Incidence of Bacteremia at the Time of ICU Admission and its Impact on Outcome

Background: For patients admitted in ICU, if they are suspected with infection, at admission time, blood culture is taken. Aim: This study aimed to evaluate the bacteraemia incidence at the ICU admission time, and assess its impact on the outcome.Subjects and Methods:This is a retrospective study which was conducted in a tertiary hospital. At time of admission, data from all the ICU admissions with suspected sepsis were analysed over a period of July 2016 to June 2018. The positive blood culture group (Group A) consisted of patients with clinically significant BSI.Results:600 patients were selected in the study. 250 patients out of 600 patients (42%) were on antibiotics. 380 patients out of 600 patients (63%) were direct ICU admission from casualty, 70 patients from hospital wards (11%), 45 patients from other ICU’s in the hospital (8%) and 105 patients from other hospitals (18%). Blood cultures were positive only in 70 patients (11.6%) with significant BSI. ICU mortality was significantly higher in positive blood culture group (i.e. 30/70), when compared with negative blood culture group (i.e. 68/530). Mortality was higher in patients with pseudomonas aeruginosa (75%) though it was not statistically significant.Conclusion:In the ICU, only in minority of patients with suspected infection, blood cultures may be positive. Even though the patients are administered with antibiotics, prognosis of the patients with positive blood culture is worse.

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Nosocomial Bacteremia Clinical Significance of a Single Blood Culture Positive for Coagulase-Negative Staphylococci

Infection Control and Hospital Epidemiology ◽

10.1086/502605 ◽

2005 ◽

Vol 26 (8) ◽

pp. 697-702 ◽

Cited By ~ 39

Author(s):

Benoît Favre ◽

Stéphane Hugonnet ◽

Luci Correa ◽

Hugo Sax ◽

Peter Rohner ◽

...

Keyword(s):

Blood Culture ◽

Clinical Significance ◽

Positive Blood Culture ◽

Blood Cultures ◽

University Teaching ◽

Coagulase Negative Staphylococci ◽

Nosocomial Bacteremia ◽

Single Positive ◽

Clinically Significant ◽

Culture Positive

AbstractObjectives:To describe the epidemiology of nosocomial coagulase-negative staphylococci (CoNS) bacteremia and to evaluate the clinical significance of a single blood culture positive for CoNS.Design:A 3-year retrospective cohort study based on data prospectively collected through hospital-wide surveillance. Bacteremia was defined according to CDC criteria, except that a single blood culture growing CoNS was not systematically considered as a contaminant. All clinically significant blood cultures positive for CoNS nosocomial bacteremia were considered for analysis.Setting:A large university teaching hospital in Geneva, Switzerland.Results:A total of 2,660 positive blood cultures were identified. Of these, 1,108 (41.7%) were nosocomial; CoNS were recovered from 411 nosocomial episodes (37.1%). Two hundred thirty-four episodes of CoNS bacteremia in the presence of signs of sepsis were considered clinically relevant and analyzed. Crude mortality and associated mortality were 24.4% and 12.8%, respectively. Associated mortality was similar among patients with one positive blood culture and those with two or more (16.2% vs 10.8%, respectively;P= .3). Mortality rates after bacteremia for patients with a single positive blood culture and for those with two or more were 15.3% and 7.0%, respectively, at day 14 (RR, 2.2; CI%, 0.87-5.46) and 20.8% and 11.3%, respectively, at day 28 (RR, 1.9; CI95, 0.9-3.8). On multivariate analysis, only age and a rapidly fatal disease were independently associated with death.Conclusion:CoNS bacteremia harbor a significant mortality and a single positive blood culture in the presence of signs of sepsis should be considered as clinically relevant.

