PARTICIPANTS Adults with severe manifestations of sepsis, including systolic blood pressure less than 90 mm Hg or a serum lactate level of 4 mmol/L or more. INTERVENTION Blood cultures were obtained before and within 120 minutes after initiation of antimicrobial treatment. MEASUREMENTS Sensitivity of blood cultures obtained after initiation of antimicrobial therapy. RESULTS Of 3164 participants screened, 325 were included in the study (mean age, 65.6 years; 62.8% men) and had repeated blood cultures drawn after initiation of antimicrobial therapy (median time, 70 minutes [interquartile range, 50 to 110 minutes]). Preantimicrobial blood cultures were positive for 1 or more microbial pathogens in 102 of 325 (31.4%) patients. Postantimicrobial blood cultures were positive for 1 or more microbial pathogens in 63 of 325 (19.4%) patients. The absolute difference in the proportion of positive blood cultures between pre- and postantimicrobial testing was 12.0% (95% CI, 5.4% to 18.6%; P < 0.001). Sensitivity of postantimicrobial culture was 52.9% (CI, 42.8% to 62.9%). When the results of other microbiological cultures were included, microbial pathogens were found in 69 of 102 (67.6% [CI, 57.7% to 76.6%]) patients. LIMITATION Only a proportion of screened patients were recruited. CONCLUSION Among patients with severe manifestations of sepsis, initiation of empirical antimicrobial therapy significantly reduces the sensitivity of blood cultures drawn shortly after treatment initiation. PRIMARY FUNDING SOURCE Vancouver Coastal Health, St. Paul's Hospital Foundation Emergency Department Support Fund, the Fonds de recherche Santé-Québec, and the Maricopa Medical Foundation.
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Affiliation(s)
- Matthew P Cheng
- Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts (M.P.C.)
| | - Robert Stenstrom
- University of British Columbia, St. Paul's Hospital, and the Centre for Health Evaluation and Outcome Sciences, Vancouver, British Columbia, Canada (R.S.)
| | - Katryn Paquette
- Montreal Children's Hospital, McGill University, Montreal, Quebec, Canada (K.P.)
| | - Sarah N Stabler
- Surrey Memorial Hospital, University of British Columbia, Surrey, British Columbia, Canada (S.N.S.)
| | - Murtaza Akhter
- University of Arizona College of Medicine, Phoenix, Arizona (M.A.)
| | - Adam C Davidson
- University of British Columbia and Lion's Gate Hospital, Vancouver, British Columbia, Canada (A.C.D.)
| | - Marko Gavric
- University of British Columbia, Vancouver, British Columbia, Canada (M.G., R.J., K.H., C.S.)
| | - Alexander Lawandi
- McGill University Health Centre, McGill University, Montreal, Quebec, Canada (A.L., K.D., C.C., J.T., G.C., C.P.Y.)
| | - Rehman Jinah
- University of British Columbia, Vancouver, British Columbia, Canada (M.G., R.J., K.H., C.S.)
| | - Zahid Saeed
- Banner University Medical Center, Phoenix, Arizona (Z.S.)
| | - Koray Demir
- McGill University Health Centre, McGill University, Montreal, Quebec, Canada (A.L., K.D., C.C., J.T., G.C., C.P.Y.)
| | - Kelly Huang
- University of British Columbia, Vancouver, British Columbia, Canada (M.G., R.J., K.H., C.S.)
| | - Amirali Mahpour
- London Health Sciences Centre, London, Ontario, Canada (A.M.)
| | - Chris Shamatutu
- University of British Columbia, Vancouver, British Columbia, Canada (M.G., R.J., K.H., C.S.)
| | - Chelsea Caya
- McGill University Health Centre, McGill University, Montreal, Quebec, Canada (A.L., K.D., C.C., J.T., G.C., C.P.Y.)
| | - Jean-Marc Troquet
- McGill University Health Centre, McGill University, Montreal, Quebec, Canada (A.L., K.D., C.C., J.T., G.C., C.P.Y.)
| | - Greg Clark
- McGill University Health Centre, McGill University, Montreal, Quebec, Canada (A.L., K.D., C.C., J.T., G.C., C.P.Y.)
| | - Cedric P Yansouni
- McGill University Health Centre, McGill University, Montreal, Quebec, Canada (A.L., K.D., C.C., J.T., G.C., C.P.Y.)
| | - David Sweet
- University of British Columbia and Vancouver General Hospital, Vancouver, British Columbia, Canada (D.S.)
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13
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Qu J, Yuan HY, Huang Y, Qu Q, Ou-Yang ZB, Li GH, Zhu HH, Lu Q. Evaluation of neutrophil–lymphocyte ratio in predicting bloodstream infection. Biomark Med 2019; 13:1255-1261. [PMID: 31580146 DOI: 10.2217/bmm-2018-0253] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Aim: The prognostic role of neutrophil-to-lymphocyte ratio (NLR) in bloodstream infection (BSI) deserves further investigation. Patients & methods: The NLR values were measured and compared in BSI patients and healthy controls. The receiver operating characteristic of NLR and cut-off values were measured in BSI patients and subgroups. Results: We have measured the NLR of study group with 2160 BSI patients and normal group with 2523 healthy controls, which was significantly high in study group (11.36 ± 21.38 vs 2.53 ± 0.86; p < 0.001) and the area under the curve was 0.834 (95% CI: 0.825–0.842; p < 0.001). The critical value of NLR for diagnosis of BSI was 3.09, with a sensitivity of 75.3%, and a specificity of 93.6%. Conclusion: NLR is an effective diagnostic indicator of including BSIs of Gram-negative bacteria, Gram-positive bacteria and fungus.
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Affiliation(s)
- Jian Qu
- Department of Pharmacy, The Second Xiangya Hospital, Central South University; Institute of Clinical Pharmacy, Central South University, Changsha 410011, PR China
| | - Hai-Yan Yuan
- Department of Pharmacy, The Second Xiangya Hospital, Central South University; Institute of Clinical Pharmacy, Central South University, Changsha 410011, PR China
| | - Ying Huang
- Department of Pharmacy, College of Pharmacy, Central South University, Changsha 410011, PR China
| | - Qiang Qu
- Department of Pharmacy, Xiangya Hospital, Central South University, Changsha 410078, PR China
| | - Zhan-Bo Ou-Yang
- Department of Pharmacy, The Second Xiangya Hospital, Central South University; Institute of Clinical Pharmacy, Central South University, Changsha 410011, PR China
| | - Guo-Hua Li
- Department of Pharmacy, The Second Xiangya Hospital, Central South University; Institute of Clinical Pharmacy, Central South University, Changsha 410011, PR China
| | - Hai-Hong Zhu
- Department of Pharmacy, The Second Xiangya Hospital, Central South University; Institute of Clinical Pharmacy, Central South University, Changsha 410011, PR China
| | - Qiong Lu
- Department of Pharmacy, The Second Xiangya Hospital, Central South University; Institute of Clinical Pharmacy, Central South University, Changsha 410011, PR China
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Sheikhbahaei S, Mohammadi A, Sherkat R, Naeini AE, Yaran M, Najafi S. Invasive Fungal Infection in Febrile Patients with Hematologic Malignancies Undergoing Chemotherapy in Iran. Endocr Metab Immune Disord Drug Targets 2019; 19:302-307. [PMID: 30747087 DOI: 10.2174/1871530319666190211163245] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2017] [Revised: 05/15/2018] [Accepted: 01/02/2019] [Indexed: 11/22/2022]
Abstract
BACKGROUND Patients with hematological malignancies undergoing cytotoxic chemotherapy are susceptible to develop invasive fungal infections particularly Aspergillus and Candida spp. Early detection of these infections is required to start immediate antifungal therapy and increase the survival of these patients. METHOD Our study included consecutive patients of any age with hematologic malignancies who were hospitalized to receive chemotherapy and suffer from persistent fever (rectal temperature >38.5°C) for more than 5 days despite receiving broad-spectrum antibiotics. A whole blood sample was taken and sent for blood culture. PCR was also conducted for Aspergillus and Candida species. RESULTS One hundred and two patients were investigated according to the inclusion criteria. The most common hematologic malignancy was AML affecting 38 patients (37.2%). Six patients were diagnosed with invasive fungal infections (A. fumigatus n=3, C. albicans n=2, A. flavus n=1) by PCR (5.8%) while blood culture showed fungus only in 1 patient. Three more cases were known as probable IFI since they responded to antifungal therapy but the PCR result was negative for them. AML was the most prevalent malignancy in IFI patients (83.3%) and odds ratio for severing neutropenia was 21.5. Odds for each of the baseline characteristics of patients including gender, age>60, diabetes mellitus, previous IFI, history of using more than 3 antibiotics, antifungal prophylaxis, episodes of chemotherapy> 8 and chemotherapy regimen of daunarubicin+cytarabine were calculated. CONCLUSION We found that multiplex real-time PCR assay is more accurate than blood culture in detecting fungal species and the results are prepared sooner. Among all factors, the only type of cancer (AML) and severe neutropenia, were found to be risk factors for the development of fungal infections in all hematologic cancer patients and previous IFI was a risk factor only AML patients.
