scholarly journals 249. Limited Diagnostic Utility of Extended Aerobic Blood Culture Incubation for Fungal Pathogen Detection

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S140-S140
Author(s):  
Lori Bourassa ◽  
Olivia Kates ◽  
Catherine Liu
Keyword(s):  
Blood Culture ◽  
Candida Species ◽  
Fungal Pathogens ◽  
Pathogen Detection ◽  
Tertiary Care ◽  
Marrow Transplant ◽  
Blood Cultures ◽  
Diagnostic Utility ◽  
Hold Period ◽  
Fungal Organisms

Abstract Background Blood cultures are an important diagnostic tool for the detection of fungemia. At our institution, fungal blood cultures consist of aerobic blood culture with incubation extended from the standard 5 days to 14 days. Orders for fungal blood cultures exist in multiple electronic order sets for selected populations, including oncology and bone marrow transplant services. Methods To determine the yield of fungal blood cultures at our institution, a 570-bed tertiary-care referral center, we extracted all fungal blood culture results over a 4.5-year period (January 1, 2014–May 15, 2018) from a Laboratory Information System. Results Of the 21,657 fungal blood cultures performed, only 202 (0.9%) demonstrated growth and 189 (0.9%) grew fungal organisms. The majority (90%, n = 182/202) of positive fungal blood cultures grew a Candida or other yeast species. 96% (n = 174/182) of the fungal cultures that grew yeast would have been detected with standard bacterial blood culture. Eight of these cultures became positive during the extended hold period and grew a Candida species. All 8 cultures were collected from patients who had previous positive cultures for the same Candida species detected by standard incubation. Five fungal blood cultures from 4 patients turned positive after 5 days of incubation. Among these, two additional fungal pathogens were identified including 2 cases of Lomentospora prolificans and 2 cases of Fusarium. In both cases of L. prolificans and one case of Fusarium, the patients had previous positive blood cultures that detected the same organism with standard incubation. One patient with Fusarium had no previous positive blood cultures, but had multiple tissue cultures positive for Fusarium. The remaining cultures that turned positive after 5 days of incubation contained bacterial organisms, a number of which were considered clinically insignificant (e.g., Cutibacterium species). Conclusion These data suggest that extended incubation of aerobic blood culture bottles has limited diagnostic utility beyond standard bacterial blood culture for detection of fungemia. Fungal blood cultures represent an opportunity for improved diagnostic test stewardship, and use should be restricted to selected situations in consultation with Infectious Diseases or Laboratory Medicine. Disclosures All authors: No reported disclosures.

Risk factors and clinical outcomes associated with blood culture contamination

2021 ◽  
pp. 1-7
Author(s):  
Justin M. Klucher ◽  
Kevin Davis ◽  
Mrinmayee Lakkad ◽  
Jacob T. Painter ◽  
Ryan K. Dare
Keyword(s):  
Risk Factors ◽  
Logistic Regression ◽  
Blood Culture ◽  
Hospital Mortality ◽  
Clinical Outcomes ◽  
Tertiary Care ◽  
Blood Cultures ◽  
Hospital Charges ◽  
Patient Specific ◽  
Contaminated Blood

