scholarly journals 394. Pseudo-outbreak of Coagulase-negative Staphylococcus Species from Blood Cultures Highlights Unique Challenges in Care of Critically Ill Patients With COVID-19

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S266-S266
Author(s):  
Stacy Park ◽  
April E Attai ◽  
Kyle Enfield ◽  
Taison Bell ◽  
Brandon Hill ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Blood Culture ◽  
Peripheral Blood ◽  
Blood Cultures ◽  
Coagulase Negative Staphylococcus ◽  
Clinical Microbiology Laboratory ◽  
Blood Draw ◽  
Usual Practice ◽  
Standard Work

Abstract Background In response to the COVID-19 pandemic, a dedicated intensive care unit for patients infected with SARS-CoV-2 was created at our institution. We noticed a marked increase in the number of blood cultures positive for coagulase-negative Staphylococcus species (CoNS) that highlights unique challenges that arise with the creation of new units and workflows. Methods We reviewed all blood culture results from the COVID-19 intensive care unit (CoVICU) from April 15 to May 29. We reviewed all blood cultures taken from the oncology ward, medical intensive care unit (MICU), and emergency department (ED) for the same time frame as a comparison. We calculated contamination rates, using the clinical microbiology laboratory criteria for possible contaminants based on species and number of positive blood cultures. Results There were 324 total blood cultures collected from the CoVICU with 27/324 (8.3%) positive for organisms deemed contaminant, 10/324 (3.1%) were positive considered bloodstream infections (BSI); the ratio of BSI:contaminant was 1:2.7. For the MICU, ED, and oncology units contamination rates were 2/197 (1%), 33/747 (4.4%), and 2/334 (0.6%), respectively; and the ratio of BSI:contaminant was 5:1, 2.2:1, and 17.5:1, respectively. There was a significant relationship between contamination rates and unit, X2(3, N = 1602) = 30.85, p < 0.001. Conclusion Upon investigation, peripheral blood draw kits were not stocked in the CoVICU. Additionally, certain components of standard work for blood culture collection (e.g. glove exchange) could not be performed per usual practice due to isolation precautions. Peripheral blood draws were routinely performed by nurses in CoVICU and MICU while phlebotomy performed these in other comparison units. We suspect that lack of availability of blood draw kits and disruption of typical workflow in isolation rooms contributed to an unusually high number of contaminated blood cultures among patients admitted to the CoVICU. Notably, the CoVICU and MICU providers were the same pool of caregivers, further supporting a process issue related to isolation precautions. Institutions should be aware of the need for extra attention to supply chain management and examination of disruption to standard work that arise in the management of COVID-19 patients. Disclosures All Authors: No reported disclosures

scholarly journals Microbial Contamination of Three-Way Taps on Arterial Lines

1998 ◽  
Vol 26 (1) ◽  
pp. 51-55 ◽  
Author(s):  
W. M. Widdowson ◽  
L. Walker ◽  
J. H. Havill ◽  
J. W. Sleigh
Keyword(s):  
Blood Pressure ◽  
Intensive Care Unit ◽  
Intensive Care ◽  
Blood Culture ◽  
Microbial Contamination ◽  
General Intensive Care Unit ◽  
Contamination Rate ◽  
Coagulase Negative Staphylococcus ◽  
Potential Source ◽  
Measure Blood Pressure

Arterial lines with three-way taps are used to measure blood pressure and aspirate blood, and are a potential source of catheter-related sepsis. Swabs were taken daily from 118 three-way taps on 98 arterial lines in a general intensive care unit. Infusion lines were changed weekly but arterial cannulae were not changed routinely. An overall contamination rate of 24.6% was found with the predominant organism being coagulase negative staphylococcus. The three-way taps became increasingly contaminated with time but this was shown to be unrelated to the manipulation rates. Blood culture organisms in those showing contamination of the three-way taps showed no relationship to the bacteria causing the contamination.

scholarly journals Antimicrobial Stewardship Opportunities in Patients with Bacteremia Not Identified by BioFire FilmArray

2019 ◽  
Vol 57 (5) ◽  
Author(s):  
P. Ny ◽  
A. Ozaki ◽  
J. Pallares ◽  
P. Nieberg ◽  
A. Wong-Beringer
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Blood Culture ◽  
Intensive Care Unit Admission ◽  
Clinical Characteristics ◽  
Length Of Hospital Stay ◽  
Blood Cultures ◽  
Rapid Diagnostics ◽  
Admission Data ◽  
Culture Identification