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Predictors of positive blood culture and deaths among neonates with suspected neonatal sepsis in a tertiary hospital, Mwanza- Tanzania

BMC Pediatrics ◽

10.1186/1471-2431-10-39 ◽

2010 ◽

Vol 10 (1) ◽

Cited By ~ 124

Author(s):

Neema Kayange ◽

Erasmus Kamugisha ◽

Damas L Mwizamholya ◽

Seni Jeremiah ◽

Stephen E Mshana

Keyword(s):

Blood Culture ◽

Positive Blood Culture ◽

Neonatal Sepsis ◽

Tertiary Hospital

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Baseline Study for Improving Diagnostic Stewardship at Secondary Health Care Facilities in Nigeria

10.21203/rs.3.rs-829161/v1 ◽

2021 ◽

Author(s):

Abiodun Egwuenu ◽

Adaora Ejikeme ◽

Sara Tomczyk ◽

Anja Von-Laer ◽

Olaniyi Ayobami ◽

...

Keyword(s):

Health Care ◽

Quality Control ◽

Blood Culture ◽

Online Survey ◽

Case Finding ◽

Blood Cultures ◽

Health Care Facilities ◽

Suspected Sepsis ◽

Care Facilities ◽

Secondary Health Care

Abstract BackgroundBlood culture diagnostics are a critical tool for sepsis management and antimicrobial resistance (AMR) surveillance. A baseline study was conducted to assess existing sepsis case finding, blood culture diagnostics and antimicrobial susceptibility testing (AST) at secondary health care facilities to inform the development of diagnostic stewardship improvement strategies in Nigeria.MethodsA cross-sectional online survey was conducted among 25 public secondary health care facilities in Abuja, FCT and Lagos State in Nigeria to evaluate the capacity for pathogen identification and AST. Following this, data were prospectively extracted on all patients with suspected sepsis from electronic medical records at two facilities in Abuja from October 2020 to May 2021 to further assess practices concerning sepsis case-finding, clinical examination findings, samples requested, and laboratory test results. Data were descriptively analysed, and a multivariate logistic regression analysis was conducted to determine factors associated with blood culture requests among suspected sepsis patients.ResultsIn the online survey, 32% (8/25) of facilities reported performing routine blood cultures. Only one had access to a clinical microbiologist, and 28% (7/25) and 4% (1/25) used standard bacterial organisms for quality control of media and quality control strains for AST, respectively. At the two facilities where data abstraction was performed, 7.1% (2924/41066) of patients were found to have suspected sepsis. A majority of the suspected sepsis patients came from the paediatrics department and were outpatients, and the median age was two years. Most did not have vital signs and major foci of infection documented. Blood cultures were only requested for 2.7% (80/2924) of patients, of which twelve were positive for bacteria, mainly Staphylococcus aureus. No clinical breakpoints were used for AST. Inpatients (adjusted odds ratio [aOR]:7.5, 95% CI:4.6 – 12.3) and patients from the urban health care facility (aOR:16.9, 95% CI:8.1 – 41.4) were significantly more likely to have a blood culture requested.ConclusionLow blood culture utilisation remains a key challenge in Nigeria. This has implications for patient care. AMR surveillance and antibiotics use. Diagnostic stewardship strategies should focus on improving access to clinical microbiology expertise, practical guidance on sepsis case finding and improving blood culture utilisation and diagnostics.

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[18F]FDG hypermetabolisms of the spleen and/or bone marrow: indirect signs of bacteremia

European Heart Journal - Cardiovascular Imaging ◽

10.1093/ehjci/jeab111.073 ◽

2021 ◽

Vol 22 (Supplement_3) ◽

Author(s):

R Zanca ◽

F Bartoli ◽

E Lazzeri ◽

M Sollini ◽

RHJA Slart ◽

...

Keyword(s):