Abstract Objective: To determine patient-specific risk factors and clinical outcomes associated with contaminated blood cultures. Design: A single-center, retrospective case-control risk factor and clinical outcome analysis performed on inpatients with blood cultures collected in the emergency department, 2014–2018. Patients with contaminated blood cultures (cases) were compared to patients with negative blood cultures (controls). Setting: A 509-bed tertiary-care university hospital. Methods: Risk factors independently associated with blood-culture contamination were determined using multivariable logistic regression. The impacts of contamination on clinical outcomes were assessed using linear regression, logistic regression, and generalized linear model with γ log link. Results: Of 13,782 blood cultures, 1,504 (10.9%) true positives were excluded, leaving 1,012 (7.3%) cases and 11,266 (81.7%) controls. The following factors were independently associated with blood-culture contamination: increasing age (adjusted odds ratio [aOR], 1.01; 95% confidence interval [CI], 1.01–1.01), black race (aOR, 1.32; 95% CI, 1.15–1.51), increased body mass index (BMI; aOR, 1.01; 95% CI, 1.00–1.02), chronic obstructive pulmonary disease (aOR, 1.16; 95% CI, 1.02–1.33), paralysis (aOR 1.64; 95% CI, 1.26–2.14) and sepsis plus shock (aOR, 1.26; 95% CI, 1.07–1.49). After controlling for age, race, BMI, and sepsis, blood-culture contamination increased length of stay (LOS; β = 1.24 ± 0.24; P < .0001), length of antibiotic treatment (LOT; β = 1.01 ± 0.20; P < .001), hospital charges (β = 0.22 ± 0.03; P < .0001), acute kidney injury (AKI; aOR, 1.60; 95% CI, 1.40–1.83), echocardiogram orders (aOR, 1.51; 95% CI, 1.30–1.75) and in-hospital mortality (aOR, 1.69; 95% CI, 1.31–2.16). Conclusions: These unique risk factors identify high-risk individuals for blood-culture contamination. After controlling for confounders, contamination significantly increased LOS, LOT, hospital charges, AKI, echocardiograms, and in-hospital mortality.

scholarly journals Controlled Comparative Evaluation of BacT/Alert FAN and ESP 80A Aerobic Media as Means for Detecting Bacteremia and Fungemia

1998 ◽  
Vol 36 (9) ◽  
pp. 2686-2689 ◽  
Author(s):  
Gary V. Doern ◽  
Ann Barton ◽  
Sudah Rao
Keyword(s):  
Blood Culture ◽  
Antimicrobial Therapy ◽  
Enhanced Recovery ◽  
Tertiary Care ◽  
Blood Cultures ◽  
Two Systems ◽  
Absorbing Material ◽  
Clinically Significant ◽  
One Year ◽  
Organism Group

During a one-year period, a total of 6,305 blood cultures were processed in a tertiary-care teaching hospital; 6 to 12 ml of blood was inoculated into both a BacT/Alert Fan aerobic bottle and an ESP 80A aerobic bottle. The FAN aerobic bottle contains an antimicrobial-absorbing material; the 80A aerobic bottle does not. Bottles were processed on their respective continuous-monitoring blood culture instruments for up to five days of incubation. Four hundred thirty-three cultures (6.9%) representing 301 septic episodes in 235 different patients yielded 490 bacteria or yeasts thought to be clinically significant. Two hundred seventy-five of the 433 presumed clinically significant positive cultures (63.5%) representing 195 septic episodes and yielding 301 isolates were positive in both FAN and 80A bottles. One hundred nine significant positive cultures (25.2%) (i.e., cultures positive with an organism judged to be of probable clinical significance) from 70 septic episodes yielded 126 isolates only in FAN bottles. Conversely, the 80A bottle was exclusively positive in 49 instances (11.3%), representing 36 septic episodes and yielding 63 isolates. The higher rates of significant positive blood cultures, numbers of septic episodes documented, and numbers of isolates recovered in FAN bottles versus 80A bottles were all statistically significant (P < 0.05). Enhanced rates of detection of presumed clinically significant isolates in FAN bottles were largely accounted for by Staphylococcus aureus, members of the Enterobacteriaceae, and non-Pseudomonas aeruginosa miscellaneous gram-negative bacilli from patients receiving antimicrobial therapy at the time blood cultures were obtained. Enhanced recovery of one organism group, the β-hemolytic streptococci, occurred in 80A. With one exception, detection times were essentially equivalent in the two systems. The single exception pertained to streptococci and enterococci, which were recovered significantly faster in 80A bottles. Three hundred thirty-eight of the 6,305 blood cultures evaluated in this study (5.4%) were judged likely to be contaminated. The percentages of probable contaminated cultures were as follows: 26.6% FAN and 80A; 42.3% FAN only; 31.1% 80A only (P < 0.05). Finally, the instrument false-positive rates for the two systems were 0.7% with FAN and 3.0% with 80A (P < 0.05). We conclude that while contamination rates were slightly higher with FAN than with 80A, use of FAN aerobic bottles in conjunction with the BacT/Alert system will yield significantly higher numbers of clinically significant blood culture isolates than 80A bottles and the ESP system. Furthermore, this enhanced detection is most conspicuous in patients receiving antimicrobial therapy at the time blood cultures are performed, probably due to the presence of an antimicrobial-absorbing material in FAN aerobic bottles.