ABSTRACTA subset of bacteremia cases are caused by organisms not detected by a rapid-diagnostics platform, BioFire blood culture identification (BCID), with unknown clinical characteristics and outcomes. Patients with ≥1 positive blood culture over a 15-month period were grouped by negative (NB-PC) versus positive (PB-PC) BioFire BCID results and compared with respect to demographics, infection characteristics, antibiotic therapy, and outcomes (length of hospital stay [LOS] and in-hospital mortality). Six percent of 1,044 positive blood cultures were NB-PC. The overall mean age was 65 ± 22 years, 54% of the patients were male, and most were admitted from home; fewer NB-PC had diabetes (19% versus 31%,P= 0.0469), although the intensive care unit admission data were similar. Anaerobes were identified in 57% of the bacteremia cases from the NB-PC group by conventional methods:Bacteroidesspp. (30%),Clostridium(11%), andFusobacteriumspp. (8%). Final identification of the NB-PC pathogen was delayed by 2 days (P< 0.01) versus the PB-PC group. The sources of bacteremia were more frequently unknown for the NB-PC group (32% versus 11%,P< 0.01) and of pelvic origin (5% versus 0.1%,P< 0.01) compared to urine (31% versus 9%,P< 0.01) for the PB-PC patients. Fewer NB-PC patients received effective treatment before (68% versus 84%,P= 0.017) and after BCID results (82% versus 96%,P= 0.0048). The median LOS was similar (7 days), but more NB-PC patients died from infection (26% versus 8%,P< 0.01). Our findings affirm the need for the inclusion of anaerobes in BioFire BCID or other rapid diagnostic platforms to facilitate the prompt initiation of effective therapy for bacteremia.

scholarly journals 265. Blood culture results pre- and post- antimicrobial administration in the Medicine Intensive Care Unit: a retrospective study in South Bronx

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S131-S132
Author(s):  
Chia-Yu Chiu ◽  
Amara Sarwal ◽  
Addi Feinstein
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Blood Culture ◽  
Blood Cultures ◽  
Antibiotic Administration ◽  
Culture Result ◽  
Blood Culture Result ◽  
South Bronx ◽  
Coagulase Negative Staphylococci ◽  
Before And After

Abstract Background It is intuitive that obtaining blood cultures prior to administering antibiotics can increase the likelihood of a positive blood culture result. Surviving Sepsis Campaign Hour-1 bundle stipulates that obtaining a blood culture and administering antibiotics within 1 hour is a critical determinant of survival. However, the diagnostic sensitivity shortly after antibiotic administration remains unknown. In clinical practice, some health care providers delay antibiotic administration in order to first obtain a blood culture. Methods Adult patients (&gt; 18 years of age) admitted to the Medicine Intensive Care Unit in Lincoln Medical Center, located in South Bronx, New York City, from 09/2019 to 12/2019. Patients needed to have at least one blood culture obtained within 12 hours of admission and have received intravenous antibiotics during the admission to the Medicine Intensive Care Unit. Results Of 327 patients screened, 196 met enrolment criteria and 253 sets of blood cultures underwent analysis. Blood cultures grew bacteria in 21.8% of pre-antimicrobial group whereas 26.9% in post-antimicrobial group (p=0.37). 25.9% of patients received antibiotics within 1 hour before blood culture sampling, while 34.0% of patients received antibiotics &gt;1 hour prior to obtaining blood culture. Blood culture results positive for coagulase-negative staphylococci were more prevalent in the pre-antimicrobial group. Table 1. Patient Characteristics Table 2. Number of blood cultures obtained and blood culture result Table 3. Initial antimicrobial agent and 30-day mortality Conclusion In the sequence of blood culture and antibiotic administration, there is no 30-day survival difference in pre-antimicrobial group and post-antimicrobial group (p=0.15), as long as both received antibiotics within 12 hours of coming to the hospital. Coagulase-negative staphylococci were higher in the pre-antimicrobial group which may indicate that the health care provider hastily obtained the blood culture in a non-sterile manner. Antibiotic administration should not be delayed because of pending blood culture collection. In addition, given that more than 70% of patients were ultimately found to have negative blood cultures, it would be useful to develop practical tools to identify low-risk patients that can be treated without obtaining blood culture, as the blood culture would not be likely to provide diagnostic information. Figure 1: Hours Before and After IV Antibiotic Started Figure 2: Distribution of Blood Culture Before and After IV Antibiotics Disclosures All Authors: No reported disclosures

Establishing a Long-Term Model for Analysis and Improvement of Underfilled Blood Culture Volumes

