scholarly journals 2178. Sensitivity of Blood Cultures in Detection of Bacteremia in Febrile Neutropenia

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S739-S739
Author(s):  
Vanisha Patel ◽  
Jose Amadeo A Ferrolino ◽  
Randall Hayden ◽  
Randall Hayden ◽  
Aditya H Gaur
Keyword(s):  
Blood Culture ◽  
Febrile Neutropenia ◽  
Positive Blood Culture ◽  
Culture Media ◽  
Febrile Episode ◽  
Advisory Board ◽  
Blood Cultures ◽  
Coagulase Negative Staphylococcus ◽  
Media Type ◽  
Time To Detection

Abstract Background Febrile neutropenia (FN) secondary to bacteremia is a treatable complication of chemotherapy that increases mortality if not promptly recognized and managed. Methods The sensitivity of blood cultures collected in pediatric oncology patients with FN was assessed and stratified based on the day of FN episode, culture media type, and the source of blood culture draw at a single US center between 2013 and 2018. Paired aerobic and lytic media bottles were inoculated with each culture draw using a weight-based volume of blood; anaerobic cultures were included with initial cultures starting in September of 2015. Results In a retrospective analysis of 10,596 patients, a total of 3,039 episodes of FN were identified. Of the FN episodes, 17.7% had at least one positive blood culture; 84.5%, 1.3%, 0.9% and 13.3% of positive cultures were collected on day 0, day 1, day 2 and ≥ day 3 of a febrile episode. Among the positive day 0 cultures, the median time to detection of an organism was 14.1 hours. Host characteristics of blood culture-positive FN episodes are summarized in Table 1. Bacteremia was identified in 537 FN cases; 18.1%, 11.9% and 2.6% of cultures were positive in only aerobic, lytic or anaerobic media cultures, respectively. The most commonly isolated organisms were Escherichia coli, coagulase-negative Staphylococcus, viridans group streptococcus, Klebsiella pneumoniae and Pseudomonas aeruginosa. Fifteen percent of infectious episodes with a positive blood culture were polymicrobial. Conclusion In summary, the study findings have important clinical implications such as emphasizing the value of day 0 cultures and highlighting the importance of routinely collecting blood cultures in more than one media type. Despite an optimized blood culture approach, less than a fifth of FN episodes had a blood culture-based diagnosis. Disclosures Randall Hayden, MD, Abbott Molecular: Advisory Board; Quidel: Advisory Board; Roche Diagnostics: Advisory Board.

scholarly journals 298. Multicenter retrospective cohort study of the clinical significance of Staphylococcus lugdunensis isolated from a single blood culture set

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S147-S148
Author(s):  
Naomi Hauser ◽  
Justin Kim ◽  
Paul Luethy ◽  
Sarah Schmalzle ◽  
Jacqueline Bork
Keyword(s):  
Blood Culture ◽  
Clinical Significance ◽  
Positive Blood Culture ◽  
Positive Culture ◽  
Central Line ◽  
Blood Cultures ◽  
Adult Patients ◽  
Coagulase Negative Staphylococcus ◽  
Staphylococcus Lugdunensis ◽  
Clinical Criteria

Abstract Background Staphylococcus lugdunensis is a coagulase negative Staphylococcus (CoNS) species with the potential to cause aggressive infection. Guidance surrounding S. lugdunensis bacteremia (SLB) is lacking, especially in the case of a single positive set of blood cultures. Methods We performed a multicenter, retrospective observational cohort review of adult patients with SLB from at least one blood culture set within the University of Maryland Medical System from November 2015-November 2019. Objectives were to (1) describe baseline characteristics, (2) compare available criteria for evaluating clinical significance, and (3) evaluate the clinical outcomes among patients with SLB in 1 vs ≥2 positive blood culture sets. Descriptive statistics with Chi-squared and Mann-Whitney U tests were carried out. Results There were 5,548 CoNS-positive blood culture sets, 49 (0.88%) with S. lugdunensis comprising 36 adult patients (24 with 1 positive set and 12 with ≥2 positive sets). Patients with ≥2 positive sets were more likely to be on hemodialysis (HD) (p=0.029) and to have an HD catheter present (p=0.10) (Table 1). Thirty-five of the 36 patients fulfilled at least one of the following: systemic inflammatory response syndrome (SIRS), Souvenir criteria, or clinical criteria (infectious focus on imaging and/or second positive culture site) (Table 2). Twenty-eight (78%) patients were treated with antimicrobial therapy and/or central line removal. SIRS criteria were met more often among patients with 1 positive set (p=0.05). Patients with ≥2 positive sets were more often treated with antibiotics for longer than 2 weeks (p=0.02). The mean time of positive cultures to discharge was 11 days and was longer for patients with only one set of positive blood cultures (13 vs. 6 days), although this difference was not statistically significant (p=0.29) (Table 3). Conclusion SLB was rare and occurred more frequently as a single set of positive blood cultures. Though limited by sample size, this study found similar patient characteristics, clinical significance and outcomes between patients with one set and those with ≥2 sets of blood cultures positive for S. lugdunensis. Given the potential severity of SLB, it seems prudent to treat S. lugdunensis in a single blood culture, but larger studies are needed. Disclosures All Authors: No reported disclosures

scholarly journals 182. Clinical Presentation of Patients with Staphylococcus lugdunensis Positive Blood Cultures After the Implementation of Rapid Molecular Blood Culture Diagnostics