scholarly journals A retrospective analysis of community-onset bloodstream infections at a tertiary-care academic hospital in South Africa. Are current empiric antimicrobial practices appropriate?

2021 ◽  
Vol 1 (1) ◽  
Author(s):  
Vinitha Alex ◽  
Trusha Nana ◽  
Vindana Chibabhai
Keyword(s):  
South Africa ◽  
Blood Culture ◽  
Antimicrobial Agents ◽  
Tertiary Care ◽  
Laboratory Data ◽  
Blood Cultures ◽  
Contamination Rate ◽  
Older Children ◽  
Academic Hospital ◽  
Community Onset

Abstract Background: Community-onset bloodstream infection (CO-BSI) is associated with substantial morbidity and mortality. Knowledge of locally prevalent pathogens and antimicrobial susceptibility patterns can promptly guide appropriate empiric therapy and improve outcomes. Objectives: We sought to determine the epidemiology of CO-BSI, the blood culture positivity rate and the contamination rate. We also sought to establish appropriateness of current empiric antimicrobial therapy practices. Methods: We retrospectively analyzed blood cultures taken from January 2015 to December 2019 at the emergency departments (EDs) of a tertiary-care academic hospital in South Africa using extracted laboratory data. Results: The overall positivity rate of blood cultures taken at the EDs was 15% (95% confidence interval [CI], 0.15–0.16) and the contamination rate was 7% (95% CI, 0.06–0.07). Gram-positive bacteria predominated in the pediatric cohort: neonates, 52 (54%) of 96; infants, 57 (52%) of 109; older children, 63 (61%) of 103. Methicillin-susceptible Staphylococcus aureus was the predominant pathogen among older children: 30 (35%) of 85. Escherichia coli was the most common pathogen isolated among adults and the elderly: 225 (21%) of 1,060 and 62 (29%) of 214, respectively. Among neonates, the susceptibility of E. coli and Klebsiella pneumoniae to the combination of ampicillin and gentamicin was 17 (68%) of 25. Among adults, the susceptibility of the 5 most common pathogens to amoxicillin-clavulanate was 426 (78%) of 546 and their susceptibility to ceftriaxone was 481 (85%) of 565 (P = .20). The prevalence of methicillin-resistant S. aureus, extended-spectrum β-lactamase–producing and carbapenem-resistant Enterobacterales were low among all age groups. Conclusions: Review of blood culture collection techniques is warranted to reduce the contamination rate. High rates of resistance to currently prescribed empiric antimicrobial agents for CO-BSI warrants a re-evaluation of local guidelines.

scholarly journals Strengthening sepsis care at a tertiary care teaching hospital in New Delhi, India

2021 ◽  
Vol 10 (Suppl 1) ◽  
pp. e001335
Author(s):  
Charu Malhotra ◽  
Akshay Kumar ◽  
Ankit Kumar Sahu ◽  
Akshaya Ramaswami ◽  
Sanjeev Bhoi ◽  
...  
Keyword(s):  
Blood Culture ◽  
Hospital Mortality ◽  
Teaching Hospital ◽  
Screening Tool ◽  
Tertiary Care ◽  
Blood Cultures ◽  
Antibiotic Administration ◽  
Suspected Sepsis ◽  
Tertiary Care Teaching Hospital ◽  
Care Teaching

