657. Diagnostic Utility of Dedicated Fungal Blood Cultures for Diagnosis of Candidemia

Abstract Background Blood culture techniques have improved to the point where they are considered sensitive enough for detection of Candida. Expert guidelines clarifying the utility of use of dedicated fungal isolator cultures are lacking, and we wondered what utility, if any, they add for the diagnosis of candidemia. Methods All patients with cultures between March 2016-February 2020 positive for Candida were examined via manual chart review, noting time to positivity and time of initiation of antifungal therapy. Results We focused on cases of candidemia where a fungal culture was ordered and turned positive (59 out of the total 181 cases of candidemia). We eliminated an additional 10 cases where fungal cultures were sent while already on antifungal therapy or in patients already known to be fungemic, given our interest in de novo diagnoses. Another case was removed due to lack of clinical details, as the patient was discharged prior to culture results and managed at a different medical facility. There were 14 cases with discordant growth (fungal culture positive, bacterial culture negative). One patient passed away prior to culture results, but in the remaining 13 cases, the fungal culture changed clinical management, in most cases by prompting initiation of antifungal therapy. The remaining 36 cases involved with concordant growth between bacterial and fungal cultures. In 11 of those cases, the fungal culture isolated yeast 12 or more hours faster than its paired bacterial culture (average 40.7 +/- 26.6 hours). In 7 of these cases, the fungal culture changed management – in the remaining cases, the patient was already on empiric therapy. Among all cultures sent in patients not receiving antifungals that isolated Candida, the overall time to positivity for fungal cultures was 37.2 +/- 13 hours, while bacterial cultures took 54 +/- 26.4 hours. Fungal Culture Results Conclusion Fungal cultures changed management in 20/59 cases of candidemia (34%) either by making the diagnosis faster than a bacterial culture or making it outright. Given the morbidity and mortality associated with candidemia, rapid diagnosis is critically important. More specific guidelines optimizing how to best utilize fungal cultures to help standardize practice among clinicians will be critical going forward. Disclosures Omai Garner, PhD, D(ABMM), Beckman Coulter (Scientific Research Study Investigator)

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Associations Between Procalcitonin and Markers of Bacterial Sepsis

Medicina ◽

10.3390/medicina48080057 ◽

2012 ◽

Vol 48 (8) ◽

pp. 57 ◽

Cited By ~ 4

Author(s):

Veeresh Patil ◽

Jaymin Morjaria ◽

Francois De Villers ◽

Suresh Babu

Keyword(s):

Bacterial Culture ◽

White Cell Count ◽

Bacterial Sepsis ◽

Reactive Protein ◽

Paired Samples ◽

Positive Bacterial Culture ◽

Specificity And Sensitivity ◽

Significant Difference ◽

Culture Positive ◽

Culture Negative

Background. Bacterial sepsis with no bacterial isolates can be a difficult clinical conundrum, where other markers like C-reactive protein (CRP), white cell count (WCC), and neutrophilia are helpful to arrive at a diagnosis. Procalcitonin (PCT) has been shown to be a useful biomarker in bacterial sepsis. The aim of the study was to look at the association of PCT with bacterial cultures and compare this to currently used markers of bacterial sepsis. Material and Methods. WCC, neutrophil count, and CRP with PCT were compared in patients with a positive bacterial culture from blood/body fluid. The specificity and sensitivity of PCT were compared with those of CRP. Results. Of the 99 paired samples obtained, 25 cultures were positive for bacteria. There was a significant difference in CRP (P=0.04) and PCT (P<0.001) levels between culture-positive and culture-negative samples. PCT had a better sensitivity and specificity than CRP (84% and 64.9% vs. 69.6% and 52.9%, respectively), with a combined specificity (CRP and PCT) of 83.5%. Conclusions. PCT has a better association with bacterial sepsis and is superior to currently available biomarkers in the clinical setting. The rapid pharmacodynamics of PCT can serve as an early predictor of the diagnosis of bacterial sepsis while awaiting the bacterial culture results avoiding undue delay in the institution of antibiotics, hence, potentially improving the prognosis of patients with bacterial sepsis.

