Yield of positive blood cultures in pediatric oncology patients by a new method of blood culture collection

1996 ◽  
Vol 15 (7) ◽  
pp. 615-620 ◽  
Author(s):  
ATHANASIOS G. KADITIS ◽  
AENGUS S. O'MARCAIGH ◽  
K. HABLE RHODES ◽  
AMY L. WEAVER ◽  
NANCY K. HENRY
Keyword(s):  
Blood Culture ◽  
Pediatric Oncology ◽  
Culture Collection ◽  
Blood Cultures ◽  
New Method ◽  
Oncology Patients

scholarly journals A Sterile Collection Bundle Intervention Reduces the Recovery of Bacteria from Neonatal Blood Culture

2018 ◽  
Vol 3 (1) ◽  
pp. 1-7 ◽  
Author(s):  
Linze F. Hamilton ◽  
Helen E. Gillett ◽  
Adam Smith-Collins ◽  
Jonathan W. Davis
Keyword(s):  
Intensive Care ◽  
Blood Culture ◽  
False Positive ◽  
Neonatal Intensive Care ◽  
Intervention Group ◽  
Group Versus ◽  
Antibiotic Use ◽  
Culture Collection ◽  
Blood Cultures ◽  
Before And After

Background: In neonatal intensive care, coagulase-negative Staphylococcus species can be both blood culture contaminants and pathogens. False-positive cultures can result in clinical uncertainty and unnecessary antibiotic use. Objective: This study sought to assess whether a sterile blood culture collection bundle would reduce the incidence of false-positive blood cultures in a regional neonatal intensive care unit. Method: Clinical data was collected from all infants who had blood cultures taken before and after the introduction of the sterile blood culture collection bundle intervention. This intervention required 2% chlorhexidine and full sterile precautions for blood culture collection. False-positive blood culture rates (presence of skin commensals and ≥3 clinical infection signs) were compared before and after the intervention. The number of days of unnecessary antibiotics associated with false-positive blood cultures was also analysed. Results: In the pre-intervention group (PRE) 197 cultures were taken from 161 babies. In the post-intervention group (POST) 170 cultures from 133 babies were acquired. Baseline demographics were similar in both groups. The rate of false-positive cultures in the PRE group versus the POST group was 9/197 (4.6%) compared to 1/170 (0.6%) (p < 0.05). Unnecessary antibiotic exposure was reduced in the PRE group in comparison to the POST group (27 vs. 0 days, p < 0.01). Conclusions: Implementation of sterile blood culture collection intervention reduced the number of false-positive results. This has potential benefit in reducing unnecessary antibiotic use.

scholarly journals Identification of Potentially Unnecessary Micafungin Use Patterns: Opportunities for Antifungal Stewardship Interventions

2021 ◽  
Vol 1 (S1) ◽  
pp. s32-s33
Author(s):  
Miguel Chavez Concha ◽  
Kevin Hsueh ◽  
Michael Durkin ◽  
Andrej Spec
Keyword(s):  
Blood Culture ◽  
Urine Culture ◽  
Tracheal Aspirate ◽  
Culture Collection ◽  
Blood Cultures ◽  
Urine Specimen ◽  
Antifungal Stewardship ◽  
Microbiological Test ◽  
First Line Therapy ◽  
Patterns Of Use

Background: Echinocandins are used as first-line therapy for suspected and confirmed Candida spp, and its indiscriminate use may drive selection for echinocandin resistance. We evaluated patterns of use of micafungin to identify opportunities for antifungal stewardship. Methods: We identified all micafungin completed orders and microbiological test result data from July 2018 to November 2020 among hospitalized patients in Barnes-Jewish Hospital. Continuous micafungin courses with <48 hours of interruption were considered independent courses. We evaluated micafungin use in 3 scenarios in which its use may be unnecessary: (1) patients with blood cultures negative for Candida spp, (2) patients with recovery of yeast or Candida spp from tracheal aspirates, and (3) patients with recovery of yeast or Candida spp from urine cultures. We only included micafungin courses if they were initiated within 5 days of blood culture collection or up to 4 days after tracheal or urine culture collection to account for incubation and decision to initiate treatment. Results: We found 3,381 micafungin courses in 3,287 admissions. Of these, 2,532 courses had blood culture collection around micafungin initiation and were included in the first analysis: 1,879 (74%) were negative, 149 (6%) had Candida spp isolated in the blood, and 504 (20%) had positive blood cultures for other organisms. Micafungin was given for a median duration of 3 days (IQR, 2–7) to those with negative blood cultures and for 3 days (IQR, 1–5) to those with positive blood cultures without candidemia (p < 0.001), and prolonged durations of more than 5 days was seen in 768/1879 (41%) and 143/504 (28%) of courses, respectively (p <0.001). A total of 487 micafungin courses were initiated after tracheal aspirate culture collection. Those with yeast isolated (n = 100, 21%) received similar micafungin duration compared to those that had no yeast isolated [3 (2-7 IQR) vs. 3 (2-7) days, respectively; p = 0.56). Finally, a total of 844 micafungin courses started after urine culture collection. A total of 49 (6%) had yeast isolated from the urine and treatment duration was similar to those that did not [3 (1-6 IQR) vs. 3 (2-6) days, respectively; p = 0.87). Conclusions: Echinocandin treatment courses did not differ when a yeast was identified from a tracheal isolate or urine specimen. However, a substantial proportion of treatment courses were prolonged in those with negative Candida spp in the blood, suggesting opportunities for antifungal stewardship interventions.Funding: NoDisclosures: None