IntroductionFailure of early identification of sepsis in the emergency department (ED) leads to significant delays in antibiotic administration which adversely affects patient outcomes.AimThe primary objective of our Quality Improvement (QI) project was to reduce the door-to-antibiotic time (DTAT) by 30% from the preintervention in patients with suspected sepsis. Secondary objectives were to increase the blood culture collection rate by 30% from preintervention, investigate the predictors of improving DTAT and study the effect of these interventions on 24-hour in-hospital mortality.MethodsThis QI project was conducted in the ED of a tertiary care teaching hospital of North India; the ED receives approximately 400 patients per day. Adult patients with suspected sepsis presenting to our ED were included in the study, between January 2019 and December 2020. The study was divided into three phases; preintervention phase (100 patients), intervention phase (100 patients) and postintervention phase (93 patients). DTAT and blood cultures prior to antibiotic administration was recorded for all patients. Blood culture yield and 24-hour in-hospital mortality were also recorded using standard data templates. Change ideas planned by the Sepsis QI Team were implemented after conducting plan-do-study-act cycles.ResultsThe median DTAT reduced from 155 min in preintervention phase to 78 min in postintervention phase. Drawing of blood cultures prior to antibiotic administration improved by 67%. Application of novel screening tool at triage was found to be an independent predictor of reduced DTAT.ConclusionOur QI project identified the existing lacunae in implementation of the sepsis bundle which were dealt with in a stepwise manner. The sepsis screening tool and on-site training improved care of patients with sepsis. A similar approach can be used to deal with complex quality issues in other high-volume low-resource settings.

scholarly journals Assessment of clinical profile, antibiotic sensitivity and prescription pattern in blood culture positive enteric fever among pediatric and adult patients admitted in a tertiary care hospital: a prospective study

2019 ◽  
Vol 7 (9) ◽  
pp. 3270
Author(s):  
Swapnil Gautam ◽  
Suraj Purushothaman ◽  
Kinjal P. Patel ◽  
Ajay P. Sankhe ◽  
Madhuri R. Mahadik
Keyword(s):  
Blood Culture ◽  
Prospective Study ◽  
Enteric Fever ◽  
Tertiary Care Hospital ◽  
Tertiary Care ◽  
Antibiotic Sensitivity ◽  
Multidrug Resistant ◽  
Blood Cultures ◽  
Care Hospital ◽  
Prescription Pattern

Background: Asterion Introduction: Enteric fever is a major concern in developing country. It is predominantly caused by serovars typhi and paratyphi of Salmonella enterica. Recently, an upsurge in antimicrobial resistant strains has worsened the management of enteric fever. So, aim of present study is to evaluate the clinical profile, antibiotic sensitivity and prescription pattern in blood culture proven cases of enteric fever in pediatric and adult patients.Methods: Single centre, prospective study was conducted at a tertiary care hospital. Demographic and clinical details of blood culture proven enteric fever admitted in hospital were collected over the period from August 2016 to November 2018.Results: Total 58 blood cultures grew Salmonella spp. , amongst them 84.48 % had growth of Salmonella typhi. Blood culture was sent after a mean period of 9 days and 10 days of fever in pediatric and adult patients respectively. All isolates of S. paratyphi A were pansusceptible, whereas 36.73 % isolates of S. typhi were multidrug resistant and nalidixic acid resistant. 68.97% patients received antibiotics before admission. The difference between mean time to defervescence in patients who received ceftriaxone and those who received more than one antibiotic was not statistically significant. (P value 0.87)Conclusion: Blood cultures are the important diagnostic tool to identify multidrug resistant Salmonellae. Study showed that combination therapy was not statistically superior and awareness of local antimicrobial susceptibility pattern significantly helps for better management of the patients.

scholarly journals 103. An Association Between Abnormal CSF Analysis and Inpatient Mortality in Cryptococcal Meningitis, a Tertiary Care Center Experience

