Bacteraemia variation during the COVID-19 pandemic; a multi-centre UK secondary care ecological analysis

Abstract Background We investigated for change in blood stream infections (BSI) with Enterobacterales, coagulase negative staphylococci (CoNS), Streptococcus pneumoniae, and Staphylococcus aureus during the first UK wave of SARS-CoV-2 across five London hospitals. Methods A retrospective multicentre ecological analysis was undertaken evaluating all blood cultures taken from adults from 01 April 2017 to 30 April 2020 across five acute hospitals in London. Linear trend analysis and ARIMA models allowing for seasonality were used to look for significant variation. Results One hundred nineteen thousand five hundred eighty-four blood cultures were included. At the height of the UK SARS-CoV-2 first wave in April 2020, Enterobacterales bacteraemias were at an historic low across two London trusts (63/3814, 1.65%), whilst all CoNS BSI were at an historic high (173/3814, 4.25%). This differed significantly for both Enterobacterales (p = 0.013), CoNS central line associated BSIs (CLABSI) (p < 0.01) and CoNS non-CLABSI (p < 0.01), when compared with prior periods, even allowing for seasonal variation. S. pneumoniae (p = 0.631) and S. aureus (p = 0.617) BSI did not vary significant throughout the study period. Conclusions Significantly fewer than expected Enterobacterales BSI occurred during the UK peak of the COVID-19 pandemic; identifying potential causes, including potential unintended consequences of national self-isolation public health messaging, is essential. High rates of CoNS BSI, with evidence of increased CLABSI, but also likely contamination associated with increased use of personal protective equipment, may result in inappropriate antimicrobial use and indicates a clear area for intervention during further waves.

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Bacteraemia Variation During The COVID-19 Pandemic; A Multi-Centre UK Secondary Care Ecological Analysis.

10.21203/rs.3.rs-113509/v1 ◽

2020 ◽

Author(s):

Sarah Denny ◽

Timothy M Rawson ◽

Giovanni Satta ◽

Scott JC Pallett ◽

Ahmed Abdulaal ◽

...

Keyword(s):

Linear Trend ◽

Blood Stream ◽

Unintended Consequences ◽

Blood Cultures ◽

Arima Models ◽

Coagulase Negative Staphylococci ◽

Ecological Analysis ◽

Clear Area ◽

Acute Hospitals ◽

The Uk

Abstract Objectives – We investigated for change in blood stream infections (BSI) with Enterobacterales, coagulase negative staphylococci (CoNS), Streptococcus pneumoniae, and Staphylococcus aureus during the first UK wave of SARS-CoV-2 across six London hospitals.Methods – A retrospective multicentre ecological analysis was undertaken evaluating all blood cultures taken from adults from 01 April 2017 to 30 April 2020 across six acute hospitals in London. Linear trend analysis and ARIMA models allowing for seasonality were used to look for significant variation.Results –119,584 blood cultures were included. At the height of the UK SARS-CoV-2 first wave in April 2020, Enterobacterales bacteraemias were at an historic low across two London trusts (63/3814, 1.65%), whilst CoNS were at an historic high (173/3814, 4.25%). This differed significantly for both Enterobacterales (p=0.013) and CoNS (p<0.01), when compared with prior periods, even allowing for seasonal variation. S. pneumoniae (p=0.631) and S. aureus (p=0.617) BSI did not vary significant throughout the study period.Conclusions – Significantly fewer than expected Enterobacteriales BSI occurred during the UK peak of the COVID-19 pandemic; identifying potential causes, including potential unintended consequences of national self-isolation public health messaging, is essential. High rates of CoNS BSI, presumably representing contamination associated with increased use of personal protective equipment, may result in inappropriate antimicrobial use and indicates a clear area for intervention during further waves.

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577. Incidence and Outcomes of Positive Outpatient Surveillance Blood Cultures in Hematopoietic Stem Cell Transplant (HSCT) Patients with Graft Versus Host Disease (GvHD) On High Dose ≥ 0.5 mg/kg/day (HD) and Low Dose < 0.5mg/kg/day (LD) Steroid Therapy

Open Forum Infectious Diseases ◽

10.1093/ofid/ofaa439.771 ◽

2020 ◽

Vol 7 (Supplement_1) ◽

pp. S353-S354

Author(s):

Sarah Perreault ◽

Molly Schiffer ◽

Jennifer Zhao ◽

Dayna McManus ◽

Francine Foss ◽

...