Drawing blood cultures through intravascular catheters: Controversy and update

2019 ◽  
Vol 40 (4) ◽  
pp. 457-459 ◽  
Author(s):  
Leonard A. Mermel
Keyword(s):  
Blood Culture ◽  
Central Venous Catheter ◽  
Venous Catheter ◽  
Culture Collection ◽  
Blood Cultures ◽  
Central Venous ◽  
Intravascular Catheters

AbstractStudies published between 1999 and 2011 demonstrated increased blood culture contamination with catheter-drawn cultures compared with percutaneously-drawn cultures. Studies published between 2012 and 2015 reported that use of antiseptic barrier caps on central venous catheter hubs significantly reduces the incidence of catheter-drawn blood culture contamination. Local guidelines regarding sites for blood culture collection should reflect institution-level blood culture contamination rates for percutaneously-drawn and catheter-drawn cultures using currently available technologies that reduce contamination at both sites.

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.

Outpatient management of pediatric oncology patients with low-risk fever and neutropenia: Implementation of new clinical practice guideline at Texas Children's Hospital.

2017 ◽  
Vol 35 (8_suppl) ◽  
pp. 26-26
Author(s):  
Abhishek Amar Bavle ◽  
Amanda Bell Grimes ◽  
Sibo Zhao ◽  
Daniel Joseph Zinn ◽  
Andrea Jackson ◽  
...  
Keyword(s):  
Clinical Practice ◽  
Pediatric Oncology ◽  
Clinical Practice Guideline ◽  
Practice Guideline ◽  
Outpatient Care ◽  
Blood Cultures ◽  
Low Risk ◽  
Outpatient Management ◽  
Oncology Patients

26 Background: Traditionally, pediatric oncology patients with fever and severe neutropenia (absolute neutrophil count [ANC] <500) are admitted on empiric intravenous (IV) antibiotics pending blood cultures, fever resolution, and a rising ANC. Based on significant evidence that risk-stratification of these patients with fever and neutropenia (FN) and outpatient management of “low-risk” FN (LRFN) patients with oral antibiotics can be safe and effective, we implemented an institutional clinical practice guideline (CPG) to provide outpatient care for children with LRFN. Methods: A validated “Alexander” clinical decision rule was adopted to risk stratify pediatric oncology patients with FN. A new CPG was formulated for the outpatient management of LRFN patients, with either discharge on presentation or at 24-48 hours after admission, with levofloxacin and close follow-up. All stakeholders were educated regarding the new guidelines and process prior to implementation, and the guidelines were approved by the institutional Evidence Based Outcomes Center. Results: In 9 months since guideline implementation, 10/11 (91%) of the eligible patients have been managed outpatient for LRFN (mean ANC 160, range 0 - 480). Seven patients were discharged home from the ER or oncology clinic. Three patients were discharged early at 24 – 48 hours after admission. Outpatient management was safe, and all but one patient had resolution of fever within 48 hours and negative blood cultures. One patient had a positive blood culture with Staphylococcus epidermidis and was admitted for IV antibiotics with no complications. Parents of 9/10 patients responded to surveys. All 9 families found outpatient management to be a good experience, follow-up easy, and reported no adverse effects with levofloxacin. One family preferred inpatient care due to anxiety, while importantly 8/9 (89%) parents said they preferred outpatient care compared to inpatient observation. Conclusions: Pediatric oncology patients with low-risk fever and neutropenia were successfully idenitified and managed in the outpatient setting without adverse events with a high level of parent satisfaction.

