Microbiological findings in emergency department patients with sepsis identified by the Sepsis-3 criteria: a single-center prospective population-based cohort study

Abstract Background Studies comparing the microbiological profiles among sepsis patients identified with either Sequential Organ Failure Assessment (SOFA) score or systemic inflammatory response syndrome (SIRS) criteria are limited. The aim was to examine if there are differences in the microbiological findings among septic patients identified by Sepsis-3 criteria compared to patients identified by the previous sepsis criteria, SIRS, and without organ failure. A secondary purpose was to examine if we could identify microbiological characteristics with increased risk of 28-day mortality. Methods Prospective cohort study of all adult (≥ 18 years) patients admitted with sepsis to the Emergency Department of Slagelse Hospital, Denmark from 1st October 2017 to 31st March 2018. Information regarding microbiological findings was obtained via linkage between a sepsis database and the local microbiological laboratory data system. Data regarding 28-day mortality were obtained from the Danish Civil Registration System. We used logistic regression to estimate the association between specific microbiological characteristics and 28-day mortality. Results A total of 1616 patients were included; 466 (28.8%; 95% CI 26.6%-31.1%) met SOFA criteria, 398 (24.6%; 95% CI 22.5–26.8%) met SIRS criteria. A total of 127 patients (14.7%; 95% CI 12.4–17.2%) had at least one positive blood culture. SOFA patients had more often positive blood cultures compared to SIRS (13.9% vs. 9.5%; 95 CI on difference 0.1–8.7%). Likewise, Gram-positive bacteria (8.6% vs. 2.8%; 95 CI on difference 2.8–8.8%), infections of respiratory origin (64.8% vs. 57.3%; 95 CI on difference 1.0–14%), Streptococcus pneumoniae (3.2% vs. 1.0%; 95% CI on difference 0.3–4.1) and polymicrobial infections (2.6% vs. 0.3% 95 CI on difference 0.8–3.8%) were more common among SOFA patients. Polymicrobial infections (OR 3.70; 95% CI 1.02–13.40), Staphylococcus aureus (OR 6.30; 95% CI 1.33–29.80) and a pool of “other” microorganisms (OR 3.88; 95% CI 1.34–9.79) in blood cultures were independently associated with mortality. Conclusion Patients identified with sepsis by SOFA score were more often blood culture-positive. Gram-positive pathogens, pulmonary tract infections, Streptococcus pneumoniae, and polymicrobial infections were also more common among SOFA patients. Polymicrobial infection, Staphylococcus aureus, and a group of other organisms were independently associated with an increased risk of death.

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Neither Blood Culture Positivity nor Time to Positivity is Associated with Mortality among Patients Presenting with Severe Manifestations of Sepsis: The FABLED Cohort Study

Open Forum Infectious Diseases ◽

10.1093/ofid/ofab321 ◽

2021 ◽

Author(s):

Katryn Paquette ◽

David Sweet ◽

Robert Stenstrom ◽

Sarah N Stabler ◽

Alexander Lawandi ◽

...

Keyword(s):