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Affiliation(s)
- Saba Sheikhbahaei
- Acquired Immunodeficiency Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Alireza Mohammadi
- Acquired Immunodeficiency Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Roya Sherkat
- Acquired Immunodeficiency Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Alireza Emami Naeini
- Infectious Diseases and Tropical Medicine Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Majid Yaran
- Nosocomial Infection Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Somaye Najafi
- Acquired Immunodeficiency Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
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15
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Pilecky M, Schildberger A, Knabl L, Orth-Höller D, Weber V. Influence of antibiotic treatment on the detection of S. aureus in whole blood following pathogen enrichment. BMC Microbiol 2019; 19:180. [PMID: 31387527 PMCID: PMC6683330 DOI: 10.1186/s12866-019-1559-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2019] [Accepted: 07/30/2019] [Indexed: 02/06/2023] Open
Abstract
Background Early pathogen detection and identification are crucial for an effective and targeted antibiotic therapy in patients suffering from blood stream infection. Molecular diagnostic methods can accelerate pathogen identification as compared to blood culture, but frequently suffer from the inhibition of polymerase chain reation (PCR) by sample matrix components, such as host DNA, anticoagulants, or plasma proteins. To overcome this limitation, molecular diagnostic methods commonly rely on pathogen enrichment by selective lysis of blood cells and pelleting of intact pathogens prior to analysis. Results Here, we investigated the impact of antibiotic treatment on the recovery of pathogen DNA using an established pathogen enrichment protocol. Based on the hypothesis that induction of bacterial cell wall disintegration following antibiotic administration leads to incomplete pelleting of pathogen DNA, S. aureus was grown in human whole blood with or without addition of cell wall active (vancomycin, piperacillin) or non cell wall active (ciprofloxacin, clindamycin) antibiotics at clinically relevant concentrations. Pathogen detection remained unaffected by non cell wall active antibiotics or even increased in the presence of cell wall active antibiotics, indicating improved accessibility of pathogen DNA. Likewise, mechanical lysis of S. aureus prior to pathogen enrichment resulted in increased recovery of pathogen DNA. Quantification of pathogen and human DNA after selective lysis of blood cells and pathogen enrichment confirmed partial depletion of human DNA, leading to a net enrichment of pathogen DNA over human DNA. Conclusion Concurrent antibiotic administration does not reduce the recovery of pathogen DNA during pathogen enrichment by selective lysis and centrifugation. Leads to a 10-fold human DNA depletion as compared to pathogen DNA. Moreover, we confirm that the recovery of pathogen DNA after pathogen enrichment is not negatively influenced by concurrent antibiotic administration. Electronic supplementary material The online version of this article (10.1186/s12866-019-1559-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Matthias Pilecky
- Center for Biomedical Technology, Department for Health Sciences and Biomedicine, Danube University Krems, Dr.-Karl-Dorrek-Strasse 30, 3500, Krems, Austria
| | - Anita Schildberger
- Center for Biomedical Technology, Department for Health Sciences and Biomedicine, Danube University Krems, Dr.-Karl-Dorrek-Strasse 30, 3500, Krems, Austria
| | - Ludwig Knabl
- Division of Hygiene and Medical Microbiology, Medical University of Innsbruck, Schöpfstraße 41, A-6020, Innsbruck, Austria
| | - Dorothea Orth-Höller
- Division of Hygiene and Medical Microbiology, Medical University of Innsbruck, Schöpfstraße 41, A-6020, Innsbruck, Austria
| | - Viktoria Weber
- Center for Biomedical Technology, Department for Health Sciences and Biomedicine, Danube University Krems, Dr.-Karl-Dorrek-Strasse 30, 3500, Krems, Austria. .,Christian Doppler Laboratory for Innovative Therapy Approaches in Sepsis, Department for Health Sciences and Biomedicine, Danube University Krems, Dr.-Karl-Dorrek-Strasse 30, 3500, Krems, Austria. .,Department for Biomedical Research, Danube University Krems, Dr.-Karl-Dorrek-Strasse 30, 3500, Krems, Austria.
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16
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Rand KH, Beal SG, Rivera K, Allen B, Payton T, Lipori GP. Hourly Effect of Pretreatment With IV Antibiotics on Blood Culture Positivity Rate in Emergency Department Patients. Open Forum Infect Dis 2019; 6:ofz179. [PMID: 31139670 PMCID: PMC6527085 DOI: 10.1093/ofid/ofz179] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Accepted: 05/10/2019] [Indexed: 11/18/2022] Open
Abstract
Although it is intuitive that antibiotics administered before obtaining a blood culture would reduce the likelihood of obtaining a positive culture, it is not clear exactly how rapidly and to what extent blood becomes sterile after administration of intravenous (IV) antibiotics. Using a large data set of patients admitted from the UFHealth Shands Adult Emergency Department (ED) between 2012 and 2016 (n = 25 686), we had the opportunity to more closely examine the effect of starting IV antibiotics before vs after obtaining blood cultures. We present data on the effect of pretreatment with IV antibiotics for both septic and nonseptic ED patients on the blood culture positivity rate on an hour-by-hour basis, as well as the effects on distribution of species recovered and the impact of antibiotic resistance in empiric treatment with antibiotics.
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Affiliation(s)
- Kenneth H Rand
- Department of Pathology, Immunology and Laboratory Medicine, Gainesville, Florida
| | - Stacy G Beal
- Department of Pathology, Immunology and Laboratory Medicine, Gainesville, Florida
| | - Kimberly Rivera
- Department of Emergency Medicine, UFHealth Shands Hospital, University of Florida, Gainesville, Florida
| | - Brandon Allen
- Department of Emergency Medicine, UFHealth Shands Hospital, University of Florida, Gainesville, Florida
| | - Thomas Payton
- Department of Emergency Medicine, UFHealth Shands Hospital, University of Florida, Gainesville, Florida
| | - Gloria P Lipori
- Office of Chief Information Officer, UFHealth Shands Hospital, University of Florida, Gainesville, Florida
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Gozdas HT, Gel KT, Yasayacak A, Kesgin MT, Akdeniz H. The role of hematological parameters in estimating nosocomial sepsis. ELECTRONIC JOURNAL OF GENERAL MEDICINE 2019. [DOI: 10.29333/ejgm/108678] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
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18
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Giuliano C, Patel CR, Kale-Pradhan PB. A Guide to Bacterial Culture Identification And Results Interpretation. P & T : A PEER-REVIEWED JOURNAL FOR FORMULARY MANAGEMENT 2019; 44:192-200. [PMID: 30930604 PMCID: PMC6428495] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
PURPOSE To provide a guide to interpreting bacterial culture results. METHODS Studies were identified via a PubMed literature search (from 1966 to January 2018). Search terms included microbial sensitivity tests, microbial drug resistance, and anti-infective agents/pharmacology. Articles were included if they were published in English. References within identified articles were also reviewed. RESULTS This paper reviewed core concepts of interpreting bacterial culture results, including timing of cultures, common culture sites, potential for contamination, interpreting the Gram stain, role of rapid diagnostic tests, conventional antibiotic susceptibility testing, and automated testing. CONCLUSION This guide can assist pharmacists in their role as integral members of the antimicrobial stewardship team in an effort to improve patient care.
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19
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McKenzie GAG. Evidence-based out-of-hours hospital medicine. Postgrad Med J 2018; 94:588-595. [PMID: 30373909 DOI: 10.1136/postgradmedj-2017-135049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2017] [Revised: 06/14/2017] [Accepted: 09/28/2018] [Indexed: 11/04/2022]
Abstract
Out-of-hours (OOH) hospital ward cover is generally provided by junior doctors and is typified by heavy workloads, reduced staff numbers and various non-urgent nurse-initiated requests. The present inefficiencies and management problems with the OOH service are reflected by the high number of quality improvement projects recently published. In this narrative review, five common situations peculiar to the OOH general ward setting are discussed with reference to potential areas of inefficiency and unnecessary management steps: (1) prescription of hypnotics and sedatives; (2) overnight fluid therapy; (3) fever; (4) overnight hypotension and (5) chasing outstanding routine diagnostic tests. It is evident that research and consensus guidelines for many clinical situations in the OOH setting are a neglected arena. Many recommendations made herein are based on expert opinion or first principles. In contrast, the management of significant abnormalities in outstanding blood results is based on well-established guidelines using high-quality systematic reviews.