Bone Marrow ◽

Blood Culture ◽

Positive Blood Culture ◽

Test Procedure ◽

Lumbar Vertebrae ◽

Final Diagnosis ◽

Negative Blood Culture ◽

Suspected Infection ◽

Significant Difference ◽

18F Fdg

Abstract Funding Acknowledgements Type of funding sources: None. Aim Recently hypermetabolisms of the spleen and/or bone marrow has been proposed as an indirect sign of infective endocarditis (IE), useful to reinforce the suspicion of IE in the absence of any other infectious, inflammatory, or malignant disease. The purpose of this study is to determine whether hypermetabolisms of the spleen and/or bone marrow are indirect signs of bacteremia rather than of IE, specifically. Materials and Method In this work we retrospectively evaluated a series 240 patients who performed between January 2015 to December 2020 [18F]FDG PET/CT (Discovery 710 GE) for suspected infection. In particular, 80 pts had infections from different origin and a positive blood culture (PBC), 80 pts presented localized infection, but negative blood culture (IDBCN) and 80 pts were classified as definite IE (IED) according to the 2015 ESCcriteria. [18F]FDG SUVmax SUVmean in bone marrow, spleen and liver were measured drawind a 14 cm3 regions of interest (ROIs) positioned close to the centers of the spleen and of the right liver lobe, but excluding abscess and/or ischemic lesions., as previously described (Caroline Boursier et al. ; Jordy P.Pijl et al.). BM SUVmax and SUVmean was obtained from ROIs placed on the bodies of each of the five lumbar vertebrae, excluding any damaged vertebra. BM to liver SUV ratios (BLR) and spleen to liver SUV ratios (SLR) were calculated. Kruskal-Wallis tests and the Dunn’s test procedure for multiple comparison were performed using JMP Statistical Discoverytm. Results No significant difference among the three groups of SUVmax/mean or in SLR were found. Nevertheless, by grouping patients for the presence of positive blood culture (142 pts) or negative blood culture (98 pts), irrespectively from the final diagnosis a significant associations of SLR was found (p = 0.0070). No significant associations were found with BLR. Conclusions Based on our data SLR in seems to represent an indirect signs of bacteremia, rather than IE.

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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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The Addition of Anaerobic Blood Cultures for Pediatric Patients with Concerns for Bloodstream Infections: Prevalence and Time to Positive Cultures

Journal of Clinical Microbiology ◽

10.1128/jcm.01844-19 ◽

2020 ◽

Vol 58 (9) ◽

Author(s):

Jennifer Dien Bard ◽

Todd P. Chang ◽

Rebecca Yee ◽

Keya Manshadi ◽

Nhan Lichtenfeld ◽

...

Keyword(s):

Blood Culture ◽

Pediatric Patients ◽

Bloodstream Infections ◽

Pediatric Emergency ◽

Blood Cultures ◽

Secondary Outcome ◽

Culture Positivity ◽

Blood Culture Positivity ◽

Anaerobic Bottle ◽

Clinically Significant

ABSTRACT Anaerobes are an important but uncommon cause of bloodstream infections (BSIs). For pediatric patients, routine inclusion of an anaerobic blood culture alongside the aerobic remains controversial. We implemented automatic anaerobic blood culture alongside aerobic blood cultures in a pediatric emergency department (ED) and sought to determine changes in recovery of obligate and facultative anaerobes. This was a cohort study in a pediatric ED (August 2015 to July 2018) that began in February 2017. Blood culture positivity results for true pathogens and contaminants were assessed, along with a secondary outcome of time to positivity (TTP) of blood culture. A total of 14,180 blood cultures (5,202 preimplementation and 8,978 postimplementation) were collected, with 8.8% (456) and 7.1% (635) positive cultures in the pre- and postimplementation phases, respectively. Of 635 positive cultures in the postimplementation phase, aerobic blood cultures recovered 7.6% (349/4,615), whereas anaerobic blood cultures recovered 6.6% (286/4,363). In 211/421 (50.0%) paired blood cultures, an organism was recovered in both cultures. The number of cases where organisms were only recovered from an aerobic or an anaerobic bottle in the paired cultures were 126 (30.0%) and 84 (20.0%), respectively. The TTP was comparable regardless of bottle type. Recovery of true pathogens from blood cultures was approximately 7 h faster than recovery of contaminants. Although inclusion of anaerobic blood cultures only recovered 2 (0.69%) obligate anaerobes, it did allow for recovery of clinically significant pathogens that were negative in aerobic blood cultures and supports the routine collection of both bottles in pediatric patients with a concern of bloodstream infections.