2018 ◽  
Vol 151 (2) ◽  
pp. 164-170 ◽  
Author(s):  
Michael Zaleski ◽  
Patrick Erdman ◽  
Joshua Adams ◽  
Amanda Michael ◽  
Abigail Rudy ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Blood Culture ◽  
False Negative ◽  
Blood Cultures ◽  
Surgical Intensive Care Unit ◽  
Surgical Intensive Care ◽  
Hospital Units ◽  
Time To Detection ◽  
Oncology Unit

Abstract Objectives Underfilling of blood culture bottles decreases the sensitivity of the culture. We attempt to increase average blood culture fill volumes (ABCFVs) through an educational program. Methods Partnerships were established with four hospital units (surgical intensive care unit [SICU], medical intensive care unit [MICU], medical intermediate care unit [MIMCU], and hematology and oncology unit [HEME/ONC]). ABCFVs were continuously tracked and communicated to each unit monthly. Educational sessions were provided to each unit. Results ABCFVs for the SICU, MICU, MIMCU, and HEME/ONC were 4.8, 5.0, 5.0, and 6.3 mL/bottle, respectively. After the final education session, the SICU, MICU, MIMCU, and HEME/ONC were able to maintain an ABCFV of 6.8, 8.1, 7.9, and 8.2 mL/bottle, respectively. Conclusions Partnering with a specific unit and providing monthly volume reports with educational sessions has a direct positive correlation on increasing ABCFVs. Increasing ABCFVs has the potential to decrease false-negative blood cultures, time to detection of positive blood cultures, and time to appropriate and specific antimicrobial therapy, as well as improve patient outcomes in high-acuity patient care units.

scholarly journals 1528. Rates of Peripheral Blood Culture Contamination in an Urban Children’s Hospital

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S556-S557
Author(s):  
Derek Tam ◽  
Kyle Hengel ◽  
Aparna Arun
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Blood Culture ◽  
Peripheral Blood ◽  
Contamination Rate ◽  
Improvement Project ◽  
Culture Bottle ◽  
Children's Hospital ◽  
Peripheral Blood Culture ◽  
Children’S Hospital

Abstract Background Positive peripheral blood culture results are essential in guiding antimicrobial therapy in patients with bacteremia. However, false-positive results may frequently pose diagnostic issues in interpreting the test. These results can lead to increased costs and patient harm through the administration of unnecessary antibiotics and prolongation of hospital stay. The maximum acceptable contamination rate for peripheral blood cultures as suggested by the College of American Pathologists is 3%. Methods We initiated a longitudinal quality improvement project to monitor peripheral blood contamination rates at our children’s hospital in Brooklyn, NY. We reviewed positive blood culture results on a monthly basis and assessed whether they represented true infections vs. contamination based on review of patient charts. Residents and nurses in the pediatric emergency department (ED), neonatal intensive care unit (NICU), pediatric intensive care unit (PICU), inpatient unit, and newborn nursery were educated on proper skin sterilization techniques using video demonstration; the importance of avoiding palpating the venipuncture site after sterilization and the importance of cleaning the port on the blood culture bottle were reinforced. Results The pediatric ED and the PICU had the highest contamination rates in 2018 at 4.38% and 3.82%, respectively. The newborn nursery had the lowest contamination rate, at 0%. The NICU and pediatric inpatient units had contamination rates that met the goal as well, at 1.25% and 0.72%, respectively. Conclusion The departments in need of targeted interventions are the pediatric ED and the PICU, both of which had contamination rates greater than the 3% goal rate set for our project. Future interventions currently being considered include re-education of nursing and resident staff as well as the creation of equipment bundles to facilitate adequate skin preparation prior to venipuncture. Disclosures All authors: No reported disclosures.

scholarly journals Infecções da corrente sanguínea em unidade de terapia intensiva: estudo retrospectivo em um hospital de ensino

2019 ◽  
Vol 87 (25) ◽  
Author(s):  
Betina Brixner ◽  
Nayanna Dias Bierhals ◽  
Caio Fernando de Oliveira ◽  
Jane Dagmar Pollo Renner
Keyword(s):  
Risk Factors ◽  
Intensive Care Unit ◽  
Intensive Care ◽  
Bloodstream Infection ◽  
Heart Diseases ◽  
Blood Cultures ◽  
Coagulase Negative Staphylococcus ◽  
Resistance Profile ◽  
History Of ◽  
Terapia Intensiva