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20
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Jiang J, Liu R, Yu X, Yang R, Xu H, Mao Z, Wang Y. The neutrophil-lymphocyte count ratio as a diagnostic marker for bacteraemia: A systematic review and meta-analysis. Am J Emerg Med 2018; 37:1482-1489. [PMID: 30413366 DOI: 10.1016/j.ajem.2018.10.057] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2018] [Revised: 10/24/2018] [Accepted: 10/28/2018] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Bacteraemia is a common cause of increased morbidity and mortality in critically ill patients, but its early diagnosis and identification are complicated. The neutrophil-lymphocyte count ratio (NLCR) has been suggested as a useful indicator for the diagnosis of bacteraemia. We performed this meta-analysis to investigate the diagnostic accuracy of the NLCR for bacteraemia. METHODS We searched the PubMed, Embase, Web of Science, and Cochrane Library databases for this meta-analysis. We calculated individual and pooled sensitivities and specificities. I2 statistics and Cochran's Q test were used to evaluate heterogeneity, and the cause of heterogeneity was explored with sensitivity analyses. RESULTS In total, 8 of 1086 eligible articles were included in the present meta-analysis. The pooled analyses revealed that the diagnostic accuracy of the NLCR in terms of its bacteraemia sensitivity was 0.723 [95% CI: 0.660, 0.777], and its specificity was 0.596 [95% CI: 0.556, 0.634]. The area under the summary receiver operating characteristic curve was 0.69 [95% CI 0.65-0.73]. CONCLUSION The NLCR is an easy-to-collect marker for bacteraemia. However, the NLCR is inadequate, and only a combination of multiple biomarkers will improve its diagnostic accuracy for bacteraemia.
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Affiliation(s)
- Jiawei Jiang
- Department of Critical Care Medicine, Tianjin Medical University First Center Clinical College, Tianjin, People's Republic of China
| | - Rui Liu
- Department of Critical Care Medicine, Tangdu Hospital, Second Affiliated Hospital of Air Force Military Medical University, Xian, People's Republic of China
| | - Xin Yu
- Department of Critical Care Medicine, Tianjin Medical University First Center Clinical College, Tianjin, People's Republic of China
| | - Rui Yang
- Department of Critical Care Medicine, Tianjin Medical University First Center Clinical College, Tianjin, People's Republic of China
| | - Hua Xu
- Department of Critical Care Medicine, Tianjin First Center Hospital, Tianjin, People's Republic of China; Tianjin First Center Hospital Emergency Medical Research Institute, Tianjin, People's Republic of China
| | - Zhi Mao
- Department of Critical Care Medicine, Chinese People's Liberation Army General Hospital, Beijing, People's Republic of China
| | - Yongqiang Wang
- Department of Critical Care Medicine, Tianjin First Center Hospital, Tianjin, People's Republic of China; Tianjin First Center Hospital Emergency Medical Research Institute, Tianjin, People's Republic of China.
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21
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Alemkere G, Gilagil G, Gebrehiwot T, Tilahun Z, Mengist HM. Physicians' utilization of microbiologic reports and determinants of their preference to order culture in Tikur Anbessa Specialized Hospital, Addis Ababa, Ethiopia. BMC Res Notes 2018; 11:675. [PMID: 30241563 PMCID: PMC6151033 DOI: 10.1186/s13104-018-3782-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2018] [Accepted: 09/19/2018] [Indexed: 12/29/2022] Open
Abstract
Objective The main aim of the study was to assess physicians’ utilization of microbiologic reports and determinants of their preference in ordering microbiologic
culture among patients with systemic bacterial infection at Tikur Anbessa Specialized Hospital. Results Of the total 369 patients observed, 91 (24.7%) had microbiologic reports (culture and gram stain). About 12% of the patients had culture reports of which majority (77.8%) were available after 72 h of the initial antibiotic start. Antimicrobial susceptibility test was done for 83.3% of the positive cultures. Although 99.5% of the patients were initially placed on empiric therapy, adjustment was done in 114 (30.9%) of the patients. Among these patients with adjusted therapy, changes were unrelated to microbiologic reasons in 103 (90.4%) patients. None of these changes were for the reason of streamlining therapy. Prolonged hospital stay (AOR = 2.9, 95% CI 1.2–6.7), senior physician consultation (AOR = 4.1, 95% CI 1.1–17.7) and suspicion of new site of infection (AOR = 2.6, 95% CI 1.1–6.2) were positive independent predictors for physicians’ preference in ordering culture. Electronic supplementary material The online version of this article (10.1186/s13104-018-3782-y) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Getachew Alemkere
- Department of Clinical Pharmacy, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Getu Gilagil
- Department of Pharmacology and Clinical Pharmacy, School of Pharmacy, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Teklu Gebrehiwot
- Department of Clinical Pharmacy, Ayder Referral Hospital, Mekele, Ethiopia
| | - Zelalem Tilahun
- Department of Pharmacology and Clinical Pharmacy, School of Pharmacy, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Hylemariam Mihiretie Mengist
- Department of Medical Laboratory Sciences, College of Health Sciences, Debre Markos University, Debre Markos, Ethiopia. .,Laboratory of Structural Immunology, School of Life Sciences, University of Science and Technology of China (USTC), Hefei, Anhui, China.
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Nuutila J, Hohenthal U, Oksi J, Jalava-Karvinen P. A single-tube two-color flow cytometric method for distinguishing between febrile bacterial and viral infections. J Microbiol Methods 2018; 152:61-68. [DOI: 10.1016/j.mimet.2018.07.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2018] [Revised: 07/26/2018] [Accepted: 07/27/2018] [Indexed: 02/07/2023]
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23
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Jiang H, Huai Y, Chen H, Uyeki TM, Chen M, Guan X, Liu S, Peng Y, Yang H, Luo J, Zheng J, Huang J, Peng Z, Xiang N, Zhang Y, Klena JD, Hu DJ, Rainey JJ, Huo X, Xiao L, Xing X, Zhan F, Yu H, Varma JK. Invasive Streptococcus pneumoniae infection among hospitalized patients in Jingzhou city, China, 2010-2012. PLoS One 2018; 13:e0201312. [PMID: 30125283 PMCID: PMC6101356 DOI: 10.1371/journal.pone.0201312] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2017] [Accepted: 07/12/2018] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Streptococcus pneumoniae (Sp) is a leading cause of bacterial pneumonia, meningitis, and sepsis and a major source of morbidity and mortality worldwide. Invasive pneumococcal disease (IPD) is defined as isolation of Sp from a normally sterile site, including blood or cerebrospinal fluid. The aim of this study is to describe outcomes as well as clinical and epidemiological characteristics of hospitalized IPD case patients in central China. METHODS We conducted surveillance for IPD among children and adults from April 5, 2010 to September 30, 2012, in four major hospitals in Jingzhou City, Hubei Province. We collected demographic, clinical, and outcome data for all enrolled hospitalized patients with severe acute respiratory infection (SARI) or meningitis, and collected blood, urine, and cerebrospinal fluid (CSF) for laboratory testing for Sp infections. Collected data were entered into Epidata software and imported into SPSS for analysis. RESULTS We enrolled 22,375 patients, including 22,202 (99%) with SARI and 173 (1%) with meningitis. One hundred and eighteen (118, 3%) with either SARI or meningitis were Sp positive, 32 (0.8%) from blood/CSF culture, and 87 (5%) from urine antigen testing. Of those 118 patients, 57% were aged ≥65 years and nearly 100% received antibiotics during hospitalization. None were previously vaccinated with 7-valent pneumococcal conjugate vaccine (PCV 7), 23-valent pneumococcal polysaccharide vaccine, or seasonal influenza vaccine. The main serotypes identified were 14, 12, 3, 1, 19F, 4, 5, 9V, 15 and 18C, corresponding to serotype coverage rates of 42%, 63%, and 77% for PCV7, PCV10, and PCV13, respectively. CONCLUSIONS Further work is needed to expand access to pneumococcal vaccination in China, both among children and potentially among the elderly, and inappropriate use of antibiotics is a widespread and serious problem in China.
