scholarly journals 114. Prospective Trial of Passive Diversion Device to Reduce Blood Culture Contamination

2021 ◽  
Vol 8 (Supplement_1) ◽  
pp. S70-S70
Author(s):  
Sami Arnaout ◽  
Richard T Ellison ◽  
Thomas C Greenough ◽  
Azalea Wedig ◽  
Michael J Mitchell ◽  
...  
Keyword(s):  
Blood Culture ◽  
Medical Center ◽  
Academic Medical Center ◽  
Prospective Trial ◽  
The Other ◽  
Relative Reduction ◽  
Study Phase ◽  
Standard Equipment ◽  
Culture Bottle ◽  
Physician Review

Abstract Background Blood culture contaminants can lead to inappropriate antibiotic use, prolonged length of stay, and additional hospital costs. Several devices have been developed to reduce the risk of blood culture contamination by diverting a portion of the initial blood sample from the blood culture bottle. We have assessed the effectiveness of one blood diversion device in a prospective trial performed at the two separate emergency departments (EDs) of a three-campus Academic Medical Center. Methods A multi-phase prospective crossover trial was performed with the blood diversion device initially in use at one ED (Memorial) and standard equipment at the other ED (University) for 10 weeks. After a washout phase, a second 10-week study phase used the blood diversion device in the other ED (University) and standard equipment at the first ED (Memorial). Contaminants were identified by the clinical microbiology lab using standard criteria, and further defined by independent retrospective review by 3 infectious disease physicians prior to statistical analysis. An intention-to-treat analysis was performed, and Chi-square tests were used to compare contaminant rates among samples obtained using the blood diversion device versus standard equipment. Results 5,675 blood samples were obtained with 5,661 samples analyzed after 14 were deemed inconclusive by the ID physician review. There were 1,719 samples obtained at Memorial ED and 3,942 at University ED, with 2,836 samples collected during diversion device periods and 2,825 during standard equipment periods. Based on the ID physician review, the contaminant rates were 1.9% in diversion device periods versus 2.9% in standard equipment periods (P = 0.018). There was a marked difference in blood culture contamination rates between the two EDs with contaminant rates at the Memorial ED of 1.1% and 1.4% (P=0.57), and at the University ED of 2.3% and 3.5% (P=0.024) for the diversion device and standard equipment periods, respectively. Conclusion The blood diversion device was able to significantly lower blood culture contamination rates overall by 1% at the institution’s two EDs (34% relative reduction), with a stronger effect noted at the campus with both a level 1 trauma center and transplant programs. Disclosures All Authors: No reported disclosures

scholarly journals 161. Evaluating the Predictive Value of Blood Culture Bottle Reporting for Coagulase Negative Staphylococci-Positive Cultures: Assessing Contamination vs. True Bacteremia

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S105-S106
Author(s):  
Pamela Bailey ◽  
Christopher Doern
Keyword(s):  
Blood Culture ◽  
Chart Review ◽  
Blood Stream Infection ◽  
Medical Center ◽  
Academic Medical Center ◽  
Tertiary Care ◽  
Positive Culture ◽  
Antibiotic Use ◽  
Coagulase Negative Staphylococci ◽  
Culture Bottle

Abstract Background Coagulase-negative staphylococci (CoNS) are common blood culture (BCx) contaminants, but can also be causes of true blood stream infection (BSI). As a result, the clinical interpretation of CoNS positive BCx poses a significant challenge for providers and drives unnecessary antibiotic use, extended lengths of stay, and increased hospital costs. Despite these challenges, little is known about whether the number of positive BCx bottles within a set can be used to predict contamination vs. true BSI. Methods This study was conducted in an 865-bed tertiary care academic medical center in Richmond, VA. A retrospective chart review of CoNS-positive BCx from October to December 2018 was performed. Data collection included patient demographics, number of positive bottles within a set (i.e., were 1 or 2 bottles positive), care setting, antibiotic use, clinical judgement of contamination, and additional workup following the positive BCx result. Polymicrobic BCx were excluded. Results 50 patients (mean age 58.2 years, 60% male) with CoNS-positive BCx were included in this study. Forty (80%) of the cultures had only 1 of 2 BCx bottles positive within a set. 10 (20%) were positive from both bottles in the set. All patients were drawn in the Emergency Department and 90% were subsequently admitted to the hospital. Upon chart review, 47 (94%) and 3 (6%) of cultures were considered to be contaminants and real BSI, respectively. Of those judged to be contaminants, 10 (20%) were positive in both bottles within a set, and thus falsely suggested true BSI. Of the 3 judged to be true BSI, 2 (66%) were positive in 1 out of 2 bottles, and thus falsely suggested contamination. 42 (84%) patients had repeat BCx drawn following the initial positive culture, and 26 (52%) were continued on IV antibiotics. Forty (80%) of the cultures were judged contaminants by the primary medical service, and 77% stopped antibiotics (20/26) when CoNS was identified. Conclusion These data show that reporting the number of bottles which are positive within a set provides misleading information and should not be used to determine whether a culture result represents contamination or true BSI. Disclosures All authors: No reported disclosures.