Emergency Department ◽

Cohort Study ◽

Blood Culture ◽

Blood Cultures ◽

Cell Counts ◽

Culture Positivity ◽

Time To Positivity ◽

Blood Culture Positivity ◽

Normal White Blood Cell ◽

Support Fund

Abstract Background Sepsis is a leading cause of morbidity, mortality, and health care costs worldwide. Methods We conducted a multi-center, prospective cohort study evaluating the yield of blood cultures drawn before and after empiric antimicrobial administration among adults presenting to the emergency department with severe manifestations of sepsis (ClinicalTrials.gov: NCT01867905). Enrolled patients who had the requisite blood cultures drawn were followed for 90 days. We explored the independent association between blood culture positivity and its time to positivity in relation to 90-day mortality. Findings 325 participants were enrolled; 90-day mortality among the 315 subjects followed-up was 25·4% (80/315). Mortality was associated with age (mean age in those who died was 72·5 ±15·8 vs. 62·9 ±17·7 years among survivors, p<0·0001), greater Charlson Comorbidity Index (2 (IQR 1,3) vs. 1 (IQR 0,3), p=0·008), dementia (13/80 (16·2%) vs. 18/235 (7·7%), p=0·03), cancer (27/80 (33·8%) vs. 47/235 (20·0%), p=0·015), positive qSOFA score (57/80 (71·2%) vs. 129/235 (54·9%), p=0·009), and normal white blood cell counts (25/80 (31·2%) vs. 42/235 (17·9%), p=0·02). The presence of bacteremia, persistent bacteremia after antimicrobial infusion, and shorter time to blood culture positivity were not associated with mortality. Neither the source of infection nor pathogen affected mortality. Interpretation Although severe sepsis is an inflammatory condition triggered by infection, its 90-day survival is not influenced by blood culture positivity nor its time to positivity. Funding Vancouver Coastal Health; St-Paul’s Hospital Foundation Emergency Department Support Fund; the Fonds de Recherche Santé – Québec (CPY); Intramural Research Program of the NIH, Clinical Center (AL); the Maricopa Medical Foundation

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Community-acquired bacteraemia in COVID-19 in comparison to influenza A and influenza B: a retrospective cohort study

BMC Infectious Diseases ◽

10.1186/s12879-021-05902-5 ◽

2021 ◽

Vol 21 (1) ◽

Cited By ~ 1

Author(s):

Julinha M. Thelen ◽

A. G. ( Noud) Buenen ◽

Marjan van Apeldoorn ◽

Heiman F. Wertheim ◽

Mirjam H. A. Hermans ◽

...

Keyword(s):

Cohort Study ◽

Blood Culture ◽

The Netherlands ◽

Retrospective Cohort Study ◽

Retrospective Cohort ◽

Influenza A ◽

Blood Cultures ◽

Influenza B ◽

Significant Difference ◽

All Cause Mortality

Abstract Background During the coronavirus disease 2019 (COVID-19) pandemic in the Netherlands it was noticed that very few blood cultures from COVID-19 patients turned positive with clinically relevant bacteria. This was particularly evident in comparison to the number of positive blood cultures during previous seasonal epidemics of influenza. This observation raised questions about the occurrence and causative microorganisms of bacteraemia in COVID-19 patients, especially in the perspective of the widely reported overuse of antibiotics and the rising rate of antibiotic resistance. Methods We conducted a retrospective cohort study on blood culture results in influenza A, influenza B and COVID-19 patients presenting to two hospitals in the Netherlands. Our main outcome consisted of the percentage of positive blood cultures. The percentage of clinically relevant blood cultures, isolated bacteria and 30-day all-cause mortality served as our secondary outcomes. Results A total of 1331 viral episodes were analysed in 1324 patients. There was no statistically significant difference (p = 0.47) in overall occurrence of blood culture positivity in COVID-19 patients (9.0, 95% CI 6.8–11.1) in comparison to influenza A (11.4, 95% CI 7.9–14.8) and influenza B patients (10.4, 95% CI 7.1–13.7,). After correcting for the high rate of contamination, the occurrence of clinically relevant bacteraemia in COVID-19 patients amounted to 1.0% (95% CI 0.3–1.8), which was statistically significantly lower (p = 0.04) compared to influenza A patients (4.0, 95% CI 1.9–6.1) and influenza B patients (3.0, 95% CI 1.2–4.9). The most frequently identified bacterial isolates in COVID-19 patients were Escherichia coli (n = 2) and Streptococcus pneumoniae (n = 2). The overall 30-day all-cause mortality for COVID-19 patients was 28.3% (95% CI 24.9–31.7), which was statistically significantly higher (p = <.001) when compared to patients with influenza A (7.1, 95% CI 4.3–9.9) and patients with influenza B (6.4, 95% CI 3.8–9.1). Conclusions We report a very low occurrence of community-acquired bacteraemia amongst COVID-19 patients in comparison to influenza patients. These results reinforce current clinical guidelines on antibiotic management in COVID-19, which only advise utilization of antibiotics when a bacterial co-infection is suspected.