Keyword(s):

Steroid Therapy ◽

Central Line ◽

Blood Cultures ◽

High Dose ◽

Cell Transplant ◽

Coagulase Negative Staphylococci ◽

Hematopoietic Stem ◽

Surveillance Cultures ◽

Number Of Patients ◽

Clinically Significant

Abstract Background Treatment of GvHD with steroids increases the risk of infection in HSCT patients due to additive immunosuppression and may delay the diagnosis of infection due to lack of symptoms. Outpatient surveillance blood cultures in HSCT with GvHD being treated with HD steroids has demonstrated a blood culture positivity rate of 3.5%. Currently, the utility of surveillance cultures in patients receiving LD steroid therapy is unknown. Our practice includes weekly outpatient surveillance cultures for all GvHD patients treated with steroids regardless of the dose. The primary endpoint of this study was to assess the incidence of positive surveillance blood cultures in GvHD patients receiving HD or LD steroids. Secondary endpoints included number of patients treated, hospitalization, 30 day mortality due to infection, and organisms isolated. Methods This was a single-center, retrospective review of GvHD patients at Yale New Haven Hospital between January 2013 and May 2019. Patients were excluded if: lack of signs or symptoms of GvHD, treatment with steroids for any indication other than GvHD, and active GvHD without central line. Cultures from patients receiving antibiotics for concurrent infection were also excluded. Results A total of 71 patients met criteria with 901 blood cultures. On HD, eight patients (14%) had 12 positive cultures (4%), and on LD, 16 patients (25%) had 22 positive cultures (4%) (p=0.15). Treatment occurred in six patients (75%) with four (24%) requiring hospitalization on HD, and 12 patients (75%) with 10 (83%) requiring hospitalization on LD (p=0.45). The median duration of steroid therapy was 93 and 236 days with a median dose of steroids of 1mg/kg/day and 0.15mg/kg/day, respectively. The number of positive cultures/1000 steroid days was 1.2 on HD and 0.5 on LD (RR 2.2). 30 day mortality was only noted in one patient (8%) on LD. The most common organism in both groups was Coagulase-negative staphylococci with all six cultures on HD classified as contaminants and 6/10 cultures requiring treatment on LD. Conclusion Although the relative risk of positive surveillance blood cultures in HD patients compared to LD was twofold higher, there were clinically significant infections identified in the LD group. Disclosures All Authors: No reported disclosures

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Nosocomial blood stream infections in Imam Khomeini Hospital, Urmia, Islamic Republic of Iran, 1999-2001

Eastern Mediterranean Health Journal ◽

10.26719/2005.11.3.478 ◽

2005 ◽

Vol 11 (3) ◽

pp. 478-484

Author(s):

M. Rahbar

Keyword(s):

Blood Stream ◽

Blood Cultures ◽

Microbiology Laboratory ◽

Islamic Republic ◽

Coagulase Negative Staphylococci ◽

Gram Positive ◽

Blood Stream Infections ◽

Skin Contamination ◽

Islamic Republic Of Iran ◽

Gram Positive Cocci

Ina 2-year retrospective study, the database of the microbiology laboratory of the Imam Khomeini Hospital was reviewed to identify patients who had nosocomial bacteraemia between 1 May 1999 and 31 May 2001 and identify the pathogen responsible and its resisitance to antibiotics. Of 6492 patients in various wards, 593 [9.1%] had positive blood cultures; 85 of those [14.3%] had signs of potential skin contamination. Gram-positive cocci, including coagulase-negative staphylococci, Staphylococcus aureus, Streptococcus pneumoniae and other Gram-positive cocci, accounted for 42.3% of isolates. Gram-negative bacilli were responsible for another 42.3% of isolates; Pseudomonas aeruginosa was the predominant isolate. Patterns of drug resistance varied according to species of bacteria but were generally quite high

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81. Reducing Unnecessary Blood Cultures Through Diagnostic Stewardship

Open Forum Infectious Diseases ◽

10.1093/ofid/ofab466.283 ◽

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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Prevalence of infective endocarditis in patients with positive blood cultures: a Danish nationwide study

European Heart Journal ◽

10.1093/eurheartj/ehz327 ◽

2019 ◽

Vol 40 (39) ◽

pp. 3237-3244 ◽

Cited By ~ 13

Author(s):

Lauge Østergaard ◽

Niels Eske Bruun ◽

Marianne Voldstedlund ◽

Magnus Arpi ◽

Christian Østergaard Andersen ◽

...