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Affiliation(s)
- Hui Jiang
- Key Laboratory of Surveillance and Early-warning on Infectious Disease, Division of Infectious Disease, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Yang Huai
- China-US Collaborative Program on Emerging and Re-Emerging Infection Disease, Center for Global Health, Centers for Disease Control and Prevention, Beijing, China
| | - Hui Chen
- Hubei Provincial Center for Disease Control and Prevention, Wuhan, China
| | - Timothy M. Uyeki
- Influenza Division, National Center for Immunization and Respiratory Diseases, Atlanta, GA, United States of America
| | - Maoyi Chen
- Jingzhou Center for Disease Control and Prevention, Jingzhou, China
| | - Xuhua Guan
- Hubei Provincial Center for Disease Control and Prevention, Wuhan, China
| | - Shali Liu
- Jingzhou Central Hospital, Jingzhou, China
| | - Youxing Peng
- Jingzhou First People’s Hospital, Jingzhou, China
| | - Hui Yang
- Jingzhou Second People’s Hospital, Jingzhou, China
| | - Jun Luo
- Jingzhou Maternal and Children’s Hospital, Jingzhou, China
| | - Jiandong Zheng
- Key Laboratory of Surveillance and Early-warning on Infectious Disease, Division of Infectious Disease, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Jigui Huang
- Jingzhou Center for Disease Control and Prevention, Jingzhou, China
| | - Zhibin Peng
- Key Laboratory of Surveillance and Early-warning on Infectious Disease, Division of Infectious Disease, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Nijuan Xiang
- Key Laboratory of Surveillance and Early-warning on Infectious Disease, Division of Infectious Disease, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Yuzhi Zhang
- China-US Collaborative Program on Emerging and Re-Emerging Infection Disease, Center for Global Health, Centers for Disease Control and Prevention, Beijing, China
| | - John D. Klena
- China-US Collaborative Program on Emerging and Re-Emerging Infection Disease, Center for Global Health, Centers for Disease Control and Prevention, Beijing, China
| | - Dale J. Hu
- China-US Collaborative Program on Emerging and Re-Emerging Infection Disease, Center for Global Health, Centers for Disease Control and Prevention, Beijing, China
| | - Jeanette J. Rainey
- China-US Collaborative Program on Emerging and Re-Emerging Infection Disease, Center for Global Health, Centers for Disease Control and Prevention, Beijing, China
- Global Disease Detection Branch, Division of Global Health Protection, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, GA, United States of America
| | - Xixiang Huo
- Hubei Provincial Center for Disease Control and Prevention, Wuhan, China
| | - Lin Xiao
- Jingzhou Center for Disease Control and Prevention, Jingzhou, China
| | - Xuesen Xing
- Hubei Provincial Center for Disease Control and Prevention, Wuhan, China
| | - Faxian Zhan
- Hubei Provincial Center for Disease Control and Prevention, Wuhan, China
| | - Hongjie Yu
- Key Laboratory of Surveillance and Early-warning on Infectious Disease, Division of Infectious Disease, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Jay K. Varma
- China-US Collaborative Program on Emerging and Re-Emerging Infection Disease, Center for Global Health, Centers for Disease Control and Prevention, Beijing, China
- Global Disease Detection Branch, Division of Global Health Protection, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, GA, United States of America
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Nakanishi K, Kawano H, Amano T, Omori Y, Kanma H, Hirano T. [Stroke due to infective endocarditis diagnosed by the retrieved thrombus: a case report]. Rinsho Shinkeigaku 2018; 58:35-40. [PMID: 29269698 DOI: 10.5692/clinicalneurol.cn-001099] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
A 80-years-old woman suddenly presented with aphasia, right hemiparesis, and dysesthesia. MRA showed the left middle cerebral artery occlusion. She was diagnosed as hyperacute ischemic stroke. She was treated with intravenous recombinant tissue plasminogen activator and underwent endovascular thrombectomy. On admission, she had a fever and high C reactive protein, and was treated with antibiotic therapy. The pathological diagnosis of the retrieved thrombus revealed the cluster of the gram positive cocci. The blood culture was negative and thransthoracic echocardiogram did not detect the vegetation. She was finally diagnosed as cardioembolic stroke due to infective endocarditis based on the pathological diagnosis of the retrieved thrombus. The pathological diagnosis of the retrieved thrombus was quite important to clarify the cause of ischemic stroke.
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Affiliation(s)
- Kaoru Nakanishi
- Department of Stroke and Cerebrovascular Medicine, Kyorin University
| | - Hiroyuki Kawano
- Department of Stroke and Cerebrovascular Medicine, Kyorin University
| | - Tatsuo Amano
- Department of Stroke and Cerebrovascular Medicine, Kyorin University
| | | | | | - Teruyuki Hirano
- Department of Stroke and Cerebrovascular Medicine, Kyorin University
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Ashrafi M, Bates M, Baguneid M, Alonso-Rasgado T, Rautemaa-Richardson R, Bayat A. Volatile organic compound detection as a potential means of diagnosing cutaneous wound infections. Wound Repair Regen 2017; 25:574-590. [DOI: 10.1111/wrr.12563] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2017] [Accepted: 06/22/2017] [Indexed: 12/11/2022]
Affiliation(s)
- Mohammed Ashrafi
- Plastic and Reconstructive Surgery Research; Institute of Inflammation and Repair, Centre for Dermatological Research, University of Manchester, Manchester; United Kingdom
- University Hospital South Manchester NHS Foundation Trust, Wythenshawe Hospital; Manchester United Kingdom
- Bioengineering Group, School of Materials; University of Manchester, Manchester; United Kingdom
| | | | - Mohamed Baguneid
- University Hospital South Manchester NHS Foundation Trust, Wythenshawe Hospital; Manchester United Kingdom
| | - Teresa Alonso-Rasgado
- Bioengineering Group, School of Materials; University of Manchester, Manchester; United Kingdom
| | - Riina Rautemaa-Richardson
- University Hospital South Manchester NHS Foundation Trust, Wythenshawe Hospital; Manchester United Kingdom
- Institute of Inflammation and Repair, Manchester Academic Health Science Centre, University of Manchester; Manchester United Kingdom
| | - Ardeshir Bayat
- Plastic and Reconstructive Surgery Research; Institute of Inflammation and Repair, Centre for Dermatological Research, University of Manchester, Manchester; United Kingdom
- Bioengineering Group, School of Materials; University of Manchester, Manchester; United Kingdom
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Kotaskova I, Nemec P, Vanerkova M, Malisova B, Tejkalova R, Orban M, Zampachova V, Freiberger T. First report of Sneathia sanguinegens together with Mycoplasma hominis in postpartum prosthetic valve infective endocarditis: a case report. BMC Infect Dis 2017; 17:563. [PMID: 28806998 PMCID: PMC5557263 DOI: 10.1186/s12879-017-2654-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2017] [Accepted: 07/30/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The presence of more than one bacterial agent is relatively rare in infective endocarditis, although more common in prosthetic cases. Molecular diagnosis from a removed heart tissue is considered a quick and effective way to diagnose fastidious or intracellular agents. CASE PRESENTATION Here we describe the case of postpartum polymicrobial prosthetic valve endocarditis in a young woman. Sneathia sanguinegens and Mycoplasma hominis were simultaneously detected from the heart valve sample using broad range 16S rRNA polymerase chain reaction (PCR) followed by sequencing while culture remained negative. Results were confirmed by independent PCR combined with denaturing gradient gel electrophoresis. Before the final agent identification, the highly non-compliant patient left from the hospital against medical advice on empirical intravenous treatment with aminopenicillins, clavulanate and gentamicin switched to oral amoxycillin and clavulanate. Four months after surgery, no signs of inflammation were present despite new regurgitation and valve leaflet flail was detected. However, after another 5 months the patient died from sepsis and recurrent infective endocarditis of unclarified etiology. CONCLUSIONS Mycoplasma hominis is a rare causative agent of infective endocarditis. To the best of our knowledge, presented case is the first report of Sneathia sanguinegens detected in this condition. Molecular techniques were shown to be useful even in polymicrobial infective endocarditis samples.
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Affiliation(s)
- Iva Kotaskova
- Molecular and Genetics Laboratory, Centre for Cardiovascular Surgery and Transplantation, Brno, Czech Republic.,Medical Genomics Research Group, CEITEC, Masaryk University, Brno, Czech Republic
| | - Petr Nemec
- Department of Cardiosurgery, Centre for Cardiovascular Surgery and Transplantation, Brno, Czech Republic
| | - Martina Vanerkova
- Molecular and Genetics Laboratory, Centre for Cardiovascular Surgery and Transplantation, Brno, Czech Republic
| | - Barbora Malisova
- Molecular and Genetics Laboratory, Centre for Cardiovascular Surgery and Transplantation, Brno, Czech Republic
| | - Renata Tejkalova
- Department of Microbiology, Faculty of Medicine, Masaryk University and St. Anne's University Hospital, Brno, Czech Republic
| | - Marek Orban
- Department of Cardiology, Centre for Cardiovascular Surgery and Transplantation, Brno, Czech Republic
| | - Vita Zampachova
- 1st Institute of Pathological Anatomy, Faculty of Medicine, Masaryk University and St. Anne's University Hospital, Brno, Czech Republic
| | - Tomas Freiberger
- Molecular and Genetics Laboratory, Centre for Cardiovascular Surgery and Transplantation, Brno, Czech Republic. .,Medical Genomics Research Group, CEITEC, Masaryk University, Brno, Czech Republic. .,Department of Clinical Immunology and Allergology, Faculty of Medicine, Masaryk University, Brno, Czech Republic.