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Bacteremia With Otitis Media

PEDIATRICS ◽

10.1542/peds.87.1.48 ◽

1991 ◽

Vol 87 (1) ◽

pp. 48-53 ◽

Cited By ~ 1

Author(s):

Sara A. Schutzman ◽

Stephen Petrycki ◽

Gary R. Fleisher

Keyword(s):

Staphylococcus Aureus ◽

Streptococcus Pneumoniae ◽

Blood Culture ◽

Haemophilus Influenzae ◽

Otitis Media ◽

Potential Benefit ◽

Blood Cultures ◽

Children At Risk ◽

Focus Of Infection ◽

Persistent Bacteremia

To investigate the occurrence and outcome of bacteremia associated with otitis media, charts were reviewed from patients who were 3 to 36 months of age, had temperatures ≥39°C, and were diagnosed with isolated clinical otitis media. A total of 2982 patients were identified. Blood cultures were obtained from 1666 (56%). Of the 1666 patients, who had blood drawn for cultures, 50 (3.0%) had bacteremia. These included 39 with Streptococcus pneumoniae, 4 with Haemophilus influenzae, 2 with Neisseria meningitidis, 3 with Salmonella species, and 2 with Staphylococcus aureus. The incidence of bacteremia increased at higher temperatures, being 1.9% at temperatures ≤40°C and 5.0% at temperatures >40°C. Younger children were more likely to have bacteremia; 3.7% ≤12 months of age, 2.4% 13 to 24 months of age, and 1.9% 25 to 36 months of age had blood culture results that were positive (not significant). Reevaluation of the 50 bacteremic patients showed that 9 patients had continued fever, 3 patients had persistent bacteremia, pneumonia developed in 1 patient, and meningitis developed in 1 patient. It was concluded that (1) 3% of young febrile children with otitis media have bacteremia at the time of evaluation, a rate comparable to that previously reported in children with no focus of infection; (2) the incidence of bacteremia increases at higher temperatures; and (3) most febrile children with otitis media do well. The clinician must therefore weigh the potential benefit of drawing a blood culture to identify children at risk for complications against the inherent cost, inconvenience, and discomfort.

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High prevalence of clindamycin resistance in Staphylococcus aureus blood culture isolates in São Paulo, Brazil

Journal of Laboratory Physicians ◽

10.4103/jlp.jlp_161_16 ◽

2017 ◽

Vol 9 (04) ◽

pp. 314-316 ◽

Cited By ~ 1

Author(s):

Felipe S. Lupinacci ◽

Daniel Bussius ◽

Felipe Acquesta ◽

Gustavo Fam ◽

Raphael Rossi ◽

...

Keyword(s):

Staphylococcus Aureus ◽

Blood Culture ◽

Susceptibility Testing ◽

Sao Paulo ◽

Resistance Rate ◽

Blood Cultures ◽

São Paulo ◽

Inducible Clindamycin Resistance ◽

Total Prevalence ◽

High Prevalence

Abstract BACKGROUND: Clindamycin has become an important antimicrobial option for the treatment of Staphylococcus aureus. However, little is known about the current patterns of clindamycin-susceptibility in S. aureus invasive isolates, both in our country and in other developing countries in the world. AIMS: The aim of this study was to determine the prevalence of constitutive and inducible clindamycin resistance in methicillin-susceptible S. aureus (MSSA) and methicillin-resistant S. aureus (MRSA) blood culture isolates in São Paulo, Brazil. MATERIALS AND METHODS: From July 2011 to June 2012, all S. aureus isolates from blood cultures collected at our hospital were included in the study. Antimicrobial susceptibility testing was performed according to recommendations of the Clinical and Laboratory Standards Institute. RESULTS: Total prevalence of clindamycin resistance was 68%, including 7.2% with inducible resistance. In MRSA resistance rate was 90.8% whereas in MSSA the rate was 32.7%. CONCLUSIONS: Our high prevalence of clindamycin resistance highlights the importance of performing D-test in a routine base, as well of maintaining continued surveillance for the prevalence of clindamycin resistance.