2021 ◽  
Vol 8 (Supplement_1) ◽  
pp. S199-S200
Author(s):  
Kristin Constance ◽  
Alauna Hunt ◽  
Sam Karimaghaei ◽  
Nigo Masayuki
Keyword(s):  
Blood Culture ◽  
Bloodstream Infection ◽  
Positive Blood Culture ◽  
Central Line ◽  
Blood Cultures ◽  
Coagulase Negative Staphylococcus ◽  
Medical Systems ◽  
Hospital System ◽  
Severe Infections ◽  
Acid Test

Abstract Background Since the implementation of improved laboratory techniques, coagulase negative Staphylococcus (CoNS) have been routinely speciated to screen for S. lugdunensis (SL), which has led to increased identification. The objective of this study is to describe the characteristics of patients with SL positive blood cultures after the introduction of Verigene® Gram-Positive Blood Culture Nucleic Acid Test (BC-GP) in two large medical systems. Methods Retrospective review of all blood culture isolates positive for SL from Memorial Hermann Hospital System (14 hospitals) and HarrisHealth System (two acute care hospitals) since implementation of BC-GP. Results Between 2017 – 2021, 157 patients had SL positive blood cultures. 18 were eliminated as cultures were positive for bacteria other than CoNS, and 7 eliminated as patients were discharged prior to culture results. Of the remaining 132 patients, 39 (29.5%) were labelled contaminants by the treating physician and 93 were considered true bacteremia. Patients with hardware/implanted materials were more likely considered to have true bacteremia, while patients with other CoNS species in blood cultures were more likely considered contaminants. Only one death was attributed to SL bloodstream infection in the true bacteremia group. None of the deaths in the contaminated group were attributed to SL infection. Of the 93 patients labelled true bacteremia, the source was most frequently listed as central line associated bloodstream infection (17.2%), followed by skin/soft tissue infection (11.8%), and infective endocarditis (IE) (10.8%). Table 1. Characteristics of Patients with S. lugdunensis Positive Blood Cultures Conclusion In our study, 29% of patients with positive blood culture for SL were deemed contaminants. Patients without hardwares or positive concomitant other CoNS species from the same blood culture were often considered as contaminated cases. The incidence of IE remains as high as 10.8% in those patients identified to have true bacteremia (7.6% overall in our cohort), although lower than previously reported cases. Careful evaluation is warranted in patients with positive SL blood culture to rule out severe infections and avoid unnecessary courses of antibiotic therapy. This study suggests that increased identification of SL may impact our understanding of its significance and pathogenicity over time. Disclosures All Authors: No reported disclosures

scholarly journals Comparison of Pharmacist-Directed Management of Multiplex PCR Blood Culture Results with Conventional Microbiology Methods on Effective and Optimal Therapy within a Community Hospital

2018 ◽  
Vol 63 (1) ◽  
Author(s):  
Allison M. Porter ◽  
Christopher M. Bland ◽  
Henry N. Young ◽  
David R. Allen ◽  
Sabrina R. Croft ◽  
...  
Keyword(s):  
Blood Culture ◽  
Multiplex Pcr ◽  
Positive Blood Culture ◽  
Antimicrobial Therapy ◽  
Community Hospital ◽  
Intervention Group ◽  
Standard Of Care ◽  
Pharmacist Intervention ◽  
Coagulase Negative Staphylococcus ◽  
Optimal Therapy

ABSTRACT Multiplex PCR combined with a pharmacist-driven reporting protocol was compared to the standard of care within a community hospital to evaluate initial changes after notification of a positive blood culture. The intervention group demonstrated decreased times to changes in antimicrobial therapy (P = 0.0081), increased changes to optimal antimicrobial therapy (P = 0.013), and decreased vancomycin use for coagulase-negative staphylococcus contaminants (P < 0.01) with multiplex PCR implementation and pharmacist intervention.

