scholarly journals A retrospective analysis of community-onset bloodstream infections at a tertiary-care academic hospital in South Africa. Are current empiric antimicrobial practices appropriate?

2021 ◽  
Vol 1 (1) ◽  
Author(s):  
Vinitha Alex ◽  
Trusha Nana ◽  
Vindana Chibabhai
Keyword(s):  
South Africa ◽  
Blood Culture ◽  
Antimicrobial Agents ◽  
Tertiary Care ◽  
Laboratory Data ◽  
Blood Cultures ◽  
Contamination Rate ◽  
Older Children ◽  
Academic Hospital ◽  
Community Onset

Abstract Background: Community-onset bloodstream infection (CO-BSI) is associated with substantial morbidity and mortality. Knowledge of locally prevalent pathogens and antimicrobial susceptibility patterns can promptly guide appropriate empiric therapy and improve outcomes. Objectives: We sought to determine the epidemiology of CO-BSI, the blood culture positivity rate and the contamination rate. We also sought to establish appropriateness of current empiric antimicrobial therapy practices. Methods: We retrospectively analyzed blood cultures taken from January 2015 to December 2019 at the emergency departments (EDs) of a tertiary-care academic hospital in South Africa using extracted laboratory data. Results: The overall positivity rate of blood cultures taken at the EDs was 15% (95% confidence interval [CI], 0.15–0.16) and the contamination rate was 7% (95% CI, 0.06–0.07). Gram-positive bacteria predominated in the pediatric cohort: neonates, 52 (54%) of 96; infants, 57 (52%) of 109; older children, 63 (61%) of 103. Methicillin-susceptible Staphylococcus aureus was the predominant pathogen among older children: 30 (35%) of 85. Escherichia coli was the most common pathogen isolated among adults and the elderly: 225 (21%) of 1,060 and 62 (29%) of 214, respectively. Among neonates, the susceptibility of E. coli and Klebsiella pneumoniae to the combination of ampicillin and gentamicin was 17 (68%) of 25. Among adults, the susceptibility of the 5 most common pathogens to amoxicillin-clavulanate was 426 (78%) of 546 and their susceptibility to ceftriaxone was 481 (85%) of 565 (P = .20). The prevalence of methicillin-resistant S. aureus, extended-spectrum β-lactamase–producing and carbapenem-resistant Enterobacterales were low among all age groups. Conclusions: Review of blood culture collection techniques is warranted to reduce the contamination rate. High rates of resistance to currently prescribed empiric antimicrobial agents for CO-BSI warrants a re-evaluation of local guidelines.

scholarly journals Blood Culturing Practices at an Academic Medical Center

2020 ◽  
Vol 41 (S1) ◽  
pp. s142-s143
Author(s):  
Priya Sampathkumar ◽  
Kyle Rodino ◽  
Stacy (Tram) Ung
Keyword(s):  
Blood Culture ◽  
Care Center ◽  
Academic Medical Center ◽  
Tertiary Care ◽  
Central Line ◽  
Blood Cultures ◽  
High Rate ◽  
Contamination Rate ◽  
Blood Samples ◽  
Central Lines

Background: Blood cultures are part of the evaluation of hospital patients with fever. Patients with central lines in place, frequently have blood samples for culture drawn through lines. We sought to assess blood culturing practices at our institution. Methods: Retrospective review of BCs performed in hospitalized patients over a 12-month period (August 2018–July 2019) at an academic, tertiary-care center with 1,297 licensed beds and >62,000 admissions a year. A specialized phlebotomy team is involved in all peripherally drawn blood samples; however, the patient’s nurse obtains a blood sample through a central line. Results: Overall, 35,121 blood cultures were performed for an incidence rate of 106 BC per 1,000 patient days or 566 blood cultures per 1,000 admissions. Most blood samples (67%) were collected via peripheral venipuncture. We detected significant variation in culturing rates and the proportion of blood samples obtained through central lines among collecting units (Table 1). Overall, the blood culture contamination rate was 1.6%. Blood samples obtained through a central line had a higher contamination rate (2.2%) compared to samples obtained through peripheral venipuncture (1.3%; P < .0001). Blood culture rates were highest in intensive care units (ICUs) compared with other types of patient care units (Table 1). The blood culture positivity rate was significantly lower in ICUs (8.8%) compared with hematology-oncology (10%; HR, 0.88; CI, 0.80–0.96; P = .006), general medicine (10%; HR, 0.88; CI, 0.80–0.97; P = .013), and pediatrics (12%; HR, 0.74; CI, 0.59–0.92; P = .008). The ICUs had the lowest rate of BC contamination at 1.3%. Conclusions: Blood samples obtained through central lines for culture are more likely to be contaminated than peripherally drawn blood samples. Despite a relatively high rate of line-drawn blood samples for culture, ICUs had the lowest BC contamination rate, possibly reflecting high familiarity of ICU nurses with line draws. Blood samples collected through lines were most frequently performed in pediatrics and hematology-oncology, and these units had correspondingly higher rates of contamination. This information will be used to inform institutional guidelines on blood culturing and to identify ways to minimize blood culture contamination, which often results in additional testing and/or unnecessary antimicrobial use.Funding: NoneDisclosures: Consulting fee- Merck (Priya Sampathkumar)