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Etiology of Pertussis Syndrome

PEDIATRICS ◽

10.1542/peds.66.1.50 ◽

1980 ◽

Vol 66 (1) ◽

pp. 50-55

Author(s):

Margaret A. Keller ◽

Rouben Aftandelians ◽

James D. Connor

Keyword(s):

Bordetella Pertussis ◽

Bacterial Culture ◽

Index Case ◽

Family Group ◽

Isolation Rate ◽

Bordetella Parapertussis ◽

Positive Bacterial Culture ◽

Serologic Evidence ◽

Family Contact ◽

Culture Negative

One hundred patients with clinical pertussis were studied to determine the etiology of pertussis syndrome. Forty-two (42%) of the patients had either Bordetella pertussis or Bordetella parapertussis isolated from the nasopharynx. In an additional 36 (36%) patients, B pertussis was isolated from the nasopharynx of the associated index case or family contact case. Thus, Bordetella was isolated from 78 (78%) of the patients or from their immediate family group. Of the 22 culture-negative patients residing in culture-negative families, 12 had serologic evidence of Bordetella infection and another was from a family group in which two members were seropositive. Therefore, 91 patients (91%) had bacteriologic or serologic evidence of Bordetella infection themselves or within their families. Viral cultures were obtained on 75 of the patients. Adenoviruses were isolated from 33% of those with positive cultures for B pertussis and from 14% of those with negative cultures. In the group without direct or indirect, bacteriologic or serologic evidence of Bordetella infection, the adenoviral isolation rate (13%) was not significantly different from the adenoviral isolation rate (33%) in patients with a positive bacterial culture. These data do not support a role for adenovirus alone in causing pertussis syndrome.

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Comparison of real-time PCR with fungal culture for the diagnosis of Microsporum canis dermatophytosis in shelter cats: a field study

Journal of Feline Medicine and Surgery ◽

10.1177/1098612x17695899 ◽

2017 ◽

Vol 20 (2) ◽

pp. 103-107 ◽

Cited By ~ 4

Author(s):

Linda S Jacobson ◽

Lauren McIntyre ◽

Jenny Mykusz

Keyword(s):

Real Time ◽

Sensitivity And Specificity ◽

False Positive ◽

False Negative ◽

Microsporum Canis ◽

Fungal Culture ◽

Mycological Cure ◽

Hair Samples ◽

Culture Positive ◽

Culture Negative

Objectives Fungal culture requires at least 14 days for a final result, compared with 1–3 days for PCR. The study compared a commercial real-time dermatophyte PCR panel with fungal culture in cats in a shelter setting for: (1) diagnosis of Microsporum canis infection; and (2) determination of mycological cure. Methods This was a cross-sectional, observational study of cats with suspicious skin lesions or suspected exposure to dermatophytosis. Hair samples were collected for fungal culture and PCR prior to treatment and at weekly intervals until two negative culture results were obtained. Results One hundred and thirty-two cats were included, of which 28 (21.2%) were culture positive and 104 (78.8%) culture-negative for M canis. PCR correctly identified all culture-positive cats and 92/104 culture negative cats; there were 12 false-positive PCR results. The sensitivity and specificity of PCR were 100% (95% confidence interval [CI] 87.7–100) and 88.5% (95% CI 80.7–93.9), respectively. Data from 17 cats were available for assessment of mycological cure. At the time of the first and second negative fungal cultures, 14/17 (82.4%) and 11/17 (64.7%) tested PCR positive, respectively. Conclusions and relevance PCR showed high sensitivity and specificity for diagnosis of M canis dermatophytosis compared with fungal culture, but was unreliable for identifying mycological cure. False-positive results were relatively common. There were no false-negative PCR results and a negative PCR test was a reliable finding in this study. The ability to rapidly diagnose or rule out dermatophytosis could be a valuable tool to increase life-saving capacity in animal shelters.

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Comparing Diagnostic-Driven Approaches to Empiric Therapy in the Treatment of Invasive Aspergillosis in Patients with Hematologic Malignancy

Open Forum Infectious Diseases ◽

10.1093/ofid/ofx163.025 ◽

2017 ◽

Vol 4 (suppl_1) ◽

pp. S81-S82

Author(s):

Rita Wilson Dib ◽

Anne-Marie Chaftari ◽

Fady Ghaly ◽

Ying Jiang ◽

Ray Y Hachem ◽

...