Assessment of anaerobic blood cultures in pediatric oncology patients

2017 ◽  
Vol 35 (1) ◽  
pp. 33-36 ◽  
Author(s):  
Manuel Monsonís Cabedo ◽  
Susana Rives Solá ◽  
Antoni Noguera-Julian ◽  
Mireia Urrea Ayala ◽  
Ofelia Cruz Martinez ◽  
...  
Keyword(s):  
Pediatric Oncology ◽  
Blood Cultures ◽  
Oncology Patients

Assessment of anaerobic blood cultures in pediatric oncology patients

2017 ◽  
Vol 35 (1) ◽  
pp. 33-36
Author(s):  
Manuel Monsonís Cabedo ◽  
Susana Rives Solá ◽  
Antoni Noguera-Julian ◽  
Mireia Urrea Ayala ◽  
Ofelia Cruz Martinez ◽  
...  
Keyword(s):  
Pediatric Oncology ◽  
Blood Cultures ◽  
Oncology Patients

A new method for the detection of microorganisms in blood cultures: Part I. Theoretical analysis and simulation of blood culture processes

2008 ◽  
Vol 86 (5) ◽  
pp. 947-959 ◽  
Author(s):  
Jennifer M. Smith ◽  
Yulia M. Serebrennikova ◽  
Debra E. Huffman ◽  
German F. Leparc ◽  
Luis H. García-Rubio
Keyword(s):  
Blood Culture ◽  
Theoretical Analysis ◽  
Blood Cultures ◽  
New Method

scholarly journals 107. Impact of a Rapid Blood Culture Identification Panel at a Community Teaching Hospital: a Pre-Post Quasi-Experiment

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S68-S69
Author(s):  
Catherine Trinh ◽  
Steven Richardson ◽  
Benjamin Ereshefsky
Keyword(s):  
Targeted Therapy ◽  
Blood Culture ◽  
Culture Collection ◽  
Blood Cultures ◽  
Gram Stain ◽  
Post Intervention ◽  
Gram Positive ◽  
Days Of Therapy ◽  
Culture Identification ◽  
The Impact

Abstract Background Rapid diagnostic tests (RDT) for positive blood cultures can lead to quicker identification of organisms and key resistance elements. As a result time to targeted therapy may decrease, thus reducing the duration of broad, empiric antibiotic use. The purpose of this study was to determine the impact of implementing the BioFire® FilmArray® Blood Culture Identification (BCID) Panel for gram-positive organisms on antimicrobial process measures and patient outcomes at an academic community hospital. Methods This was a single-center, pre-post intervention, quasi-experimental study evaluating hospitalized adult patients who had at least one positive blood culture with gram-positive organisms from June 1, 2018 to August 31, 2018 and June 1, 2019 to August 31, 2019. Patients in the pre-intervention group were randomized and post-intervention patients were matched by identified organism. The primary outcome was the time to targeted therapy from blood culture collection. Secondary outcomes included time to targeted therapy from positive Gram stain, vancomycin and anti-pseudomonal β-lactam length of therapy (LOT), institutional vancomycin days of therapy (DOT), length of stay (LOS), and estimated hospitalization costs. Results A total of 75 patients in each group were included. The time to targeted therapy from blood culture collection was significantly decreased after RDT implementation [32.9 (23.2–51.8) hours vs. 49.2 (37.1–76.3 hours, p &lt; 0.001)], as was time to targeted therapy from Gram stain results [8.5 (0–25.2) hours vs. 30 (19.4–52.9) hours, p &lt; 0.001]. No difference was found between the groups with respect to LOS or estimated hospitalization cost. Overall the vancomycin LOT [0.86 (0.09–2.38) days vs. 2.18 (1.37–4.34) days, p = 0.001] and anti-pseudomonal β-lactam LOT for MRSA, MSSA, Streptococcus, and Enterococcus subgroup [1.15 (0.06–2.07) vs. 1.78 (1.28–2.89) days, p = 0.026] were significantly decreased in the post-RDT group. Figure 1: Institutional Use of Vnacomycin Conclusion Implementation of a rapid diagnostic test on gram-positive blood cultures was associated with decreased time to targeted therapy from blood culture collection, time to targeted therapy from positive culture, and vancomycin LOT. Disclosures All Authors: No reported disclosures

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