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A Retrospective Audit of Clinically Significant Maternal Bacteraemia in a Specialist Maternity Hospital from 2001 to 2014

Infectious Diseases in Obstetrics and Gynecology ◽

10.1155/2015/518562 ◽

2015 ◽

Vol 2015 ◽

pp. 1-4 ◽

Cited By ~ 12

Author(s):

Richard John Drew ◽

Zara Fonseca-Kelly ◽

Maeve Eogan

Keyword(s):

Blood Culture ◽

Positive Blood Culture ◽

Maternal Blood ◽

Maternity Hospital ◽

E Coli ◽

Live Births ◽

Retrospective Audit ◽

Group A ◽

Clinically Significant ◽

Group B

Maternal sepsis is a significant problem in obstetrics, with almost one in four maternal deaths related to severe sepsis. We carried out a retrospective review of clinically significant bacteraemia in obstetric patients attending Rotunda Hospital over 14 years. From 2001 to 2014, there were 252 clinically significant positive blood culture episodes in obstetric patients. There were 112,361 live births >500 g during the study period giving an overall rate of 2.24 clinically significant positive maternal blood culture episodes per 1000 live births >500 g. The median rate over the 14 years was 2.12 episodes per 1000 live births >500 g, with an interquartile range of 1.74–2.43 per 1000 live births >500 g. There was no discernable increasing or decreasing trend over the 14 years.E. coliwas the most commonly isolated organism (n= 92/252, 37%), followed by group BStreptococcus(n= 64/252, 25%),Staphylococcus aureus(n= 28/252, 11%), and anaerobes (n= 11/252, 4%). These top four organisms represented three-quarters of all positive blood culture episodes (n= 195/252, 77.3%). Of note, there were only five cases of listeriosis, representing a rate of 4.4 cases per 100,000 live births >500 g. The rate of invasive group A streptococcal infection was also very low at 5.3 cases per 100,000 live births >500 g.

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ATG Use Is Associated with Frequent Occurrence of Positive Blood Cultures in Patients in the Early Phase After Hematopoietic Stem Cell Transplantation

Blood ◽

10.1182/blood.v118.21.4564.4564 ◽

2011 ◽

Vol 118 (21) ◽

pp. 4564-4564

Author(s):

Marek Seweryn ◽

Urszula Jarosz ◽

Malgorzata Krawczyk-Kulis ◽

Miroslaw Markiewicz ◽

Grzegorz Helbig ◽

...

Keyword(s):

Stem Cell ◽

Hematopoietic Stem Cell Transplantation ◽

Blood Culture ◽

Stem Cell Transplantation ◽

Positive Blood Culture ◽

Blood Cultures ◽

Gram Negative Bacteria ◽

Hematopoietic Stem ◽

Gram Negative ◽

Gram Positive Bacteria

Abstract Abstract 4564 Background: Infectious complications remain an important cause of morbidity and mortality in the early phase after hematopoietic stem cell transplantation (HSCT). Aim: The aim of this study was to assess the frequency of positive blood cultures and its potential correlation with different studied parameters in large patient population studied in the first 30 days after HSCT. Material and methods: 431 patients at median age of 47 years (range 18–85) transplanted between 2009–2011 for hematological and non-hematological malignancies were included in our analysis. There were 242 males and 189 females. Results: The indications for autologous and allogeneic HSCT were following: AML – 105 (24%), NHL – 86 (20%), MM – 75 (17,5%), HL – 48 (11%), ALL – 40 (9%), MDS – 17 (4%), AA – 15 (3,5%), CML – 12 (2,8%), PNH – 11 (2,6%), connective tissue diseases – 5 (1,2%), CLL – 3 (0,7%) and other – 14 (3,2%). The following transplant procedures were performed: ABCT – 213 (49%), ABMT – 3 (0,7%), alloBCT – 56 (13%), alloBMT – 21 (5%), URDBCT – 87 (20%), URDBMT – 51 (12%). Pre-transplant ATG and anti-CD52 antibody were used in 142 (33%) and 5 (1.2%) patients, respectively. Amongst 431 transplanted patients, 495 blood cultures were collected; range 0–8 (median 1). Eighty seven blood samples were positive (17,6%). The following pathogens were detected: gram-positive bacteria in 48% (n=42), gram-negative bacteria in 38% (n=33), fungi in 1% (n=1) and both G(+) and G(−) bacteria in 13%(n=11). The gram-positive bacteria included: Staphylococcus epidermidis: 21 (50%), Micrococcus spp: 4 (9%), Enterococcus faecium: 3 (7%), Enterococcus faecalis: 3 (7%), Streptococcus haemolyticus: 3 (7%). The following gram-negative bacteria were found: Enterobacter cloacae: 10 (30%), Escherichia coli: 7 (21%), Pseudomonas aeruginosa: 5 (15%), Klebsiella pneumonia: 5 (15%). Candida albicans was detected only in one case. The use of ATG was associated with higher number of total blood draw and positive blood cultures. No significant correlation was found between the specific pathogen and the use of ATG. Male gender was associated with significantly higher number of blood sampling and with tendency to higher number of positive blood cultures. The type of conditioning regimen, the source of stem cell and the donor origin (auto vs sibling vs unrelated) did not influence the number of positive blood culture. There was tendency to higher number of blood intake, but not positive blood culture in patients transplanted in NR if compared to PR or CR. Conclusions: Positive blood cultures were positive in about 20% of patients after HSCT. Only pre-transplant ATG use was associated with the higher number of positive blood culture. Disclosures: No relevant conflicts of interest to declare.