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High pneumococcal DNA load, procalcitonin and suPAR levels correlate to severe disease development in patients with pneumococcal pneumonia. Eur J Clin Microbiol Infect Dis 2017; 36:1541-1547. [DOI: 10.1007/s10096-017-2963-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2016] [Accepted: 03/07/2017] [Indexed: 12/17/2022]
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McGillen KL, Boos J, Nathavitharana R, Brook A, Sun MR, Siewert B, Raptopoulos V, Kane R, Sheiman R, Brook OR. Diagnostic yield and clinical impact of microbiologic diagnosis from CT-guided drainage in patients previously treated with empiric antibiotics. Abdom Radiol (NY) 2017; 42:298-305. [PMID: 27654990 DOI: 10.1007/s00261-016-0833-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
PURPOSE The purpose of the study was to evaluate diagnostic yield and the added value of culture results on the clinical management of patients empirically treated with antibiotics prior to CT-guided drainage. METHODS This retrospective, HIPAA-compliant, IRB-approved study reviewed records of 300 consecutive patients who underwent CT-guided aspiration or drainage for suspected infected fluid collection while on empiric antibiotics (11/2011 to 9/2013) at a single institution. Patient imaging and clinical characteristics were evaluated by an abdominal imaging fellow and culture results, and patient management were evaluated by an infectious diseases fellow. RESULTS After exclusion of 14/300 (4.6%) patients who were not on empiric antibiotics and 8/300 (2.6%) patients in which no culture was acquired, 278 patients (average age 55 ± 16 years; M:F ratio 54:46) constituted the final study cohort. Leukocytosis was present in 163/278 (59%), and fever in 65/278 (24%). The average collection size was 8.5 ± 4.2 cm with gas present in 140/278 (50%) of collections; median amount drained was 35 mL, and visibly purulent material was obtained in 172/278 (63%). 236/278 (85%) received drains and the remainder were aspirated only. Average time between initiation of antibiotics and start of the drainage procedure was 4.1 ± 6.4 days (median 1.7 days). Cultures were positive in 205/278 (74%) patients with a resulting change in management in 181/278 (65%) cases. The change in management included change of antibiotics in 71/278 (26%), narrowing the antibiotic regimen in 94/278 (34%), and cessation of antibiotics in 16/278 (6%). Multidrug-resistant bacteria were cultured in 53/278 (19%). Several factors were found to be statistically significant predictors of positive cultures: patient leukocytosis (sens 62%, spec 53%), gas in the collection on CT (sens 59%, spec 77%), purulent material aspiration (sens 76%, spec 76%), and presence of polymorphonuclear cells in the specimen. CONCLUSIONS Despite predrainage antibiotic therapy, CT-guided drainage demonstrates a high yield of positive cultures and influences clinical management in the majority of patients.
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Wiggers JB, Xiong W, Daneman N. Sending repeat cultures: is there a role in the management of bacteremic episodes? (SCRIBE study). BMC Infect Dis 2016; 16:286. [PMID: 27296858 PMCID: PMC4906775 DOI: 10.1186/s12879-016-1622-z] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2015] [Accepted: 06/04/2016] [Indexed: 11/13/2022] Open
Abstract
Background In the management of bacteremia, positive repeat blood cultures (persistent bacteremia) are associated with increased mortality. However, blood cultures are costly and it is likely unnecessary to repeat them for many patients. We assessed predictors of persistent bacteremia that should prompt repeat blood cultures. Methods We conducted a retrospective cohort study of bacteremias at an academic hospital from April 2010 to June 2014. We examined variables associated with patients undergoing repeat blood cultures, and with repeat cultures being positive. A nested case control analysis was performed on a subset of patients with repeat cultures. Results Among 1801 index bacteremias, repeat cultures were drawn for 701 patients (38.9 %), and 118 persistent bacteremias (6.6 %) were detected. Endovascular source (adjusted odds ratio [aOR], 7.66; 95 % confidence interval [CI], 2.30-25.48), epidural source (aOR, 26.99; 95 % CI, 1.91-391.08), and Staphylococcus aureus bacteremia (aOR, 4.49; 95 % CI, 1.88-10.73) were independently associated with persistent bacteremia. Escherichia coli (5.1 %, P = 0.006), viridans group (1.7 %, P = 0.035) and β-hemolytic streptococci (0 %, P = 0.028) were associated with a lower likelihood of persistent bacteremia. Patients with persistent bacteremia were less likely to have achieved source control within 48 h of the index event (29.7 % vs 52.5 %, P < .001), but after variable reduction, source control was not retained in the final multivariable model. Conclusions Patients with S. aureus bacteremia or endovascular infection are at risk of persistent bacteremia. Achieving source control within 48 h of the index bacteremia may help clear the infection. Repeat cultures after 48 h are low yield for most Gram-negative and streptococcal bacteremias.
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Affiliation(s)
- J Brad Wiggers
- Department of Medicine, University of Toronto, Toronto, Canada
| | - Wei Xiong
- Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Canada
| | - Nick Daneman
- Department of Medicine, University of Toronto, Toronto, Canada. .,Division of Infectious Diseases, Department of Medicine, Sunnybrook Health Sciences Centre, Toronto, Canada. .,Institute for Clinical Evaluative Sciences, Toronto, Canada. .,Division of Infectious Diseases & Clinical Epidemiology, Sunnybrook Health Sciences Centre, University of Toronto, Institute for Clinical Evaluative Sciences, 2075 Bayview Ave, G-wing Room 106, Toronto, M4N 3 M5, Canada.
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Linsenmeyer K, Gupta K, Strymish JM, Dhanani M, Brecher SM, Breu AC. Culture if spikes? Indications and yield of blood cultures in hospitalized medical patients. J Hosp Med 2016; 11:336-40. [PMID: 26762577 DOI: 10.1002/jhm.2541] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2015] [Revised: 12/07/2015] [Accepted: 12/16/2015] [Indexed: 11/09/2022]
Abstract
BACKGROUND Although optimal utilization of blood cultures has been studied in populations, including emergency room and intensive care patients, less is known about the use of blood cultures in populations consisting exclusively of patients on a medical service. OBJECTIVE To identify the physician-selected indication and yield of blood cultures ordered after hospitalization to an acute medical service and to identify populations in which blood cultures may not be necessary. DESIGN, SETTING, AND PATIENTS A prospective cohort study was performed at a single Veterans Affairs Medical Center from October 1, 2014 through April 15, 2015. Participants included all hospitalized patients on a medical service for whom a blood culture was ordered. MEASUREMENTS The main outcomes were the rate of true positive blood cultures and the predictors of true positive cultures. RESULTS The true positive rate was 3.6% per order. The most common physician-selected indications were fever and leukocytosis, neither of which alone was highly predictive of true positive blood cultures. The only indication significantly associated with a true positive blood culture was "follow-up previous positive" (likelihood ratio [LR]+ 3.4, 95% confidence interval [CI]: 1.8-6.5). The only clinical predictors were a working diagnosis of bacteremia/endocarditis (LR+ 3.7, 95% CI: 2.5-5.7) and absence of antibiotic exposure within 72 hours of the culture (LR+ 2.4, 95% CI: 1.2-4.9). CONCLUSIONS The rate of true positive blood cultures among patients on a medical service was lower than previously studied. Using objective and easily obtainable clinical characteristics, including antibiotic exposure and working diagnosis, may improve the likelihood of true positive blood cultures. Journal of Hospital Medicine 2016;11:336-340. © 2016 Society of Hospital Medicine.
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Affiliation(s)
- Katherine Linsenmeyer
- Veterans Affairs Boston Healthcare System, West Roxbury, Massachusetts
- Boston University School of Medicine, Boston, Massachusetts
| | - Kalpana Gupta
- Veterans Affairs Boston Healthcare System, West Roxbury, Massachusetts
- Boston University School of Medicine, Boston, Massachusetts
| | - Judith M Strymish
- Veterans Affairs Boston Healthcare System, West Roxbury, Massachusetts
- Harvard Medical School, Boston, Massachusetts
| | - Muhammad Dhanani
- Veterans Affairs Boston Healthcare System, West Roxbury, Massachusetts
- Boston University School of Medicine, Boston, Massachusetts
| | - Stephen M Brecher
- Veterans Affairs Boston Healthcare System, West Roxbury, Massachusetts
- Boston University School of Medicine, Boston, Massachusetts
| | - Anthony C Breu
- Veterans Affairs Boston Healthcare System, West Roxbury, Massachusetts
- Harvard Medical School, Boston, Massachusetts
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Johnson G, Ferrini A, Dolan SK, Nolan T, Agrawal S, Doyle S, Bustin SA. Biomarkers for invasive aspergillosis: the challenges continue. Biomark Med 2014; 8:429-51. [PMID: 24712434 DOI: 10.2217/bmm.13.129] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
The incidence of invasive aspergillosis (IA), an opportunistic infection in immunocompromised individuals, is rising, but its early diagnosis remains challenging and treatment options are limited. Hence there is an urgent need to improve existing diagnostic procedures as well as develop novel approaches. The clinical usefulness of galactomannan and β-d-glucan, widely used assays detecting cell-wall antigens of Aspergillus, is unclear and depends on clinicians' awareness of their practical limitations. This leaves room for new methods that utilise genomic, proteomic and metabolomics approaches as well as novel detection procedures, for example point-of-care lateral-flow devices. Each of these strategies has its own limitations and it is likely that a combination of methods will be required to achieve optimal performance for the diagnosis of IA and subsequent appropriate patient management.