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Increased Antimicrobial Resistance of Pathogenic Coagulase-Negative Staphylococci From Blood Cultures (1961–1981)

Infection Control ◽

10.1017/s019594170006001x ◽

1984 ◽

Vol 5 (3) ◽

pp. 142-143 ◽

Cited By ~ 1

Author(s):

D.J. Flournoy

Keyword(s):

Staphylococcus Aureus ◽

Blood Culture ◽

Prosthetic Heart Valve ◽

Bacterial Endocarditis ◽

Blood Cultures ◽

Coagulase Negative Staphylococci ◽

Difficult Decision ◽

Antimicrobial Susceptibilities ◽

Cons Isolate ◽

Intravenous Catheters

Coagulase-negative staphylococci (CONS) have only recently gained notoriety as pathogens. Several reports have established their pathogenicity in bacterial endocarditis, prosthetic heart valve endocarditis, intraventricular shunts for treatment of hydrocephalus and intravenous catheters. One difficult decision for physicians is determining whether a particular CONS isolate is pathogenic or contaminant. The differentiation of pathogenic and contaminant CONS has recently been noted, but further studies are needed to aid in this differentiation. Data on antimicrobial susceptibilities of positive blood culture isolates were recently compiled at this institution. This report compares antimicrobial susceptibilities of pathogenic and contaminant CONS and Staphylococcus aureus blood culture isolates from 1961-1981 at this institution.

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Evaluation of an Initial Specimen Diversion Device (ISDD) on Rates of Blood Culture Contamination in the Emergency Department

Kansas Journal of Medicine ◽

10.17161/kjm.vol1413804 ◽

2021 ◽

Vol 14 ◽

pp. 73-76

Author(s):

Blake Buzard ◽

Patrick Evans ◽

Todd Schroeder

Keyword(s):

Emergency Department ◽

Length Of Stay ◽

Blood Culture ◽

Blood Cultures ◽

Contamination Rate ◽

Total Hospital Cost ◽

Initial Specimen ◽

Significant Difference ◽

Secondary Outcomes ◽

The Impact

Introduction: Blood cultures are the gold standard for identifying bloodstream infections. The Clinical and Laboratory Standards Institute recommends a blood culture contamination rate of <3%. Contamination can lead to misdiagnosis, increased length of stay and hospital costs, unnecessary testing and antibiotic use. These reasons led to the development of initial specimen diversion devices (ISDD). The purpose of this study is to evaluate the impact of an initial specimen diversion device on rates of blood culture contamination in the emergency department. Methods: This was a retrospective, multi-site study including patients who had blood cultures drawn in an emergency department. February 2018 to April 2018, when an ISDD was not utilized, was compared with June 2019 to August 2019, a period where an ISDD was being used. The primary outcome was total blood culture contamination. Secondary outcomes were total hospital cost, hospital and intensive care unit length of stay, vancomycin days of use, vancomycin serum concentrations obtained, and repeat blood cultures obtained. Results: A statistically significant difference was found in blood culture contamination rates in the Pre-ISDD group vs the ISDD group (7.47% vs 2.59%, p<0.001). None of the secondary endpoints showed a statistically significant difference. Conclusions: Implementation of an ISDD reduces blood culture contamination in a statistically significant manner. However, we were unable to capture any statistically significant differences in the secondary outcomes.