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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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“A Four-Leaf Clover” Sign for Rapid Identification of Coagulase-Negative Staphylococci by Gram Staining From Positive Blood Culture: A Cross-Sectional Study

10.21203/rs.3.rs-68398/v1 ◽

2020 ◽

Author(s):

Takahiro Matsuo ◽

Kuniyoshi Hayashi ◽

Aki Sakurai ◽

Masumi Suzuki Shimizu ◽

Masaya Morimoto ◽

...

Keyword(s):

Logistic Regression ◽

Regression Analysis ◽

Blood Culture ◽

Positive Predictive Value ◽

Positive Blood Culture ◽

Predictive Value ◽

Blood Cultures ◽

Coagulase Negative Staphylococci ◽

Gram Staining ◽

Sensitivity Specificity

Abstract Background: Coagulase-negative staphylococci (CoNS) are one of the most common contaminant microorganisms isolated from blood cultures. Few studies exploring the use of Gram staining to distinguish between Staphylococcus aureus (SA) and CoNS have been reported. Here, this study aimed to explore whether morphological features of Gram staining could identify SA or CoNS.Methods: This study was conducted at St. Luke’s International Hospital from November 2016 to September 2017. The positive blood cultures for which the Gram staining showed gram-positive cocci (GPC) in clusters were included in our study. The direct smear of Gram staining obtained from positive blood culture bottles were examined within 24 hours of positivity. We have identified and characterized the following two signs: “four-leaf clover (FLC)” if 4 GPC gathered like a planar four-leaf clover and “grapes” if the GPC gathered like grapes in a three-dimensional form. The number of fields with FLC and grapes signs in 10 fields per slide with ×1,000 power was counted, and the results in a total of 20 fields with ×1,000 power were combined. We performed a logistic regression analysis to assess whether these signs could serve as factors distinguishing between SA and CoNS. The predictive ability of these signs was evaluated based on the sensitivity, specificity, positive predictive value, and negative predictive value for CoNS via receiver operating curve analysis.Results: In total, 106 blood cultures for which Gram staining showed GPC in clusters were examined; 46 (43%) were SA, and 60 (57%) were CoNS samples. The result of multivariate logistic regression analysis showed that the FLC sign was a statistically significant marker of CoNS with an odds ratio of 1.31 (95 % confidential interval (CI): 1.07–1.61, p<0.05). In aerobic bottles, sensitivity, specificity, positive predictive value, and negative predictive value for CoNS were 0.67, 0.91, 0.92, and 0.65, respectively, and the value of area under the curve was 0.79 (95% CI: 0.67–0.91).Conclusions: To our knowledge, this is the first study to show that the FLC could be a rapid and useful indicator to identify CoNS in aerobic bottles. Thus, the presence of FLC sings could help clinicians to suspect the possibility of CoNS before the final identification by cultures.

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