ATG Use Is Associated with Frequent Occurrence of Positive Blood Cultures in Patients in the Early Phase After Hematopoietic Stem Cell Transplantation

Blood ◽  
2011 ◽  
Vol 118 (21) ◽  
pp. 4564-4564
Author(s):  
Marek Seweryn ◽  
Urszula Jarosz ◽  
Malgorzata Krawczyk-Kulis ◽  
Miroslaw Markiewicz ◽  
Grzegorz Helbig ◽  
...  
Keyword(s):  
Stem Cell ◽  
Hematopoietic Stem Cell Transplantation ◽  
Blood Culture ◽  
Stem Cell Transplantation ◽  
Positive Blood Culture ◽  
Blood Cultures ◽  
Gram Negative Bacteria ◽  
Hematopoietic Stem ◽  
Gram Negative ◽  
Gram Positive Bacteria

Abstract Abstract 4564 Background: Infectious complications remain an important cause of morbidity and mortality in the early phase after hematopoietic stem cell transplantation (HSCT). Aim: The aim of this study was to assess the frequency of positive blood cultures and its potential correlation with different studied parameters in large patient population studied in the first 30 days after HSCT. Material and methods: 431 patients at median age of 47 years (range 18–85) transplanted between 2009–2011 for hematological and non-hematological malignancies were included in our analysis. There were 242 males and 189 females. Results: The indications for autologous and allogeneic HSCT were following: AML – 105 (24%), NHL – 86 (20%), MM – 75 (17,5%), HL – 48 (11%), ALL – 40 (9%), MDS – 17 (4%), AA – 15 (3,5%), CML – 12 (2,8%), PNH – 11 (2,6%), connective tissue diseases – 5 (1,2%), CLL – 3 (0,7%) and other – 14 (3,2%). The following transplant procedures were performed: ABCT – 213 (49%), ABMT – 3 (0,7%), alloBCT – 56 (13%), alloBMT – 21 (5%), URDBCT – 87 (20%), URDBMT – 51 (12%). Pre-transplant ATG and anti-CD52 antibody were used in 142 (33%) and 5 (1.2%) patients, respectively. Amongst 431 transplanted patients, 495 blood cultures were collected; range 0–8 (median 1). Eighty seven blood samples were positive (17,6%). The following pathogens were detected: gram-positive bacteria in 48% (n=42), gram-negative bacteria in 38% (n=33), fungi in 1% (n=1) and both G(+) and G(&minus;) bacteria in 13%(n=11). The gram-positive bacteria included: Staphylococcus epidermidis: 21 (50%), Micrococcus spp: 4 (9%), Enterococcus faecium: 3 (7%), Enterococcus faecalis: 3 (7%), Streptococcus haemolyticus: 3 (7%). The following gram-negative bacteria were found: Enterobacter cloacae: 10 (30%), Escherichia coli: 7 (21%), Pseudomonas aeruginosa: 5 (15%), Klebsiella pneumonia: 5 (15%). Candida albicans was detected only in one case. The use of ATG was associated with higher number of total blood draw and positive blood cultures. No significant correlation was found between the specific pathogen and the use of ATG. Male gender was associated with significantly higher number of blood sampling and with tendency to higher number of positive blood cultures. The type of conditioning regimen, the source of stem cell and the donor origin (auto vs sibling vs unrelated) did not influence the number of positive blood culture. There was tendency to higher number of blood intake, but not positive blood culture in patients transplanted in NR if compared to PR or CR. Conclusions: Positive blood cultures were positive in about 20% of patients after HSCT. Only pre-transplant ATG use was associated with the higher number of positive blood culture. Disclosures: No relevant conflicts of interest to declare.

Rate of positive blood cultures after 3 days of empiric antibiotics in pediatric cancer

2007 ◽  
Vol 25 (18_suppl) ◽  
pp. 9535-9535
Author(s):  
B. Kanathezhath ◽  
J. Feusner
Keyword(s):  
Blood Culture ◽  
Pediatric Oncology ◽  
Broad Spectrum ◽  
Signs And Symptoms ◽  
Blood Cultures ◽  
Coagulase Negative Staphylococcus ◽  
Cell Transplant ◽  
Hematopoietic Stem ◽  
Broad Spectrum Antibiotics ◽  
Related Mortality