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660. Effect of the COVID-19 Pandemic on Blood Culture Contamination Rates and Quality Improvement Processes

Open Forum Infectious Diseases ◽

10.1093/ofid/ofab466.857 ◽

2021 ◽

Vol 8 (Supplement_1) ◽

pp. S432-S432

Author(s):

Alexander G Hosse

Keyword(s):

Emergency Department ◽

Blood Culture ◽

Nursing Staff ◽

Blood Cultures ◽

Hospital Length Of Stay ◽

Contamination Rate ◽

Culture Collections ◽

Total Blood ◽

Primary Driver ◽

Inpatient Units

Abstract Background Blood cultures are the gold standard for diagnosing bloodstream infections and a vital part of the work-up in systemic infections. However, contamination of blood cultures represents a significant burden on patients and the healthcare system with increased hospital length of stay, unnecessary antibiotics, and financial cost. The data discussed here offer insight into blood culture contamination rates before and through the COVID-19 pandemic at a community hospital and the processes that were affected by the pandemic. Methods Blood culture contaminations were determined by using the number of sets of blood cultures with growth and the presence of an organism from the National Healthcare Safety Network's (NHSN) commensal organism. Contamination rates were evaluated by status as a standard unit or a COVID-19 isolation unit in either the emergency department (ED) or inpatient floor units. The identified four groups had different processes for drawing blood cultures, particularly in terms of training of staff in use of diversion devices. The electronic medical record was used to track contaminations and the use of diversion devices in the different units. Results The inpatient COVID units were consistently elevated above the other units and the institutional contaminant goal of 2.25%, ranging from 9.6% to 13.3% from 4/2020-9/2020. Those units were the primary driver of the increase in overall contamination rates. COVID ED nursing staff (that had previously undergone training in the use of diversion devices) used diversion devices to draw 51 of 133 (38.3%) cultures compared to only 15 of 84 (17.9%) on the COVID inpatient units. Figure 1. Comparison of contamination rates in the ED vs the inpatient units from all campuses from September 2019 through September 2020. The blue line represents the hospital goal of 2.25% contamination rate. Solid lines represent total contamination rates including COVID isolation units whereas dotted lines represent units excluding COVID isolation units. Figure 2. Comparison of the non-COVID vs COVID isolation units in the emergency department and inpatient units. The red line represents the hospital goal of less than 2.25% for blood culture contamination rate. Table of Contaminants vs. Total Collected Blood Cultures in Each Unit by Month Figure 3. Raw data from Figure 2. Total blood culture contaminations from each unit by month compared to total blood culture collections from each unit by month. Conclusion Evaluation revealed that nursing staff with less training in blood culture collection, particularly the use of diversion devices, were the primary staff collecting blood cultures in the inpatient COVID units. The difference in training is felt to be the primary driver of the increase in contaminants in the inpatient COVID units. The marked increase in contaminations highlights the difficulties of maintaining quality control processes during an evolving pandemic and the importance of ongoing efforts to improve the quality of care. These findings demonstrate the importance of training and routine use of procedures to reduce contaminations even during. Disclosures All Authors: No reported disclosures

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Use of thermonuclease testing to identify Staphylococcus aureus by direct examination of blood cultures

Eastern Mediterranean Health Journal ◽

10.26719/2003.9.1-2.185 ◽

2003 ◽

Vol 9 (1-2) ◽

pp. 185-190

Author(s):

N. M. Kaplan

Keyword(s):

Staphylococcus Aureus ◽

Blood Culture ◽

Direct Detection ◽

Blood Cultures ◽

Military Hospital ◽

Clinical Microbiology Laboratory ◽

Microbiology Laboratory ◽

Direct Examination ◽

Gram Positive ◽

Gram Positive Cocci

Blood cultures submitted to the Clinical Microbiology Laboratory, Queen Alia Military Hospital, Amman during 1999-2001 were examined to evaluate thermonuclease testing for identifying Staphylococcus aureus in blood culture broths growing gram-positive cocci. Of 170 cultures studied, 129 yielded gram-positive staphylococci and 41 yielded other gram-positive cocci. Toluidine blue-deoxynucleic acid agar plates were used to test for thermonuclease activity. St and ard tube coagulase tests were performed on the isolates. Direct detection of thermonuclease activity in 76 blood culture broths containing gram-positive staphylococci showed 100% correlation with subsequent tube coagulase tests. The thermonuclease test provides a fast, specific and reliable confirmation of S. aureus bacteraemia by direct examination of blood culture broths that contain gram-positive cocci. This allows for timely, optimal antibiotic therapy