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Affiliation(s)
- Gemma Johnson
- Blizard Institute, Queen Mary University of London, London, UK
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Saukkoriipi A, Palmu AA, Jokinen J, Verlant V, Hausdorff WP, Kilpi TM. Effect of antimicrobial use on pneumococcal diagnostic tests in elderly patients with community-acquired pneumonia. Eur J Clin Microbiol Infect Dis 2014; 34:697-704. [DOI: 10.1007/s10096-014-2278-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2014] [Accepted: 11/05/2014] [Indexed: 11/30/2022]
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Nesher L, Chemaly RF, Shah DP, Mulanovich VE, Hosing C, Rolston KVI. Utility of routine surveillance blood cultures in asymptomatic allogeneic hematopoietic stem cell transplant recipients with indwelling central venous catheters at a comprehensive cancer center. Am J Infect Control 2014; 42:1084-8. [PMID: 25278398 DOI: 10.1016/j.ajic.2014.07.004] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2014] [Revised: 07/01/2014] [Accepted: 07/02/2014] [Indexed: 12/22/2022]
Abstract
BACKGROUND Many transplant centers obtain surveillance blood cultures (SBCs) from asymptomatic allogeneic hematopoietic stem cell transplant (allo-HCT) recipients with central venous catheters for early detection of potential blood stream infections. The aim of this study was to determine the utility of this practice. METHODS We conducted a retrospective study of all patients who underwent allo-HCT to determine the frequency, clinical significance, and costs associated with SBCs. RESULTS From 776 patients, 6,801 SBCs were obtained (median, 9 per patient). Most (96.89%) were negative. Of the 211 positive SBCs, 171 (81%) had minimal clinical significance. The remaining 40 positive cultures (19%) were considered potentially significant. The frequency of potentially significant SBCs was 5.1% for the entire cohort and 0.59% of all SBCs drawn. CONCLUSION All potentially significant cultures and some that were deemed to have minimal significance led to medical intervention, some of which were probably unnecessary. No adverse outcomes occurred in patients with positive SBCs for the first 30 days following the positive result, regardless of the pathogen isolated or the quantitative colony count. The frequency of clinically significant positive SBCs in asymptomatic adult allo-HCT recipients is very low. Routine use of this practice leads to some unnecessary medical interventions and added costs.
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Affiliation(s)
- Lior Nesher
- Department of Infectious Diseases, Infection Control and Employee Health, The University of Texas - MD Anderson Cancer Center, Houston, TX; Internal Medicine Division, Faculty of Health Sciences, Ben-Gurion University, Beer Sheba, Israel.
| | - Roy F Chemaly
- Department of Infectious Diseases, Infection Control and Employee Health, The University of Texas - MD Anderson Cancer Center, Houston, TX
| | - Dimpy P Shah
- Department of Infectious Diseases, Infection Control and Employee Health, The University of Texas - MD Anderson Cancer Center, Houston, TX
| | - Victor E Mulanovich
- Department of Infectious Diseases, Infection Control and Employee Health, The University of Texas - MD Anderson Cancer Center, Houston, TX
| | - Chitra Hosing
- Stem Cell Transplantation and Cellular Therapy, Division of Cancer Medicine, The University of Texas - MD Anderson Cancer Center, Houston, TX
| | - Kenneth V I Rolston
- Department of Infectious Diseases, Infection Control and Employee Health, The University of Texas - MD Anderson Cancer Center, Houston, TX
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Goswami U, Brenes JA, Punjabi GV, LeClaire MM, Williams DN. Associations and outcomes of septic pulmonary embolism. Open Respir Med J 2014; 8:28-33. [PMID: 25184008 PMCID: PMC4150379 DOI: 10.2174/1874306401408010028] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2014] [Revised: 07/02/2014] [Accepted: 07/10/2014] [Indexed: 11/22/2022] Open
Abstract
Background: Septic pulmonary embolism is a serious but uncommon syndrome posing diagnostic challenges because of its broad range of clinical presentation and etiologies. Objective: To understand the clinical and radiographic associations of septic pulmonary embolism in patients presenting to an acute care safety net hospital.
Methods: We conducted a retrospective analysis of imaging and electronic health records of all patients diagnosed with septic pulmonary embolism in our hospital between January 2000 and January 2013.
Results: 41 episodes of septic pulmonary embolism were identified in 40 patients aged 17 to 71 years (median 46); 29 (72%) were men. Presenting symptoms included: febrile illness (85%); pulmonary complaints (66%) including pleuritic chest pain (22%), cough (19%) and dyspnea (15%); and those related to the peripheral foci of infection (24%) and shock (19%). Sources of infection included: skin and soft tissue (44%); infective endocarditis (27%); and infected peripheral deep venous thrombosis (17%). 35/41 (85%) were bacteremic with staphylococcus aureus. All patients had peripheral nodular lesions on chest CT scan. Treatment included intravenous antibiotics in all patients. Twenty six (63%) patients required pleural drainage and/or drainage of peripheral abscesses. Seven (17%) patients received systemic anticoagulants. Eight (20%) patients died due to various complications.
Conclusion: The epidemiology of septic pulmonary embolism has broadened over the past decade with an increase in identified extrapulmonary, non-cardiac sources. In the context of an extrapulmonary infection, clinical features of persistent fever, bacteremia and pulmonary complaints should raise suspicion for this syndrome, and typical findings on the chest CT scans confirm the diagnosis. Antibiotics, local drainage procedures and increasingly, anticoagulation are keys to successful outcomes.
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Affiliation(s)
- Umesh Goswami
- Department of Pulmonary, Allergy, Critical Care and Sleep Medicine, University of Minnesota, Minneapolis, MN, USA
| | - Jorge A Brenes
- Department of Medicine, Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN, USA
| | - Gopal V Punjabi
- Department of Radiology, Hennepin County Medical Center, Minneapolis, MN, USA
| | - Michele M LeClaire
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Hennepin County Medical Center, Minneapolis, MN, USA
| | - David N Williams
- Division of Infectious Diseases, Department of Medicine, Hennepin County Medical Center and University of Minnesota, Minneapolis, MN, USA
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Loonen AJM, Wolffs PFG, Bruggeman CA, van den Brule AJC. Developments for improved diagnosis of bacterial bloodstream infections. Eur J Clin Microbiol Infect Dis 2014; 33:1687-702. [PMID: 24848132 DOI: 10.1007/s10096-014-2153-4] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2014] [Accepted: 04/30/2014] [Indexed: 12/26/2022]
Abstract
Bloodstream infections (BSIs) are associated with high mortality and increased healthcare costs. Optimal management of BSI depends on several factors including recognition of the disease, laboratory tests and treatment. Rapid and accurate identification of the etiologic agent is crucial to be able to initiate pathogen specific antibiotic therapy and decrease mortality rates. Furthermore, appropriate treatment might slow down the emergence of antibiotic resistant strains. Culture-based methods are still considered to be the "gold standard" for the detection and identification of pathogens causing BSI. Positive blood cultures are used for Gram-staining. Subsequently, positive blood culture material is subcultured on solid media, and (semi-automated) biochemical testing is performed for species identification. Finally, a complete antibiotic susceptibility profile can be provided based on cultured colonies, which allows the start of pathogen-tailored antibiotic therapy. This conventional workflow is extremely time-consuming and can take up to several days. Furthermore, fastidious and slow-growing microorganisms, as well as antibiotic pre-treated samples can lead to false-negative results. The main aim of this review is to present different strategies to improve the conventional laboratory diagnostic steps for BSI. These approaches include protein-based (MALDI-TOF mass spectrometry) and nucleic acid-based (polymerase chain reaction [PCR]) identification from subculture, blood cultures, and whole blood to decrease time to results. Pathogen enrichment and DNA isolation methods, to enable optimal pathogen DNA recovery from whole blood, are described. In addition, the use of biomarkers as patient pre-selection tools for molecular assays are discussed.
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Affiliation(s)
- A J M Loonen
- Laboratory for Molecular Diagnostics, Department of Medical Microbiology and Pathology, Jeroen Bosch Hospital, 's-Hertogenbosch, The Netherlands
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Loonen AJM, de Jager CPC, Tosserams J, Kusters R, Hilbink M, Wever PC, van den Brule AJC. Biomarkers and molecular analysis to improve bloodstream infection diagnostics in an emergency care unit. PLoS One 2014; 9:e87315. [PMID: 24475269 PMCID: PMC3903623 DOI: 10.1371/journal.pone.0087315] [Citation(s) in RCA: 128] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2013] [Accepted: 12/19/2013] [Indexed: 01/22/2023] Open
Abstract
Molecular pathogen detection from blood is still expensive and the exact clinical value remains to be determined. The use of biomarkers may assist in preselecting patients for immediate molecular testing besides blood culture. In this study, 140 patients with ≥ 2 SIRS criteria and clinical signs of infection presenting at the emergency department of our hospital were included. C-reactive protein (CRP), neutrophil-lymphocyte count ratio (NLCR), procalcitonin (PCT) and soluble urokinase plasminogen activator receptor (suPAR) levels were determined. One ml EDTA blood was obtained and selective pathogen DNA isolation was performed with MolYsis (Molzym). DNA samples were analysed for the presence of pathogens, using both the MagicPlex Sepsis Test (Seegene) and SepsiTest (Molzym), and results were compared to blood cultures. Fifteen patients had to be excluded from the study, leaving 125 patients for further analysis. Of the 125 patient samples analysed, 27 presented with positive blood cultures of which 7 were considered to be contaminants. suPAR, PCT, and NLCR values were significantly higher in patients with positive blood cultures compared to patients without (p < 0.001). Receiver operating characteristic curves of the 4 biomarkers for differentiating bacteremia from non-bacteremia showed the highest area under the curve (AUC) for PCT (0.806 (95% confidence interval 0.699–0.913)). NLCR, suPAR and CRP resulted in an AUC of 0.770, 0.793, and 0.485, respectively. When compared to blood cultures, the sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) for SepsiTest and MagicPlex Sepsis Test were 11%, 96%, 43%, 80%, and 37%, 77%, 30%, 82%, respectively. In conclusion, both molecular assays perform poorly when one ml whole blood is used from emergency care unit patients. NLCR is a cheap, fast, easy to determine, and rapidly available biomarker, and therefore seems most promising in differentiating BSI from non-BSI patients for subsequent pathogen identification using molecular diagnostics.