Keyword(s):

Invasive Aspergillosis ◽

Antifungal Therapy ◽

Empiric Therapy ◽

Response To Therapy ◽

Diagnostic Methods ◽

Attributable Mortality ◽

Cancer Center ◽

Cell Transplant ◽

Fungal Culture ◽

Research Grant

Abstract Background Early antifungal therapy of invasive aspergillosis (IA) has been shown to be associated with improved outcome. Given the difficulty to establish the diagnosis of IA based on conventional methods, early initiation of empiric antifungal therapy has been used in patients with clinically suspected IA. Diagnostic-driven approach (DDA) relies on using novel diagnostic methods (e.g., early galactomannan testing). In this current study, we compared the outcomes of hematological malignancy (HM) patients with IA who were treated with Voriconazole using the DDA (DDA-Vori) vs. empiric therapy with a non-Voriconazole containing regimen (EMP-non-Vori) or empiric therapy with Voriconazole (EMP-Vori). Methods We retrospectively reviewed the medical records of 604 HM patients with documented, proven or probable IA (according to EORTC/MSG criteria) diagnosed between July, 1993 and February, 2016 at our center. We included 346 patients with underlying host factors, a suggestive CT findings of IA, and positive biopsy, fungal culture or galactomannan indicative of IA, and who received at least 7 days of DDA-Vori, EMP-Vori, or EMP-non-Vori. Outcome assessment included response to therapy (clinical and radiographic), all causing mortality and IA attributable mortality. Results The patients’ median age was 54 years and 59% were males. By multivariate analysis, factors that were predictive of a favorable response included: localized/sinus IA vs. disseminated/pulmonary IA (P < 0.0001), not receiving WBC transfusion (P < 0.01), and DDA-VORI vs. EMP-non-Vori (P < 0.0001). On the other hand, predictors of mortality within 6 weeks of initiation of IA therapy included disseminated/pulmonary infection vs. localized/sinus IA (P < 0.01), not having stem-cell transplant within 1 year prior of IA (P = 0.01) and EMP-non-Vori vs. DDA-Vori (P < 0.001). Conclusion DDA-Vori is associated with a better outcome (response and survival) when compared with EMP-non-Vori and equivalent outcome to EMP-Vori. The superior to equivalent outcome associated with the DDA approach could also reduce unnecessary costs and adverse events associated with widespread use of empiric therapy. Disclosures I. Raad, Merck: Grant Investigator, Research grant. Allergan: Grant Investigator, Research grant. Infective Technologies, LLC: Co-Inventor of the Nitroglycerin-Citrate-Ethanol catheter lock solution technology which is owned by the University of Texas MD Anderson Cancer Center (UTMDACC) and has been licensed by Novel Anti-Infective Technologies, LLC in which Dr. Raad is a s and Shareholder, Licensing agreement or royalty

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Effect of Inadequate Empiric Antibacterial Therapy on Hospital Outcomes in SARS-CoV-2-positive and -negative US Patients with a Positive Bacterial Culture: a Multicenter Evaluation from March to November 2020

Open Forum Infectious Diseases ◽

10.1093/ofid/ofab232 ◽

2021 ◽

Author(s):

Laura Puzniak ◽

Karri A Bauer ◽

Kalvin C Yu ◽

Pamela Moise ◽

Lyn Finelli ◽

...

Keyword(s):