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Standardization of direct susceptibility test for blood cultures

Journal of Clinical Microbiology ◽

10.1128/jcm.9.3.347-350.1979 ◽

1979 ◽

Vol 9 (3) ◽

pp. 347-350

Author(s):

D Fay ◽

J E Oldfather

Keyword(s):

Escherichia Coli ◽

Staphylococcus Aureus ◽

Blood Culture ◽

Standardized Test ◽

Culture Broth ◽

Blood Cultures ◽

Insufficient Data ◽

Direct Test ◽

Standard Methods ◽

Susceptibility Tests

Insufficient data are available to establish the reliability of direct disk diffusion susceptibility tests performed utilizing positive blood culture broth as inoculum. When Staphylococcus aureus ATCC 25923, Escherichia coli ATCC 25922, and Pseudomonas aeruginosa ATCC 27853 were used, 0.03 ml of turbid overnight blood culture broth was found to produce zone diameters closely approximating the size of diameters obtained by a standardized method. Results of direct (0.03 ml of inoculum) and standardized susceptibility tests were then compared for 116 positive blood cultures (1,069 individual disk comparisons). There were 1,011 test agreements (94.6%). There were also 48 (4.5%) minor discrepancies (change between sensitive and intermediate or between intermediate and resistant) and 10 (0.9%) major discrepancies (change between sensitive and resistant). The major discrepancies were randomly distributed among several organisms and antibiotics. Discrepancies occurred most frequently in the more clinically acceptable direction; i.e., in 79.3% the direct test indicted greater resistance than the standardized test. These data establish that 0.03 ml of turbid overnight blood culture broth produces results which compare closely to those obtained with standard methods, and in practice yield direct susceptibility results with a clinically acceptable level of reliability.

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Association between QTc prolongation and mortality in patients with suspected poisoning in the emergency department: a transnational propensity score matched cohort study

BMJ Open ◽

10.1136/bmjopen-2017-020036 ◽

2018 ◽

Vol 8 (7) ◽

pp. e020036 ◽

Cited By ~ 4

Author(s):

Camilla Schade Hansen ◽

Anton Pottegård ◽

Ulf Ekelund ◽

Helene Kildegaard Jensen ◽

Jakob Lundager Forberg ◽

...

Keyword(s):

Emergency Department ◽

Cardiac Arrest ◽

Cohort Study ◽

Propensity Score ◽

Qtc Interval ◽

Qtc Prolongation ◽

Risk Of Mortality ◽

Increased Risk ◽

All Cause Mortality ◽

First Time

ObjectivesPoisoning is a frequent cause of admission to the emergency department (ED) and may involve drugs known to prolong the QT interval. This study aims to describe the prevalence of QTc prolongation among ED patients with suspected poisoning and to calculate the absolute and relative risk of mortality or cardiac arrest associated with a prolonged QTc interval.MethodsWe performed a register-based cohort study, including all adult first-time contacts with suspected poisoning to the ED of two Swedish hospitals (January 2010–December 2014) and two Danish hospitals (March 2013–April 2014). We used propensity score matching to calculate HRs for all-cause mortality or cardiac arrest (combined endpoint) within 30 days after contact comparing patients with a prolonged QTc interval (≥450 ms men, ≥460 ms women) with patients with a QTc interval of <440 ms.ResultsAmong all first-time contacts with suspected poisoning that had an ECG recorded within 4 hours after arrival (n=3869), QTc prolongation occurred in 6.5%. The overall mortality after a 30-day follow-up period was 0.8% (95% CI 0.6 to 1.2), with an absolute risk of mortality or cardiac arrest in patients with QTc prolongation of 3.2% (95% CI 1.4 to 6.1). A prolonged QTc interval on arrival was associated with a HR of 3.6 (95% CI 1.0 to 12.2).ConclusionIn the ED, a prolonged QTc interval in patients arriving with suspected poisoning seems to be associated with a threefold increased risk of 30-day all-cause mortality or cardiac arrest.

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