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Affiliation(s)
- Anne J. M. Loonen
- Jeroen Bosch Hospital, Laboratory of Molecular Diagnostics, 's-Hertogenbosch, The Netherlands
- Fontys University of Applied Sciences, Department of Medical Molecular Diagnostics, Eindhoven, The Netherlands
| | - Cornelis P. C. de Jager
- Jeroen Bosch Hospital, Department of Intensive Care and Emergency Medicine, 's-Hertogenbosch, The Netherlands
| | - Janna Tosserams
- Jeroen Bosch Hospital, Department of Intensive Care and Emergency Medicine, 's-Hertogenbosch, The Netherlands
| | - Ron Kusters
- Jeroen Bosch Hospital, Department of Clinical Chemistry and Haematology, 's-Hertogenbosch, The Netherlands
| | - Mirrian Hilbink
- Jeroen Bosch Hospital, Jeroen Bosch Academy, 's-Hertogenbosch, The Netherlands
| | - Peter C. Wever
- Jeroen Bosch Hospital, Department of Medical Microbiology and Infection Control, 's-Hertogenbosch, The Netherlands
| | - Adriaan J. C. van den Brule
- Jeroen Bosch Hospital, Laboratory of Molecular Diagnostics, 's-Hertogenbosch, The Netherlands
- Fontys University of Applied Sciences, Department of Medical Molecular Diagnostics, Eindhoven, The Netherlands
- * E-mail:
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Awad S, Alshami I, Alharbi AE. Evaluation of a duplex real-time PCR assay to detect MRSA from broth culture, human sera seeded with MRSA and from patient's serum. Bioinformation 2013; 9:896-900. [PMID: 24307766 PMCID: PMC3842574 DOI: 10.6026/97320630009896] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2013] [Accepted: 10/03/2013] [Indexed: 11/23/2022] Open
Abstract
The need for rapid methods in order to precisely detect methicillin-resistant Staphylococcus aureus (MRSA) is extensively
acknowledged. This study evaluated a quantitative real-time PCR assay targeting mecA (encoding high level resistance to
methicillin) and femB (a specific genomic marker for S. aureus) genes to detect MRSA from broth culture, from serum seeded with
MRSA and straight from the patient's serum. One hundred and thirty-five clinical isolates of MRSA strains and different species
were utilised in this study. In addition, a pilot study with 9 patients' serum samples was performed. The sensitivity and specificity
values for this assay were 99% and 100% respectively. The detection limit for this method was 1.23×102 CFU/ml from the serum
seeded with MRSA cells and the limiting concentration of DNA for detection was 18 fg, which equates to 5.14 genomic DNA
copies. In addition, this assay detected MRSA from patient's serum (7 out of 9) with sensitivity of 77.8%. Overall, the assay was
rapid, efficient, sensitive and easy to perform.
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Affiliation(s)
- Sawsan Awad
- University Hospital of South Manchester NHS Foundation Trust, Wythenshawe Hospital, Southmoor Road, Manchester, M23 9LT
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The potential for PCR based testing to improve diagnosis and treatment of sepsis. Curr Infect Dis Rep 2013; 15:372-9. [PMID: 23929539 DOI: 10.1007/s11908-013-0350-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Early and appropriate antibiotic use is critical for the treatment of sepsis. In practice, however, early antibiotic administration is hampered by diagnostic uncertainty with regard to both early diagnosis of disease and delayed or absent microbiological results. The diagnostic uncertainty often persists into the later stages of sepsis when clinical response to antibiotic treatment is assessed. Blood culture, the current "gold standard" test for diagnosis of sepsis, is inadequate due to low sensitivity and delayed results. However, despite this, the technology remains entrenched in microbiology laboratories due to decades of accumulated experience with the technique. However, in recent years there has been increasing experience with testing based on polymerase chain reaction (PCR). As the technology continues to improve, PCR testing is becoming faster and more sensitive. Moreover, PCR technologies that quantify bacterial load may enable monitoring of response to treatment and susceptibility testing.
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Abstract
Ideally, invading bacteria are detected as early as possible in critically ill patients: the strain of morbific pathogens is identified rapidly, and antimicrobial sensitivity is known well before the start of new antimicrobial therapy. Bacteria have a distinct metabolism, part of which results in the production of bacteria-specific volatile organic compounds (VOCs), which might be used for diagnostic purposes. Volatile metabolites can be investigated directly in exhaled air, allowing for noninvasive monitoring. The aim of this review is to provide an overview of VOCs produced by the six most abundant and pathogenic bacteria in sepsis, including Staphylococcus aureus, Streptococcus pneumoniae, Enterococcus faecalis, Pseudomonas aeruginosa, Klebsiella pneumoniae, and Escherichia coli. Such VOCs could be used as biological markers in the diagnostic approach of critically ill patients. A systematic review of existing literature revealed 31 articles. All six bacteria of interest produce isopentanol, formaldehyde, methyl mercaptan, and trimethylamine. Since humans do not produce these VOCs, they could serve as biological markers for presence of these pathogens. The following volatile biomarkers were found for identification of specific strains: isovaleric acid and 2-methyl-butanal for Staphylococcus aureus; 1-undecene, 2,4-dimethyl-1-heptane, 2-butanone, 4-methyl-quinazoline, hydrogen cyanide, and methyl thiocyanide for Pseudomonas aeruginosa; and methanol, pentanol, ethyl acetate, and indole for Escherichia coli. Notably, several factors that may effect VOC production were not controlled for, including used culture media, bacterial growth phase, and genomic variation within bacterial strains. In conclusion, VOCs produced by bacteria may serve as biological markers for their presence. Goal-targeted studies should be performed to identify potential sets of volatile biological markers and evaluate the diagnostic accuracy of these markers in critically ill patients.
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Affiliation(s)
- Lieuwe D J Bos
- Department of Intensive Care, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
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Affiliation(s)
- Sunjoo Kim
- Department of Laboratory Medicine, Gyeongsang Institute of Health Sciences, Gyeongsang National University School of Medicine, Jinju, Korea
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Hansen WLJ, Bruggeman CA, Wolffs PFG. Pre-analytical sample treatment and DNA extraction protocols for the detection of bacterial pathogens from whole blood. Methods Mol Biol 2013; 943:81-90. [PMID: 23104282 DOI: 10.1007/978-1-60327-353-4_4] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
Molecular diagnostics is an increasing popular approach for the direct detection and identification of pathogenic bacteria in clinical samples. Conventional culture techniques are time-consuming and therefore causing a delay in the diagnosis of the patient. Alternative techniques based on nucleic acid amplification offer a shorter turn-around-time and the ability to identify fastidious and non-cultivable organisms. However, molecular detection of bacteria in blood, by for example PCR, RT-PCR, or sequencing of the 16S rDNA genes is often complicated by the presence of PCR-inhibitory compounds. Here we describe several different methods for the extraction of bacterial DNA from whole blood samples. The methods differ regarding costs, hands-on time as well as regarding sensitivity. In combination with a model PCR the detection limits that can be reached using the different methods range from 1,000 to 50 cfu/ml.