2021 ◽  
Vol 8 (Supplement_1) ◽  
pp. S65-S65
Author(s):  
Jordan Resnick ◽  
Emad A Chishti ◽  
Mahesh Bhatt ◽  
Thein Myint
Keyword(s):  
Blood Culture ◽  
Cryptococcal Meningitis ◽  
Care Center ◽  
Tertiary Care ◽  
Blood Cultures ◽  
Tertiary Care Center ◽  
Inclusion Criteria ◽  
Inpatient Mortality ◽  
Csf Analysis ◽  
Survivor Group

Abstract Background Cryptococcal meningitis (CM) is a life-threatening condition that requires prompt recognition and management. With high morbidity in mind, we elected to compare the key CSF analysis, blood culture and serum cryptococcal antigen (CrAg) to prognosticate the probability of mortality in this population. Table 1. Comparison of demographics, serum and CSF analysis Methods We retrospectively reviewed all charts of patients admitted to our tertiary care center from 10/2005 to 10/2017. Inclusion criteria encompassed patients with positive CSF CrAg, positive CSF cultures, India ink, cytopathology, or CSF cell count &gt;5 with CNS symptoms, positive serum CrAg titer or blood cultures. Results Sixty patients who met the inclusion criteria were divided into the survivor (n=41) and the non-survivor (n=19) groups based on the inpatient mortality. There was no difference in age, sex, and immune status between the two groups. The median CSF nucleated cell counts in the non-survivor group was 39 cells/µL with median lymphocyte 59.5% whereas in the survivor group was 72 cells/µL with median lymphocyte 76% (P&lt; 0.001 and 0.04 respectively). The median CSF glucose was 27 mg/ml in the non-survivor compared to 35 mg/ml in the survivor group (P=0.02). Median CSF CrAg was higher at 1:1024 in the non-survivor group whereas the survivor group was 1:256 (P &lt; 0.01). CSF opening pressure (cm H2O), blood culture, and serum CrAg level were not statistically significant between the two groups. Conclusion Low CSF cell count, low glucose, and high CSF CrAg were independently associated with inpatient mortality in CM. This is in line with the prior findings. A novel finding in this study is significantly decreased median CSF lymphocyte % in the non-survivor group. Serum CrAg titer, positive blood cultures, and median CSF protein were not statistically significant between the two groups. However, a study with a larger sample size may be needed to confirm these findings. Disclosures All Authors: No reported disclosures

scholarly journals Comparison of the Lysis Centrifugation Method with the Conventional Blood Culture Method in Cases of Sepsis in a Tertiary Care Hospital

2012 ◽  
Vol 4 (02) ◽  
pp. 089-093 ◽  
Author(s):  
Harshal R Parikh ◽  
Anuradha S De ◽  
Sujata M Baveja
Keyword(s):  
Blood Culture ◽  
Tertiary Care ◽  
Culture Method ◽  
Blood Cultures ◽  
P Value ◽  
Care Hospital ◽  
Culture Methods ◽  
Centrifugation Method ◽  
Considerable Morbidity ◽  
Time Required

ABSTRACT Introduction: Physicians and microbiologists have long recognized that the presence of living microorganisms in the blood of a patient carries with it considerable morbidity and mortality. Hence, blood cultures have become critically important and frequently performed test in clinical microbiology laboratories for diagnosis of sepsis Objectives: To compare the conventional blood culture method with the lysis centrifugation method in cases of sepsis. Materials and Methods: Two hundred nonduplicate blood cultures from cases of sepsis were analyzed using two blood culture methods concurrently for recovery of bacteria from patients diagnosed clinically with sepsis – the conventional blood culture method using trypticase soy broth and the lysis centrifugation method using saponin by centrifuging at 3000 g for 30 minutes. Results: Overall bacteria recovered from 200 blood cultures were 17.5%. The conventional blood culture method had a higher yield of organisms, especially Gram positive cocci. The lysis centrifugation method was comparable with the former method with respect to Gram negative bacilli. The sensitivity of lysis centrifugation method in comparison to conventional blood culture method was 49.75% in this study, specificity was 98.21% and diagnostic accuracy was 89.5%. In almost every instance, the time required for detection of the growth was earlier by lysis centrifugation method, which was statistically significant. Contamination by lysis centrifugation was minimal, while that by conventional method was high. Time to growth by the lysis centrifugation method was highly significant (P value 0.000) as compared to time to growth by the conventional blood culture method. Conclusion: For the diagnosis of sepsis, combination of the lysis centrifugation method and the conventional blood culture method with trypticase soy broth or biphasic media is advocable, in order to achieve faster recovery and a better yield of microorganisms.