scholarly journals 301. Penicillin Versus Cefazolin or Anti-staphylococcal Penicillins for Penicillin-Susceptible Staphylococcus aureus Bacteremia

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S149-S149
Author(s):  
Mohammed Aldhaeefi ◽  
Jeffrey Pearson ◽  
Sanjat Kanjilal ◽  
Brandon Dionne
Keyword(s):  
Staphylococcus Aureus ◽  
Blood Culture ◽  
Positive Blood Culture ◽  
Medical Center ◽  
Academic Medical Center ◽  
Similar Distribution ◽  
Clinical Failure ◽  
Staphylococcus Aureus Bacteremia ◽  
Definitive Therapy ◽  
Significant Difference

Abstract Background Staphylococcus aureus bacteremia is a significant cause of mortality. Penicillin (PCN) may have a role in the treatment of penicillin-susceptible Staphylococcus aureus (PSSA) bacteremia as it has a narrower spectrum of activity than cefazolin and is better tolerated than antistaphylococcal penicillins (ASPs). The aim of this study is to evaluate the safety and effectiveness of PCN versus cefazolin or ASPs in the treatment of PSSA bacteremia. Methods This is a single-center, retrospective study at a tertiary academic medical center. All patients with a PSSA blood culture from January 1, 2012 to September 1, 2019 were screened. Patients were excluded if they were treated with a definitive antibiotic (defined as antimicrobial therapy received 72 hours after positive blood culture) other than the study comparators, or if they received combination antibiotic therapy >72 hours from the initial positive blood culture result. The primary outcome was 60-day clinical failure, which was a composite endpoint of change in antibiotic after 72 hours of definitive therapy, recurrence of PSSA bacteremia, infection-related readmission, or all-cause mortality. Results Of 277 patients with PSSA bacteremia, 101 patients were included in the study; 62 (61%) were male and 11 (11%) had a β-lactam allergy. At baseline, 40 patients (40%) had hardware, 25 (25%) had an intravenous line, 6 (6%) were on dialysis, and 4 (4%) had active IV drug use, with similar distribution across antibiotic groups. Penicillin was the most common antibiotic used (Table 1). There was a significant difference among groups with respect to the 60-day clinical failure (log-rank p=0.019). In terms of unadjusted 60-day clinical failure, penicillin had similar outcomes to cefazolin (95% CI -0.29 to 0.104, p=0.376), however, it had statistically significant better outcomes in comparison to the ASPs, nafcillin or oxacillin (95% CI 0.023 to 0.482, p=0.031) (Table 1). Table 1. 60-day outcomes of PSSA bacteremia Conclusion Penicillin is effective and safe in the treatment of PSSA bacteremia and may be preferable to antistaphylococcal penicillins Disclosures All Authors: No reported disclosures

Long-Term Inhalative Sedation in Children With Pulmonary Diseases

2020 ◽  
pp. 088506662095339
Author(s):  
Jochen Meyburg ◽  
David Frommhold ◽  
Johann Motsch ◽  
Navina Kuss
Keyword(s):  
Side Effects ◽  
Lung Function ◽  
Medical Center ◽  
Academic Medical Center ◽  
Tertiary Care ◽  
Prospective Trial ◽  
Pediatric Intensive Care ◽  
Normal Lung ◽  
Beneficial Effects