9535 Background: Infections continue to be a major cause of morbidity and mortality in pediatric oncology patients (pts) with febrile neutropenia (FN). The proportion of such pts who have bacteremia documented after 72 hours (hrs) of broad-spectrum antibiotics, in the absence of local or systemic signs of infection, has not been previously reported. Methods: We conducted a retrospective analysis of all FN oncology pts admitted to our hospital during the period of August 1999 to October 2006. Blood cultures (BCs) from pts who were persistently febrile more than 3 days after initiation of empiric broad-spectrum antibiotics (ceftazidime and tobramycin) were analyzed. Medical records of pts with positive late blood cultures (LBCs) after 72 hrs were reviewed for onset of new signs and symptoms of infection. Hematopoietic stem cell transplant and HIV pts were excluded. Results: Ninety-seven episodes of persistent fever occurred in 71 FN pts. The total number of positive BCs in the first 72 hours was 24 (33.8%). Three (4.2%) of the persistently febrile pts had positive LBC. Of these 3 pts, one had preceding new signs and symptoms. Another had a probable contaminant (only 1 positive BC for coagulase-negative staphylococcus). Only one pt (1.4%) had positive LBC without any new local or systemic signs of infection. The observed frequency of positive LBC was 4.2% for pts and 0.8% (3/391) for total cultures obtained after 72 hours. There were no changes made in the antibiotic regimen of pts with positive LBC and none of them suffered from sepsis related mortality. Conclusions: This is the first report of late blood culture results in FN pediatric oncology pts. The practice of obtaining daily blood culture in such pts who are stable after 72 hrs of broad- spectrum antibiotics has a low yield (<5%), and even lower (<2%) if pts with new signs or symptoms at the LBC are excluded. This observation, if confirmed by larger studies from other centers, could lead to a more efficient, risk based strategy for following these pts. No significant financial relationships to disclose.

Use of simulated blood cultures for time to detection comparison between BacT/ALERT™ and BACTEC™ 9240 blood culture systems

2002 ◽  
Vol 44 (3) ◽  
pp. 235-240 ◽  
Author(s):  
Egidio Francesco Viganò ◽  
Emanuela Vasconi ◽  
Carlo Agrappi ◽  
Pierangelo Clerici
Keyword(s):  
Blood Culture ◽  
Blood Cultures ◽  
Culture Systems ◽  
Time To Detection

Time to Detection with BacT/Alert FA Plus Compared to BacT/Alert FA Blood Culture Media

2016 ◽  
Vol 35 (9) ◽  
pp. 1469-1473 ◽  
Author(s):  
A. Nutman ◽  
S. Fisher Even-Tsur ◽  
G. Shapiro ◽  
T. Braun ◽  
D. Schwartz ◽  
...  
Keyword(s):  
Blood Culture ◽  
Culture Media ◽  
Time To Detection

scholarly journals 81. Reducing Unnecessary Blood Cultures Through Diagnostic Stewardship

2021 ◽  
Vol 8 (Supplement_1) ◽  
pp. S157-S157
Author(s):  
Sujeet Govindan ◽  
Luke Strnad
Keyword(s):  
Blood Culture ◽  
Positive Blood Culture ◽  
Cost Savings ◽  
Bloodstream Infections ◽  
Central Line ◽  
Blood Cultures ◽  
Coagulase Negative Staphylococci ◽  
Candida Sp ◽  
Daily Frequency ◽  
Oregon Health

Abstract Background At our institution, we learned the frequency of blood cultures was sometimes being changed from “Once” to “Daily” without a defined number of days. We hypothesized this led to unnecessary blood cultures being performed. Methods Over a 3 month period from 12/6/2019-3/6/2020, we retrospectively evaluated the charts of patients who had a blood culture frequency changed to “Daily”. We evaluated if there was an initial positive blood culture within 48 hours of the “Daily” order being placed and the number of positive, negative, or “contaminant” sets of cultures drawn with the order. Contaminant blood cultures were defined as a contaminant species, present only once in the repeat cultures, and not present in initial positive cultures. Results 95 unique orders were placed with 406 sets of cultures drawn from 89 adults. ~20% of the time (17 orders) the order was placed without an initial positive blood culture. This led to 62 sets of cultures being drawn, only 1 of which came back positive. 78/95 orders had an initial positive blood culture. The most common initial organisms were Staphylococcus aureus (SA) (38), Candida sp (10), Enterobacterales sp (10), and coagulase negative staphylococci (7). 43/78 (55%) orders with an initial positive set had positive repeat cultures. SA (26) and Candida sp (8) were most common to have positive repeats. Central line associated bloodstream infections (CLABSI) were found in 5 of the orders and contaminant species were found in 4 of the orders. 54% of the patients who had a “Daily” order placed did not have positive repeat cultures. The majority of the cultures were drawn from Surgical (40 orders) and Medical (35 orders) services. Assuming that SA and Candida sp require 48 hours of negative blood cultures to document clearance and other species require 24 hours, it was estimated that 51% of the cultures drawn using the "Daily" frequency were unnecessary. Cost savings over a year of removing the "Daily" frequency would be ~&14,000. Data from "Daily" blood culture orders drawn at Oregon Health & Science University from 12/6/2019-3/6/2020 Conclusion Unnecessary blood cultures are drawn when the frequency of blood cultures is changed to "Daily". Repeat blood cultures had the greatest utility in bloodstream infections due to SA or Candida sp, and with CLABSI where the line is still in place. These results led to a stewardship intervention to change blood culture ordering at our institution. Disclosures All Authors: No reported disclosures

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