Antibacterial Therapy ◽

Antimicrobial Therapy ◽

Bacterial Culture ◽

Bacterial Pathogens ◽

Empiric Therapy ◽

Research Database ◽

Gram Positive ◽

Hospital Outcomes ◽

Gram Negative ◽

Positive Bacterial Culture

Abstract Background Increased utilization of antimicrobial therapy has been observed during the coronavirus disease 2019 pandemic. We evaluated hospital outcomes based on the adequacy of antibacterial therapy for bacterial pathogens in US patients. Methods This multicenter retrospective study included patients with ≥24 hours of inpatient admission, ≥24 hours of antibiotic therapy, and discharge/death from March-November 2020 at 201 US hospitals in the BD Insights Research Database. Included patients had a test for severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) and a positive bacterial culture (gram-positive or gram-negative). We used generalized linear mixed models to evaluate the impact of inadequate empiric therapy (IET), defined as therapy not active against the identified bacteria or no antimicrobial therapy in the 48 hours following culture, on in-hospital mortality and hospital and intensive care unit (ICU) length of stay (LOS). Results Of 438,888 SARS-CoV-2 tested patients, 39,203 (8.9%) had positive bacterial cultures. Among patients with positive cultures, 9.4% were SARS-CoV-2 positive, 74.4% had a gram-negative pathogen, 25.6% had a gram-positive pathogen, and 44.1% received IET for the bacterial infection. The odds of mortality were 21% higher for IET (odds ratio 1.21 [95% confidence interval (CI), 1.10–1.33]; P<.001) compared with adequate empiric therapy. IET was also associated with increased hospital LOS(16.1 [95% CI, 15.5–16.7] vs 14.5 [95% CI 13.9–15.1] days; (P<.001). Both mortality and hospital LOS findings remained consistent for SARS-CoV-2-positive and -negative patients. Conclusions Bacterial pathogens continue to play an important role in hospital outcomes during the pandemic. Adequate and timely therapeutic management may help ensure better outcomes.

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Assessment of real-time PCR cycle threshold values in Microsporum canis culture-positive and culture-negative cats in an animal shelter: a field study

Journal of Feline Medicine and Surgery ◽

10.1177/1098612x17706270 ◽

2017 ◽

Vol 20 (2) ◽

pp. 108-113 ◽

Cited By ~ 3

Author(s):

Linda S Jacobson ◽

Lauren McIntyre ◽

Jenny Mykusz

Keyword(s):

Field Study ◽

Real Time ◽

Real Time Pcr ◽

Fungal Culture ◽

Time Points ◽

Cycle Threshold ◽

Ct Value ◽

Two Samples ◽

Culture Positive ◽

Culture Negative

Objectives Real-time PCR provides quantitative information, recorded as the cycle threshold (Ct) value, about the number of organisms detected in a diagnostic sample. The Ct value correlates with the number of copies of the target organism in an inversely proportional and exponential relationship. The aim of the study was to determine whether Ct values could be used to distinguish between culture-positive and culture-negative samples. Methods This was a retrospective analysis of Ct values from dermatophyte PCR results in cats with suspicious skin lesions or suspected exposure to dermatophytosis. Results One hundred and thirty-two samples were included. Using culture as the gold standard, 28 were true positives, 12 were false positives and 92 were true negatives. The area under the curve for the pretreatment time point was 96.8% (95% confidence interval [CI] 94.2–99.5) compared with 74.3% (95% CI 52.6–96.0) for pooled data during treatment. Before treatment, a Ct cut-off of <35.7 (approximate DNA count 300) provided a sensitivity of 92.3% and specificity of 95.2%. There was no reliable cut-off Ct value between culture-positive and culture-negative samples during treatment. Ct values prior to treatment differed significantly between the true-positive and false-positive groups ( P = 0.0056). There was a significant difference between the pretreatment and first and second negative culture time points ( P = 0.0002 and P <0.0001, respectively). However, there was substantial overlap between Ct values for true positives and true negatives, and for pre- and intra-treatment time points. Conclusions and relevance Ct values had limited usefulness for distinguishing between culture-positive and culture-negative cases when field study samples were analyzed. In addition, Ct values were less reliable than fungal culture for determining mycological cure.

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1471. Evaluation of Antibiotic De-escalation in Post Cardiac Arrest Patients with Culture-Negative versus Culture-Positive Aspiration Pneumonia

Open Forum Infectious Diseases ◽

10.1093/ofid/ofaa439.1652 ◽

2020 ◽

Vol 7 (Supplement_1) ◽

pp. S737-S737

Author(s):

Natasha R Herzig ◽

Tara L Harpenau ◽

Kevin M Wohlfarth ◽

Alicia M Hochanadel

Keyword(s):