Objectives: To describe safety and feasibility of long-term inhalative sedation (LTIS) in children with severe respiratory diseases compared to patients with normal lung function with respect to recent studies that showed beneficial effects in adult patients with acute respiratory distress syndrome (ARDS). Design: Single-center retrospective study. Setting: 12-bed pediatric intensive care unit (PICU) in a tertiary-care academic medical center in Germany. Patients: All patients treated in our PICU with LTIS using the AnaConDa® device between July 2011 and July 2019. Measurements and Main Results: Thirty-seven courses of LTIS in 29 patients were analyzed. LTIS was feasible in both groups, but concomitant intravenous sedatives could be reduced more rapidly in children with lung diseases. Cardiocirculatory depression requiring vasopressors was observed in all patients. However, severe side effects only rarely occured. Conclusions: In this largest cohort of children treated with LTIS reported so far, LTIS was feasible even in children with severely impaired lung function. From our data, a prospective trial on the use of LTIS in children with ARDS seems justified. However, a thorough monitoring of cardiocirculatory side effects is mandatory.

scholarly journals 144. Organism Identification and Antibiotic Susceptibilities with Verigene Blood Culture Assay: a Retrospective Single-Center Study

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S99-S100
Author(s):  
Stephanie Tchen ◽  
Steven Smoke ◽  
Maria DeVivo
Keyword(s):  
Blood Culture ◽  
Antibiotic Susceptibility ◽  
Susceptibility Testing ◽  
Medical Center ◽  
Academic Medical Center ◽  
Blood Cultures ◽  
Molecular Testing ◽  
Antibiotic Susceptibility Testing ◽  
Resistance Determinants ◽  
Organism Identification

Abstract Background The Verigene blood culture assay is a rapid molecular testing platform for positive blood cultures. Verigene detects a limited number of bacteria and a limited number of antibiotic resistance determinants. While certain Verigene results have clear implications for optimal antibiotic therapy prior to complete antibiotic susceptibility testing, others do not. The purpose of this study was to compare the results of the Verigene blood culture assay with standard organism identification and antibiotic susceptibility testing. Methods This was a retrospective cohort study conducted at a single academic medical center. The study period was 14 months from November 2017 to December 2018. All Verigene results from the study period were reviewed and compared with the results of standard organism identification and susceptibility testing. Organism identification and antibiotic susceptibility testing were performed by Vitek MS and Vitek 2. Duplicate results from the same patient were excluded. The primary outcome was the percentage of blood cultures correctly identified by Verigene. Secondary outcomes included the antibiotic susceptibility of organisms identified by Verigene in the presence and absence of resistance determinants and the identity and frequency of organisms not detected by Verigene. Results A total of 782 Verigene results were screened. After exclusions, 675 Verigene results including 737 organisms from 597 patients were included. Of 737 organisms, Verigene correctly identified 611 (82.9%), incorrectly identified 19 (2.6%) and was unable to identify 107 (14.5%) off-panel organisms. Tables 1 and 2 outline the antibiotic susceptibility of organisms by the presence or absence of resistance determinants in Gram-negative and Gram-positive bacteria, respectively. Table 3 describes the identities of the organisms not detected by Verigene, stratified by Gram stain result. Conclusion The Verigene blood culture assay demonstrated accuracy in identifying organisms and predicting antibiotic susceptibility. These results will help inform the prospective interpretation of Verigene results and subsequent antibiotic selection at the study institution. Disclosures All authors: No reported disclosures.

scholarly journals Detection of Carbapenem-Resistant Enterobacterales in Simulated Blood Culture in 15 Minutes

Life ◽  
2021 ◽  
Vol 11 (2) ◽  
pp. 145
Author(s):  
Daria Baer ◽  
Maya Azrad ◽  
Nora Saleh ◽  
Avi Peretz
Keyword(s):  
Blood Culture ◽  
Medical Center ◽  
Bloodstream Infections ◽  
Resistant Bacteria ◽  
Clinical Microbiology Laboratory ◽  
Antibiotic Resistant ◽  
Culture Bottle ◽  
Carbapenem Resistant ◽  
Life Threatening ◽  
Threatening Situation

