PS-214 Does A Total Sterile Collection Bundle Reduce False Positive Blood Culture Rates And Antibiotic Use In Neonatal Intensive Care?

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.

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Challenges of Antibiotic Stewardship in the Pediatric and Neonatal Intensive Care Units

The Journal of Pediatric Pharmacology and Therapeutics ◽

10.5863/1551-6776-26.7.659 ◽

2021 ◽

Vol 26 (7) ◽

pp. 659-668

Author(s):

Joshua W. Branstetter ◽

Leanna Barker ◽

April Yarbrough ◽

Shannon Ross ◽

Jeremy S. Stultz

Keyword(s):

Intensive Care ◽

Intensive Care Units ◽

Antimicrobial Stewardship ◽

Neonatal Intensive Care ◽

Adult Population ◽

Hospital Costs ◽

Antibiotic Use ◽

Definitive Treatment ◽

Neonatal Intensive Care Units ◽

Implementation Studies

The goals of antimicrobial stewardship programs (ASPs) are to optimize antimicrobial prescribing habits in order to improve patient outcomes, reduce antimicrobial resistance, and reduce hospital costs. Multiple society-endorsed guidelines and government policies reinforce the importance of ASP implementation. Effective antimicrobial stewardship can impact unique patients, hospitals, and societal antibiotic-resistance burden. The role and subsequent success of these programs has largely been reported in the adult population. Pediatric and neonatal intensive care units present unique challenges for traditional antimicrobial stewardship approaches. The purpose of this review article is to explore the challenges of appropriate antibiotic use in the pediatric and neonatal intensive care units and to summarize strategies ASPs can use to overcome these challenges. These problems include non-specific disease presentations, limited evidence for definitive treatment durations in many pediatric infections, fewer pediatric-trained infectious disease physicians, and applicability of intensive laboratory obtainment, collection, and interpretation. Additionally, many ASP implementation studies evaluating the efficacy of ASPs exclude the PICU and NICU. Areas of focus for pediatric ASPs should likely include appropriate antibiotic initiation, appropriate antibiotic duration, and appropriate antibiotic de-escalation.

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Sepsis Criteria and Revision in Toxicological Intensive Care Unit

International Journal of Medical Toxicology and Forensic Medicine ◽

10.32598/ijmtfm.v10i4.31452 ◽

2020 ◽

Vol 10 (4) ◽

pp. 31452.1-31452.10

Author(s):

Haleh Talaie ◽

◽

Maryam Nazari ◽

Habib Emami ◽

◽

...

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Blood Culture ◽

Positive Blood Culture ◽

Coagulase Negative Staphylococci ◽

International Consensus ◽

Suspected Sepsis ◽

Cross Sectional ◽

Arterial Blood ◽

Study Results

Background: Sepsis is one of the significant causes of mortality in hospitalized patients. This cross-sectional study was performed to determine the frequency of positive blood culture and assess sepsis criteria based on Third International Consensus Definitions (related to Sequential Organ Failure Assessment score) and clinical and paraclinical findings (i.e., on-admission leukocytosis, increased lactate level, and fever) in poisoned patients admitted to the Toxicological Intensive Care Unit (TICU). Methods: Medical records of a total of 2000 poisoned patients admitted to the TICU of Loghman Hakim Hospital from 2016 to 2018 were assessed. Among them, 189 cases (9.45%) with suspected sepsis were considered eligible to be enrolled in the study. Results: Of 189 cases, 146 (77.24%) had possible signs and symptoms of sepsis as well as SOFA score higher than two with positive blood culture in 81 cases (55%). The Mean±SD serum level of lactate was 25.97±16.32 on admission. The most common pathogen detected in blood culture was coagulase-negative Staphylococci in 35 (24.0%) out of 146 cases. Glasgow Coma Scale (GCS) less than 12, age older than 50 years, and bilirubin more than 1.2 mg/dL were found as independent predictors of sepsis on multivariate analysis. Conclusion: Based on our findings, it is proposed that the sepsis definition should not be restricted to the guidelines. The patients’ poisoning background and presence of many confounding factors, including poisoning-induced on-admission increased lactate levels, leukocytosis, and disturbed arterial blood gas provide a critical decision-making situation to confirm sepsis according to guidelines.

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Paenibacillus macerans pseudobacteremia resulting from contaminated blood culture bottles in a neonatal intensive care unit

American Journal of Infection Control ◽

10.1067/mic.2001.111535 ◽

2001 ◽

Vol 29 (2) ◽

pp. 126-129 ◽

Cited By ~ 19

Author(s):

Gary A. Noskin ◽

Terra Suriano ◽

Susan Collins ◽

Stefani Sesler ◽

Lance R. Peterson

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Blood Culture ◽

Neonatal Intensive Care Unit ◽

Neonatal Intensive Care ◽

Paenibacillus Macerans ◽

Contaminated Blood

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Clinical Outcomes of Carbapenem-Resistant Acinetobacter baumannii Bloodstream Infections: Study of a 2-State Monoclonal Outbreak

Infection Control and Hospital Epidemiology ◽

10.1086/656247 ◽

2010 ◽

Vol 31 (10) ◽

pp. 1057-1062 ◽

Cited By ~ 45

Author(s):

L. Silvia Munoz-Price ◽

Teresa Zembower ◽

Sudhir Penugonda ◽

Paul Schreckenberger ◽

Mary Alice Lavin ◽

...

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Blood Culture ◽

Acinetobacter Baumannii ◽

Bloodstream Infection ◽

Positive Blood Culture ◽

Culture Result ◽

Blood Culture Result ◽

Carbapenem Resistant ◽

Single Positive

Objective.To characterize the clinical outcomes of patients with bloodstream infection caused by carbapenem-resistant Acinetobacter baumannii during a 2-state monoclonal outbreak.Design.Multicenter observational study.Setting.Four tertiary care hospitals and 1 long-term acute care hospital.Methods.A retrospective medical chart review was conducted for all consecutive patients during the period January 1, 2005, through April 30, 2006, for whom 1 or more blood cultures yielded carbapenem-resistant A. baumannii.Results.We identified 86 patients from the 16-month study period. Their mortality rate was 41%; of the 35 patients who died, one-third (13) had positive blood culture results for carbapenem-resistant A. baumannii at the time of death. Risk factors associated with mortality were intensive care unit stay, malignancy, and presence of fever and/or hypotension at the time blood sample for culture was obtained. Only 5 patients received adequate empirical antibiotic treatment, but the choice of treatment did not affect mortality.Fifty-seven patients (66.2%) had a single positive blood culture result for carbapenem-resistant A. baumannii; the only factor associated with a single positive blood culture result was the presence of decubitus ulcers. Interestingly, during the study period, a transition from single to multiple positive blood culture results was observed. Four patients, 3 of whom were in a burn intensive care unit, were bacteremic for more than 30 days (range, 36–86 days).Conclusions.To our knowledge, this is the first time a study has described 2 patterns of bloodstream infection with A. baumannii: single versus multiple positive blood culture results, as well as a subset of patients with prolonged bacteremia.

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