O objetivo deste estudo foi verificar os fatores de risco e perfil epidemiológico dos pacientes diagnosticados com infecçãode corrente sanguínea, bem como os microrganismos responsáveis pela infecção. Estudo transversal, em que foi realizadoum levantamento das hemoculturas e dados dos pacientes internados em unidade de terapia intensiva adulto com diagnóstico de infecção de corrente sanguínea, durante o ano de 2016. Foram coletadas informações referente ao paciente esua internação, bem como ao agente responsável pela infecção e seu perfil de resistência. Foram incluídas 24 hemoculturaspositivas para crescimento bacteriano. A média de idade dos pacientes foi de 53,9±21,1 anos e 54,5% dos pacientes acometidos pela infecção eram homens. Dos pacientes, 59,1% apresentavam histórico de doença cardíaca, sendo que destes,63,6% foram a óbito. As bactérias Gram positivas foram mais relacionadas com a infecção, em que 54,2% eram Staphylococcus coagulase negativa e destes, 76,9% foram resistentes meticilina. Identificou-se que o sexo masculino, indivíduos idosos e com histórico de alguma comorbidades prévia, com destaque para as doenças cardíacas, foram os mais acometidoscom bacteremia. Quanto ao agente bacteriano responsável pela infecção, o Staphylococcus coagulase negativa foi o maisrelacionado aos casos diagnosticados, bem como o seu alto perfil de resistência deste microrganismo frente a meticilina.Palavras-chave: Bacteremia; Fatores de Risco; Diagnóstico; Unidade de Terapia Intensiva. ABSTRACTThe objective of this study was to verify the risk factors and epidemiological profile of the patients diagnosed with bloodstream infection, as well as the microorganisms responsible for the infection. A cross-sectional study was carried out inwhich blood cultures were collected and data were collected from patients admitted to an adult intensive care unit with adiagnosis of bloodstream infection during the year 2016. Information about the patient and hospitalization was collected,as well as the agent responsible for the infection ‘and its resistance profile. 24 blood cultures positive for bacterial growthwere included. The mean age of the patients was 53.9±21.1 years and 54.5% of the patients affected by the infection weremen. Of the patients, 59.1% had a history of heart disease, of which 63.6% died. Gram positive bacteria were more relatedto infection, in which 54.2% were coagulase negative Staphylococcus and of these, 76.9% were resistant to methicillin. Itwas identified that the male sex, elderly individuals and with history of some previous comorbidities, especially heart diseases, were the most affected with bacteremia. As for the bacterial agent responsible for the infection, Coagulase negativeStaphylococcus was the most related to the diagnosed cases, as well as its high resistance profile of this microorganismagainst methicillin.Keywords: Bacteremia; Risk factors; Diagnosis; Intensive Care Unit.

scholarly journals Increased blood culture contamination rate during COVID-19 outbreak in intensive care unit: A brief report from a single-centre

2021 ◽  
pp. 175114372110121
Author(s):  
Emanuele Russo ◽  
Giuliano Bolondi ◽  
Emiliano Gamberini ◽  
Domenico Pietro Santonastaso ◽  
Alessandro Circelli ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Blood Culture ◽  
Contamination Rate ◽  
Single Centre

Staphylococcus epidermidis Bacteremia in Neonates: Further Observations and the Occurrence of Focal Infection

PEDIATRICS ◽  
1984 ◽  
Vol 74 (5) ◽  
pp. 832-837 ◽  
Author(s):  
Gary J. Noel ◽  
Paul J. Edelson
Keyword(s):  
Intensive Care Unit ◽  
New York ◽  
Intensive Care ◽  
Neonatal Intensive Care Unit ◽  
Staphylococcus Epidermidis ◽  
Neonatal Intensive Care ◽  
Blood Cultures ◽  
Focal Infection ◽  
Clinically Significant ◽  
Vascular Catheters

The frequency and clinical significance of Staphylococcus epidermidis isolates from blood cultures of neonates collected during a 17-month period in The New York Hospital neonatal intensive care unit (NICU) were reviewed. Twenty-three episodes of clinically significant S epidermidis bacteremia were detected using the criteria of isolation from 3/3 blood culture bottles from a single culture, or isolation from two or more blood cultures taken at different times, or simultaneous isolation from blood and fluid, pus or vascular catheter. Of these 23 episodes of S epidermidis bacteremia, ten were associated with colonized vascular catheters, and four episodes occurred in infants with necrotizing enterocolitis. Focal S epidermidis infection occurred in ten episodes, and persistent bacteremia occurred frequently in this setting. S epidermidis was the most frequent cause of bacteremia in the Neonatal Intensive Care Unit during the period reviewed. Of the isolates determined to be clinically significant, 74% were resistant to methicillin and cephalothin and 91% were resistant to gentamicin. All isolates were sensitive to vancomycin. In addition to removing vascular catheters suspected of being colonized and searching for potential sites of focal infection, an antibiotic regimen that includes vancomycin should be initiated once significant S epidermidis bacteremia has been recognized in the neonate.

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