scholarly journals Rapid Identification of Candida Species from Positive Blood Cultures by Use of the FilmArray Blood Culture Identification Panel

2018 ◽  
Vol 56 (12) ◽  
Author(s):  
Andrew E. Simor ◽  
Vanessa Porter ◽  
Samira Mubareka ◽  
Marc Chouinard ◽  
Kevin Katz ◽  
...  
Keyword(s):  
Blood Culture ◽  
Candida Species ◽  
Rapid Identification ◽  
Blood Cultures ◽  
Culture Identification

scholarly journals 651. Multi-Center Evaluation of the BioFire® FilmArray® Blood Culture Identification 2 Panel for the Detection of Microorganisms and Resistance Markers in Positive Blood Cultures

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S299-S300
Author(s):  
Yang Lu ◽  
Joseph Hatch ◽  
Kristen Holmberg ◽  
Anna Hurlock ◽  
Daria Drobysheva ◽  
...  
Keyword(s):  
Blood Culture ◽  
Fungal Pathogens ◽  
Clinical Performance ◽  
Carbapenem Resistance ◽  
Blood Cultures ◽  
Microbial Culture ◽  
Candida Auris ◽  
Comprehensive Test ◽  
Resistance Markers ◽  
Culture Identification

Abstract Background The BioFire® FilmArray® Blood Culture Identification 2 (BCID2) Panel is a diagnostic test that provides results for 26 bacterial, 7 fungal pathogens and 10 antimicrobial resistance (AMR) genes from positive blood culture (PBC) specimens in about an hour. The BCID2 Panel builds upon the existing BCID Panel with several additional assays that include Candida auris and an expanded AMR gene menu that provides methicillin-resistant Staphylococcus aureus (MRSA) results plus detection for mcr-1, carbapenem resistance, and ESBL. Here, we summarize studies conducted to establish clinical performance using an Investigational Use Only version of the BCID2 Panel. Methods Three studies were performed. The first involves prospective collection and testing of an expected ~1,000 residual PBCs at 7 US and 2 EU sites, which began in October 2018 and will conclude in June 2019. BCID2 Panel performance is compared with reference methods of microbial culture as well as PCR/sequencing for AMR genes. In addition, BCID2 Panel MRSA results are compared with the FDA-cleared Xpert MRSA/SA BC system (Cepheid, Inc). Relevant bacterial isolates recovered from PBCs are also evaluated by various phenotypic antimicrobial susceptibility testing (AST) methods. The prospective evaluation is supplemented with a second study that involves testing of ~300 pre-selected, archived PBCs containing rare organisms. The third study includes over 500 seeded blood cultures containing very rare organisms with an evaluation of co-spiked samples. Results With over 1,200 samples tested to date (out of an anticipated 1,800 total), the BCID2 Panel has demonstrated an overall sensitivity of >98% and specificity of >99% for identification of microorganisms compared with culture. Concordance between the BCID2 Panel and the Xpert MRSA/SA BC test is >99% for identification of MRSA. Evaluation of BCID2 Panel AMR gene detection relative to AST and PCR is ongoing. Conclusion The FilmArray® BCID2 Panel appears to be a sensitive, specific, and robust test for rapid detection of microorganisms and MRSA in PBCs. With the use of this comprehensive test, improved antimicrobial stewardship is anticipated. Disclosures All authors: No reported disclosures

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