Cardiac Arrest ◽

Length Of Stay ◽

Clinical Outcomes ◽

Aspiration Pneumonia ◽

Antimicrobial Therapy ◽

Empiric Therapy ◽

Hospital Length ◽

Hospital Length Of Stay ◽

Culture Positive ◽

Culture Negative

Abstract Background Cardiac arrest patients are often empirically treated for aspiration pneumonia with broad-spectrum antibiotics. Previous literature has shown no difference in clinical outcomes when discontinuing antimicrobial therapy for suspected aspiration pneumonia with negative respiratory cultures, but the application is limited in this population. This study aimed to assess antibiotic de-escalation practices for suspected aspiration pneumonia in post cardiac arrest patients with respiratory cultures and explore clinical outcomes. Methods This retrospective cohort conducted at a level 1 trauma center included adult out-of-hospital cardiac arrest patients who received antimicrobial therapy for suspected aspiration pneumonia. The primary endpoint was incidence of antibiotic de-escalation before day seven comparing culture-negative and culture-positive patients. De-escalation included discontinuation of methicillin-resistant Staphylococcus aureus (MRSA) coverage, Pseudomonas aeruginosa coverage, atypical coverage or all antibiotics when respective pathogens were not identified from microbiologic or serologic methods. Secondary endpoints included type of de-escalation and clinical outcomes. Results Eighty-six patients were included: 45 culture-negative and 41 culture-positive. Figure 1 depicts the breakdown of organisms isolated. Guideline-directed empiric therapy was used in 18.6% of patients, with the remainder receiving excessively broad empiric coverage. Antibiotic de-escalation before day seven occurred in 28 (80%) culture-negative patients and 32 (82%) culture-positive patients (p = 0.82), excluding patients who died before day seven. Providers frequently stopped unnecessary MRSA coverage in both groups. In-hospital mortality was higher in the group of patients without antibacterial de-escalation (62% vs. 33%, p=0.03), but hospital length of stay, ICU length of stay, and number of ventilator-free days were not different between groups. Figure 1: Epidemiology of Pathogens Isolated From Respiratory Cultures in Cardiac Arrest Patients Conclusion Culture results were not associated with antibiotic de-escalation in post cardiac arrest patients with suspected aspiration pneumonia. Opportunities exist for further de-escalation in this population, particularly patients with unnecessary pseudomonal coverage. Disclosures All Authors: No reported disclosures

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Evaluation of a PCR to Detect Salmonella in Fecal Samples of Horses Admitted to a Veterinary Teaching Hospital

Journal of Veterinary Diagnostic Investigation ◽

10.1177/104063870501700204 ◽

2005 ◽

Vol 17 (2) ◽

pp. 118-123 ◽

Cited By ~ 29

Author(s):

Michael P. Ward ◽

Catherine A. Alinovi ◽

Laurent L. Couëtil ◽

Ching Ching Wu

Keyword(s):

Bacterial Culture ◽

Gastrointestinal Disease ◽

Test Results ◽

Salmonella Spp ◽

Fecal Samples ◽

Surveillance Programs ◽

Operon Gene ◽

Culture Positive ◽

Culture Negative ◽

Pcr Test

The diagnostic accuracy of a PCR used to identify horses shedding Salmonella spp. in their feces during hospitalization was estimated, relative to bacterial culture of serially collected fecal samples, using longitudinal data. Five or more fecal samples were collected from each of 116 horses admitted as inpatients, for reasons other than gastrointestinal disease, between July 26, 2001 and October 25, 2002. All 873 fecal samples collected were tested with a PCR based on oligonucleotide primers defining a highly conserved segment of the histidine transport operon gene of Salmonella typhimurium, and each sample was cultured for Salmonella spp. One or more samples from 87 (75%) horses were PCR positive, and Salmonella was cultured from 1 or more samples from 11 (9.5%) horses. All culture-positive horses had at least 1 PCR-positive result, whereas only 29 (28%) culture-negative horses were PCR negative on all fecal samples tested. The PCR was most specific, relative to bacterial culture of serially collected fecal samples, when used to test samples from Quarterhorse or breeds other than Thoroughbred or Standardbred, or from clinical (vs. healthy, accompanying horses) cases. Overall, the PCR had the greatest agreement (70%), compared with bacterial culture of serially collected fecal samples, using a cutoff of 2 or more positive PCR test results to define a Salmonella-positive horse. The reasons why some fecal samples, from which Salmonella organisms cannot be isolated, are PCR positive need to be determined before the PCR can be incorporated into Salmonella surveillance programs for hospitalized equine populations.

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Comparison of PCR with standard culture of fine needle aspiration samples in the diagnosis of tuberculosis lymphadenitis

The Journal of Infection in Developing Countries ◽

10.3855/jidc.2050 ◽

2011 ◽

Vol 6 (01) ◽

pp. 53-57 ◽

Cited By ~ 23

Author(s):

Yohannes Derese ◽

Elena Hailu ◽

Tekalign Assefa ◽

Yonas Bekele ◽

Adane Mihret ◽

...