Bacteremia leading to sepsis and organ dysfunction is a life-threatening situation, leading to death of up to one fourth of the infected individuals around the world. One major challenge in the treatment of sepsis is the rising prevalence of antibiotic resistant bacteria, such as carbapenem-resistant Enterobacterales (CRE). In recent years, several molecular assays have been developed for the detection of CRE mechanisms, enabling rapid results reporting. We evaluated the performance of the NG-Test CARBA 5 (NG Biotech) kit in detection of CRE in simulated blood cultures. Carbapenemase-producing (CP) CRE isolates (n = 38) and non-carbapenemase CRE (Non-CP) isolates (n = 10), previously identified using the routine methods practiced at the clinical microbiology laboratory of the Baruch Padeh Medical Center, Israel, were used in this analysis. Variable concentrations of the bacterial isolates were added to a suspension composed of human blood and saline, simulating the composition of a blood culture. Samples were then transferred to an anaerobic blood culture bottle and later tested with the NG-Test CARBA 5 (NG Biotech) kit, that identifies the CRE mechanism within 15 min. The NG-Test CARBA 5 kit correctly identified 43 samples (89.5%). The sensitivity and specificity of the kits were 86.8% and 100%, respectively. In conclusion, the NG-Test CARBA 5 kit is a reliable and accessible tool for the rapid diagnosis of CRE bloodstream infections.

scholarly journals Implementation Methods for a Collaborative Pharmacist-Led Antimicrobial Stewardship Intervention at Hospital Discharge

2020 ◽  
Vol 41 (S1) ◽  
pp. s268-s269
Author(s):  
Corey Medler ◽  
Nicholas Mercuro ◽  
Nancy MacDonald ◽  
Allison Weinmann ◽  
Melinda Neuhauser ◽  
...  
Keyword(s):  
Hospital Discharge ◽  
Antimicrobial Stewardship ◽  
Medical Center ◽  
Academic Medical Center ◽  
Study Phase ◽  
Protocol Adherence ◽  
Antibiotic Selection ◽  
Number Of Patients ◽  
Days Of Therapy ◽  
Stop Date

Background: Unnecessary and prolonged antibiotic use is an important driver of antimicrobial resistance, increasing patient harm and resource utilization. Antimicrobials prescribed at hospital discharge represent an important opportunity to intervene and optimize therapy. Objective: We describe the implementation of a pharmacist-led multidisciplinary antimicrobial stewardship (AMS) intervention at transition of care (TOC) to improve antibiotic selection and duration. Methods: This intervention an IRB-approved multihospital, quasi-experimental, 3-phase stepped-wedge project in a 5-hospital health system. The setting included a large, urban, academic medical center in Detroit, Michigan, and 4 community hospitals in southeastern Michigan. AMS is provided by a pharmacist and infectious diseases physician at each site. For the AMS TOC intervention, pharmacists implemented 3 strategies: (1) early identification of patients to be discharged on oral antibiotics; (2) collaborative planning and communication regarding guideline-recommended antibiotic selection and duration; and (3) facilitation of discharge antibiotic prescription with appropriate stop date. Process improvements were modified to fit the academic and community hospital practice models. The process was implemented in general and specialty practice wards at each hospital site. Prior to implementation in October 2018, pharmacists were trained on tools to standardize identification, collaboration, and documentation. Pocket cards were used to augment education and electronic medical record (EMR) templates standardized documentation. Physicians and nurses on participating units were educated on the rationale and process. Following initiation, ongoing feedback was provided regularly to pharmacists to discuss challenges and to identify solutions. Process measures included the total number of patients receiving the intervention monthly, as indicated by pharmacist AMS TOC notes placed. Protocol adherence was evaluated in 25 randomly selected patients in each study phase each month. Adherence was defined as a pharmacist preparing discharge prescriptions and a placing note in the EMR. Results: Over the study period, 1,558 patient encounters received AMS TOC facilitation by a pharmacist. Monthly protocol adherence ranged from 29% to 87% (higher in academic institutions than community) (Fig. 1). Months of low protocol adherence were associated with times of reduced staffing and onboarding a large group of new employees or trainees. Additional barriers included discharges over weekends. The most common area needing clarification was how to count days of therapy to determine the appropriate stop date. A guide of how to count days of therapy was created to assist. Conclusions: Pharmacist-led antimicrobial stewardship at discharge is a feasible intervention in both academic and community settings. Identifying potential barriers and assessing strategies with multidisciplinary healthcare teams allows for optimal implementation and intervention rollout.Funding: This work was completed under CDC contract number 200-2018-02928.Disclosures: None