Keyword(s):

Staphylococcus Aureus ◽

Infective Endocarditis ◽

Enterococcus Faecalis ◽

Blood Stream ◽

Blood Cultures ◽

Trend Test ◽

Coagulase Negative Staphylococci ◽

Blood Stream Infections ◽

Nationwide Study ◽

Male Patients

Abstract Aims Increasing attention has been given to the risk of infective endocarditis (IE) in patients with certain blood stream infections (BSIs). Previous studies have been conducted on selected patient cohorts, yet unselected data are sparse. We aimed to investigate the prevalence of IE in BSIs with bacteria typically associated with IE. Methods and results By crosslinking nationwide registries from 2010 to 2017, we identified patients with BSIs typically associated with IE: Enterococcus faecalis (E. faecalis), Staphylococcus aureus (S. aureus), Streptococcus spp., and coagulase negative staphylococci (CoNS) and examined the concurrent IE prevalence. A trend test was used to examine temporal changes in the prevalence of IE. In total 69 021, distributed with 15 350, 16 726, 19 251, and 17 694 BSIs were identified in the periods of 2010–2011, 2012–2013, 2014–2015, and 2016–2017, respectively. Patients with E. faecalis had the highest prevalence of IE (16.7%) followed by S. aureus (10.1%), Streptococcus spp. (7.3%), and CoNS (1.6%). Throughout the study period, the prevalence of IE among patients with E. faecalis and Streptococcus spp. increased significantly (P = 0.0005 and P = 0.03, respectively). Male patients had a higher prevalence of IE for E. faecalis, Streptococcus spp., and CoNS compared with females. A significant increase in the prevalence of IE was seen for E. faecalis, Streptococcus spp., and CoNS with increasing age. Conclusion For E. faecalis BSI, 1 in 6 had IE, for S. aureus BSI 1 in 10 had IE, and for Streptococcus spp. 1 in 14 had IE. Our results suggest that screening for IE seems reasonable in patients with E. faecalis BSI, S. aureus BSI, or Streptococcus spp. BSI.

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P3665Prevalence of infective endocarditis in patients with positive blood cultures: a Danish nationwide study

European Heart Journal ◽

10.1093/eurheartj/ehz745.0520 ◽

2019 ◽

Vol 40 (Supplement_1) ◽

Author(s):

L Ostergaard ◽

N E Bruun ◽

M Voldstedlund ◽

H C Schonheyder ◽

F Rosenvinge ◽

...

Keyword(s):

Infective Endocarditis ◽

Enterococcus Faecalis ◽

Blood Stream ◽

Blood Cultures ◽

Trend Test ◽

Coagulase Negative Staphylococci ◽

Blood Stream Infections ◽

Nationwide Study ◽

Appropriate Therapy ◽

Male Patients

Abstract Background Increasing attention has been given to the risk of infective endocarditis (IE) in patients with certain blood stream infections (BSI). Previous studies have been conducted on selected patient cohorts, yet unselected data are sparse. Purpose To investigate the nationwide prevalence of diagnosed IE in BSIs with bacteria typically associated with IE. Methods By crosslinking nationwide registries from 2010–2016, we identified patients with BSIs typically associated with IE: Enterococcus faecalis, Staphylococcus, Streptococcus spp., and coagulase negative staphylococci (CoNS) and examined the concurrent IE prevalence. A trend test was used to examine temporal changes in the prevalence of IE. Results In total 60,119 BSIs, distributed with 15,407, 16,790, and 27,922 BSIs were identified in the periods of 2010–2011, 2012–2013, and 2014–2016, respectively. Patients with E. Faecalis had the highest prevalence of diagnosed IE (16.3%) followed by S. aureus (10.2%), Streptococcus spp. (7.3%), and CoNS (1.6%) (Figure). During the study period, the prevalence of IE among patients with E. faecalis increased significantly (p=0.003), Male patients had higher prevalence of IE for all microorganisms investigated compared with females. A significant increase in the prevalence of IE was seen for E. faecalis, Streptococcus spp., and CoNS with increasing age. Percent with endocarditis Conclusion For E. faecalis BSI, 1 in 6 had IE, for S. aureus BSI 1 in 10 had IE, and for Streptococcus spp. 1 in 14 had IE. Our results support screening for IE in patients with E. faecalis, S. aureus, or Streptococcus spp. BSI in order to offer appropriate therapy.

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