Keyword(s):

Bacterial Culture ◽

Extrapulmonary Tuberculosis ◽

Needle Aspiration ◽

Fine Needle ◽

Pcr Diagnosis ◽

Suspected Tuberculosis ◽

Standard Culture ◽

Safety Procedures ◽

Culture Positive ◽

Culture Negative

Introduction: Lymphadenopathy is the commonest form of extrapulmonary tuberculosis (TB) Clinical diagnosis of TB in lymph nodes requires aspiration of the material and isolation of mycobacteria. Bacterial culture is the gold standard for detection of tubercle bacilli, but it is time-consuming and requires specialized safety procedures and a BSL3 laboratory. However, PCR is a rapid method which requires small volumes of samples and can also be performed on killed bacilli to ensure safety. This project was designed to compare direct fine needle aspirate (FNA) PCR with culture in the diagnosis of tuberculosis lymphadenitis. Methodology: Direct examination of samples with EZN staining, culture, cytology and PCR was performed on previously collected FNA from the patients with suspected tuberculosis lymphadenitis Results: In total, 38% of the samples were positive for TB by culture, 11.8% by EZN staining, 23.4% by PCR, and 59.8% by cytology. Cytology had the highest sensitivity (81%) and EZN stain the least (22.9%). The specificity of EZN stain was the highest (92.4%) while cytology was the lowest (50%). In this study, out of 50 culture-positive samples, 21 (42%) were positive by PCR while 8 (10.8%) out of 74 culture-negative samples were positive by PCR. Conclusions: Although PCR is a sensitive diagnostic method, its sensitivity was shown to be low in this study. Therefore, we recommend that further studies should be conducted on fresh aspirate samples to investigate for possible PCR inhibitors which may limit the sensitivity of PCR diagnosis.

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COMPARISON OF POSITIVE BACTERIAL CULTURE RATE FROM URINE SPECIMEN AND CATHETER SWAB IN INDWELLING CATHETER PATIENTS

Indonesian Journal of Urology ◽

10.32421/juri.v17i2.345 ◽

1970 ◽

Vol 17 (2) ◽

Author(s):

Marzuki Yusuf ◽

Sabilal Alif ◽

Doddy M Soebadi ◽

Kartuti Debora ◽

Widodo J P

Keyword(s):

Bacterial Culture ◽

Urinary Catheter ◽

Catheter Insertion ◽

Indwelling Catheter ◽

Positive Bacterial Culture ◽

Before And After ◽

Positive Rate ◽

Urinary Culture ◽

The Difference ◽

Culture Positive

Objective: The study aims to study the difference between urinary culture before and after indwelling catheter insertion and also the difference in positive bacterial culture rate between urine and catheter swab at the 7th and 14th days. Material & method: The subject of this study were patients who used indwelling catheters in urology outpatient department. The sample was allocated into two groups of 10 patients each, 7 and 14 days group. Sterile urinary culture was initially checked before catheter insertion. After 7 and 14 days of catheterisation respectively, urine and intraluminal catheter swab were performed upon removal. All samples were examined in Microbiology Department using McConkey and Nutrient agar (Mayo technique – T/T33). After 24 hours incubation, bacterial colonies were identified. Results: All urinary cultures obtained before the study were sterile, after 7 days catheter insertion two cultures (20%) remained negative and the remainder (80%) became positive. McNemar test result was 0,008 (p<0,05). In 14 days group after catheter insertion only one (10%) remained negative while 9 others were positive for bacteria. Mcnemar test shows 0,004 (p<0,05). The urinary and catheter swab culture is not significantly different in 7 days of indwelling catheterization patients (0,500; p>0,05) and also in 14 days patients (1,000, p>0,005). While the catheter swab culture is significantly positive after administering the urinary catheter in 7 and 14 days of catheterization (0,002; p<0,05). Conclusion: There was significant difference in urinary culture positive rate before and after catheter insertion in 7th and 14th day. Bacteriuria rose sharply after urinary catheter insertion despite aseptic procedure. There was no difference in culture positive rate between urine and catheter swab at 7th day as well as 14th day.

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