Detection of carbapenemase-resistant Enterobacterales in blood culture in 15 minutes

2020 ◽  
Author(s):  
Daria Baer ◽  
Maya Azrad ◽  
Nora Saleh ◽  
Avi Peretz
Keyword(s):  
Blood Culture ◽  
Medical Center ◽  
Bloodstream Infections ◽  
Resistant Bacteria ◽  
Clinical Microbiology Laboratory ◽  
Antibiotic Resistant ◽  
Culture Bottle ◽  
Carbapenem Resistant ◽  
Life Threatening ◽  
Threatening Situation

Abstract Background: Bacteremia leading to sepsis and organ dysfunction is a life-threatening situation. One major challenge in treatment of sepsis is the uprising prevalence of antibiotic resistant bacteria, such as Carbapenem-resistant Enterobacterales (CRE). In recent years several molecular assays have been developed for the detection of CRE mechanisms, enabling rapid results reporting. We evaluated the performance of NG-Test CARBA 5 (NG Biotech) kit for detection of CRE, directly from patients’ blood culture.Methods: Carbapenemase-producing (CP) CRE-positive isolates (n=38) and non-carbapenemase CRE (non-CP) isolates (n=10), previously identified using the routine methods practiced at the clinical microbiology laboratory of the Baruch Padeh Medical Center, Israel were used in this analysis. Variable concentrations of the bacterial isolates were added to a suspension composed of blood unit and saline simulating the composition of a blood culture. Samples were then transferred to an anaerobic blood culture bottle and later tested it with the NG-Test CARBA 5 (NG Biotech) kit, that identifies the CRE mechanism in 15 minutes.Results: The NG-Test CARBA 5 kit correctly identified 43 samples (89.5%). The sensitivity and specificity of the kit were 86.8% and 100%, respectively.Conclusions: The NG-Test CARBA 5 kit is a reliable and accessible tool for the rapid diagnosis of CRE bloodstream infections.

scholarly journals Multicenter Evaluation of the Portrait Staph ID/R Blood Culture Panel for Rapid Identification of Staphylococci and Detection of themecAGene

2017 ◽  
Vol 55 (4) ◽  
pp. 1140-1146 ◽  
Author(s):  
Gerald A. Denys ◽  
Vanessa Collazo-Velez ◽  
Stephen Young ◽  
Judy A. Daly ◽  
Marc Roger Couturier ◽  
...  
Keyword(s):  
Blood Culture ◽  
Great Basin ◽  
Salt Lake ◽  
Prospective Trial ◽  
Gene Sequencing ◽  
The United States ◽  
Culture Bottle ◽  
Content Type ◽  
Percent Agreement ◽  
Multiplex Pcr Assay

ABSTRACTBloodstream infections are a leading cause of morbidity and mortality in the United States and are associated with increased health care costs. We evaluated the Portrait Staph ID/R blood culture panel (BCP) multiplex PCR assay (Great Basin Scientific, Salt Lake City, UT) for the rapid and simultaneous identification (ID) ofStaphylococcus aureus,Staphylococcus lugdunensis, andStaphylococcusspecies to the genus level and the detection of themecAgene directly from a positive blood culture bottle. A total of 765 Bactec bottles demonstrating Gram-positive cocci in singles or clusters were tested during the prospective trial at 3 clinical sites. The Portrait Staph ID/R BCP results were compared with results from conventional biochemical and cefoxitin disk methods performed at an independent laboratory. Discordant ID andmecAresults were resolved byrpoBgene sequencing andmecAgene sequencing, respectively. A total of 658Staphylococcusspecies isolates (S. aureus, 211 isolates;S. lugdunensis, 3 isolates; andStaphylococcusspp., 444 isolates) were recovered from monomicrobial and 33 polymicrobial blood cultures. After discrepant analysis, the overall ratios of Portrait Staph ID/R BCP positive percent agreement and negative percent agreement were 99.4%/99.9% forStaphylococcusID and 99.7%/99.2% formecAdetection.

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