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Affiliation(s)
- Wendy L J Hansen
- Department of Medical Microbiology, Maastricht University Medical Center, Maastricht, The Netherlands
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Shin JH, Kim EC, Kim S, Koh EH, Lee DH, Koo SH, Cho JH, Kim JS, Ryoo NH. A Multicentre Study about Pattern and Organisms Isolated in Follow-up Blood Cultures. ANNALS OF CLINICAL MICROBIOLOGY 2013. [DOI: 10.5145/acm.2013.16.1.8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Affiliation(s)
- Jeong Hwan Shin
- Department of Laboratory Medicine, Inje University College of Medicine, Busan, Korea
| | - Eui Chong Kim
- Department of Laboratory Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Sunjoo Kim
- Department of Laboratory Medicine, Gyeongsang National University School of Medicine, Jinju, Korea
| | - Eun-Ha Koh
- Department of Laboratory Medicine, Gyeongsang National University School of Medicine, Jinju, Korea
| | - Dong-Hyun Lee
- Department of Laboratory Medicine, Gyeongsang National University School of Medicine, Jinju, Korea
| | - Sun-Hoi Koo
- Department of Laboratory Medicine, Chungnam National University College of Medicine, Daejeon, Korea
| | - Ji-Hyun Cho
- Department of Laboratory Medicine, Wonkwang University Medical School, Iksan, Korea
| | - Jae-Seok Kim
- Department of Laboratory Medicine, Hallym University College of Medicine, Chuncheon, Korea
| | - Nam Hee Ryoo
- Department of Laboratory Medicine, Keimyung University School of Medicine, Daegu, Korea
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The preanalytical optimization of blood cultures: a review and the clinical importance of benchmarking in 5 Belgian hospitals. Diagn Microbiol Infect Dis 2012; 73:1-8. [PMID: 22578933 DOI: 10.1016/j.diagmicrobio.2012.01.009] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2011] [Revised: 01/12/2012] [Accepted: 01/14/2012] [Indexed: 01/22/2023]
Abstract
Bloodstream infections remain a major challenge in medicine. Optimal detection of pathogens is only possible if the quality of preanalytical factors is thoroughly controlled. Since the laboratory is responsible for this preanalytical phase, the quality control of critical factors should be integrated in its quality control program. The numerous recommendations regarding blood culture collection contain controversies. Only an unambiguous guideline permits standardization and interlaboratory quality control. We present an evidence-based concise guideline of critical preanalytical determinants for blood culture collection and summarize key performance indicators with their concomitant target values. In an attempt to benchmark, we compared the true-positive rate, contamination rate, and collected blood volume of blood culture bottles in 5 Belgian hospital laboratories. The true-positive blood culture rate fell within previously defined acceptation criteria by Baron et al. (2005) in all 5 hospitals, whereas the contamination rate exceeded the target value in 4 locations. Most unexpected, in each of the 5 laboratories, more than one third of the blood culture bottles were incorrectly filled, irrespective of the manufacturer of the blood culture vials. As a consequence of this shortcoming, one manufacturer recently developed an automatic blood volume monitoring system. In conclusion, clear recommendations for standardized blood culture collection combined with quality control of critical factors of the preanalytical phase are essential for diagnostic blood culture improvement.
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Abzug JM, Chen NC, Jacoby SM. Septic olecranon bursitis. J Hand Surg Am 2012; 37:1252-3. [PMID: 22014445 DOI: 10.1016/j.jhsa.2011.08.036] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2011] [Accepted: 08/28/2011] [Indexed: 02/02/2023]
Affiliation(s)
- Joshua M Abzug
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, MD 21201, USA.
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Kim ES, Kim EC, Lee SM, Yang SC, Yoo CG, Kim YW, Han SK, Yim JJ. Bacterial yield from quantitative cultures of bronchoalveolar lavage fluid in patients with pneumonia on antimicrobial therapy. Korean J Intern Med 2012; 27:156-62. [PMID: 22707887 PMCID: PMC3372799 DOI: 10.3904/kjim.2012.27.2.156] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2011] [Revised: 09/30/2011] [Accepted: 12/20/2011] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND/AIMS Early diagnosis and appropriate antimicrobial choice are crucial when managing pneumonia patients, and quantitative culture of bronchoalveolar lavage (BAL) fluid is considered a useful method for identifying pneumonia pathogens. We evaluated the quantitative yield of BAL fluid bacterial cultures in patients being treated with antimicrobials and attempted to identify factors predictive of positive BAL cultures. METHODS Patients over 18 years old and whose BAL fluid was subjected to quantitative culture to identify the organism causative of pneumonia between January 1, 2005, and December 31, 2009, were included. We reviewed the results of BAL fluid bacterial cultures and the clinical records, laboratory tests, and radiographic findings of the patients. RESULTS BAL was performed on 340 patients with pneumonia. A positive BAL culture, defined as isolation of more than 10(4) colony forming units/mL bacteria, was documented in 18 (5.29%) patients. Of these, 9 bacteria isolated from 10 patients were classified as probable pathogens. The most frequently isolated bacteria were methicillin-resistant Staphylococcus aureus, Acinetobacter baumannii, and Pseudomonas aeruginosa. No independent predictive factor for positive BAL cultures was identified. CONCLUSIONS The yield of quantitative BAL fluid bacterial culture in patients already on antimicrobials was low. Clinicians should be cautious when performing a BAL culture in patients with pneumonia who are already on antimicrobials.
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Affiliation(s)
- Eun Sun Kim
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine and Lung Institute, Seoul National University College of Medicine, Seoul, Korea
| | - Eui-Chong Kim
- Department of Laboratory Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Sang-Min Lee
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine and Lung Institute, Seoul National University College of Medicine, Seoul, Korea
| | - Seok-Chul Yang
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine and Lung Institute, Seoul National University College of Medicine, Seoul, Korea
| | - Chul-Gyu Yoo
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine and Lung Institute, Seoul National University College of Medicine, Seoul, Korea
| | - Young Whan Kim
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine and Lung Institute, Seoul National University College of Medicine, Seoul, Korea
| | - Sung Koo Han
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine and Lung Institute, Seoul National University College of Medicine, Seoul, Korea
| | - Jae-Joon Yim
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine and Lung Institute, Seoul National University College of Medicine, Seoul, Korea
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Previsdomini M, Gini M, Cerutti B, Dolina M, Perren A. Predictors of positive blood cultures in critically ill patients: a retrospective evaluation. Croat Med J 2012; 53:30-9. [PMID: 22351576 PMCID: PMC3284177 DOI: 10.3325/cmj.2012.53.30] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
Aim To identify predictors of bacteremia in critically ill patients, to evaluate the impact of blood cultures on the outcome, and to define conditions for breakthrough bacteremia despite concurrent antibiotic treatment. Methods A descriptive retrospective study was performed over a two-year period (2007-2008) in the medico-surgical Intensive Care Unit (ICU) of the San Giovanni Hospital in Bellinzona, Switzerland. Results Forty-five out of 231 patients (19.5%) had positive blood cultures. Predictors of positive blood cultures were elevated procalcitonin levels (>2 µg/L, P < 0.001), higher severity scores (Simplified Acute Physiology Score II>43, P = 0.014; Sequential Organ Failure Assessment >4.0, P < 0.001), and liver failure (P = 0.028). Patients with bacteremia had longer hospital stays (31 vs 21 days, P = 0.058), but their mortality was not different from patients without bacteremia. Fever (t > 38.5°C) only showed a trend toward a higher rate of blood culture positivity (P = 0.053). The rate of positive blood cultures was not affected by concurrent antibiotic therapy. Conclusions The prediction of positive blood culture results still remains a very difficult task. In our analysis, blood cultures were positive in 20% of ICU patients whose blood was cultured, and positive findings increased with elevated procalcitonin levels, liver failure, and higher severity scores. Blood cultures drawn >4 days after the start of antibiotic therapy and >5 days after surgery could detect pathogens responsible for a new infection complication.
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Affiliation(s)
- Marco Previsdomini
- Intensive Care Unit, Ospedale Regionale Bellinzona e Valli, Bellinzona, Switzerland.
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Hall-Stoodley L, Stoodley P, Kathju S, Høiby N, Moser C, Costerton JW, Moter A, Bjarnsholt T. Towards diagnostic guidelines for biofilm-associated infections. ACTA ACUST UNITED AC 2012; 65:127-45. [PMID: 22469292 DOI: 10.1111/j.1574-695x.2012.00968.x] [Citation(s) in RCA: 235] [Impact Index Per Article: 19.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2011] [Revised: 03/21/2012] [Accepted: 03/25/2012] [Indexed: 12/17/2022]
Abstract
Biofilms associated with the human body, particularly in typically sterile locations, are difficult to diagnose and treat effectively because of their recalcitrance to conventional antibiotic therapy and host immune responses. The study of biofilms in medicine today requires a translational approach, with examination of clinically relevant biofilms in the context of specific anatomic sites, host tissues, and diseases, focusing on what can be done to mitigate their pathologic consequences. This review, which grew out of a discussion session on clinical biofilms at the 5th ASM Biofilm Conference in Cancun, Mexico, is designed to give an overview of biofilm-associated infections (BAI) and to propose a platform for further discussion that includes clinicians, medical microbiologists, and biofilm researchers who are stakeholders in advancing the scientific pursuit of better diagnosis and treatment of BAI to mitigate their human and healthcare costs. It also highlights the need for better diagnostic markers, which exploit the difference between planktonic and biofilm cells.
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Affiliation(s)
- Luanne Hall-Stoodley
- Wellcome Trust Clinical Research Facility, University Hospital Southampton Foundation Trust, Southampton, UK.
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True bacteremias caused by coagulase negative Staphylococcus are difficult to distinguish from blood culture contaminants. Eur J Clin Microbiol Infect Dis 2012; 31:2639-44. [DOI: 10.1007/s10096-012-1607-9] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2011] [Accepted: 03/07/2012] [Indexed: 10/28/2022]
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Molecular Approaches to the Diagnosis of Sepsis. Mol Microbiol 2011. [DOI: 10.1128/9781555816834.ch49] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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