Risk factors and clinical outcomes associated with blood culture contamination

2021 ◽  
pp. 1-7
Author(s):  
Justin M. Klucher ◽  
Kevin Davis ◽  
Mrinmayee Lakkad ◽  
Jacob T. Painter ◽  
Ryan K. Dare
Keyword(s):  
Risk Factors ◽  
Logistic Regression ◽  
Blood Culture ◽  
Hospital Mortality ◽  
Clinical Outcomes ◽  
Tertiary Care ◽  
Blood Cultures ◽  
Hospital Charges ◽  
Patient Specific ◽  
Contaminated Blood

Abstract Objective: To determine patient-specific risk factors and clinical outcomes associated with contaminated blood cultures. Design: A single-center, retrospective case-control risk factor and clinical outcome analysis performed on inpatients with blood cultures collected in the emergency department, 2014–2018. Patients with contaminated blood cultures (cases) were compared to patients with negative blood cultures (controls). Setting: A 509-bed tertiary-care university hospital. Methods: Risk factors independently associated with blood-culture contamination were determined using multivariable logistic regression. The impacts of contamination on clinical outcomes were assessed using linear regression, logistic regression, and generalized linear model with γ log link. Results: Of 13,782 blood cultures, 1,504 (10.9%) true positives were excluded, leaving 1,012 (7.3%) cases and 11,266 (81.7%) controls. The following factors were independently associated with blood-culture contamination: increasing age (adjusted odds ratio [aOR], 1.01; 95% confidence interval [CI], 1.01–1.01), black race (aOR, 1.32; 95% CI, 1.15–1.51), increased body mass index (BMI; aOR, 1.01; 95% CI, 1.00–1.02), chronic obstructive pulmonary disease (aOR, 1.16; 95% CI, 1.02–1.33), paralysis (aOR 1.64; 95% CI, 1.26–2.14) and sepsis plus shock (aOR, 1.26; 95% CI, 1.07–1.49). After controlling for age, race, BMI, and sepsis, blood-culture contamination increased length of stay (LOS; β = 1.24 ± 0.24; P < .0001), length of antibiotic treatment (LOT; β = 1.01 ± 0.20; P < .001), hospital charges (β = 0.22 ± 0.03; P < .0001), acute kidney injury (AKI; aOR, 1.60; 95% CI, 1.40–1.83), echocardiogram orders (aOR, 1.51; 95% CI, 1.30–1.75) and in-hospital mortality (aOR, 1.69; 95% CI, 1.31–2.16). Conclusions: These unique risk factors identify high-risk individuals for blood-culture contamination. After controlling for confounders, contamination significantly increased LOS, LOT, hospital charges, AKI, echocardiograms, and in-hospital mortality.

scholarly journals Antimicrobial Stewardship Standards and Patient Safety: A Case Study in Blood Culture Contamination

2021 ◽  
Vol 1 (S1) ◽  
pp. s36-s36
Author(s):  
Connie Schaefer
Keyword(s):  
Blood Culture ◽  
Healthcare System ◽  
Antimicrobial Stewardship ◽  
Standard Method ◽  
Broad Spectrum ◽  
Emergency Departments ◽  
Blood Cultures ◽  
Contamination Rate ◽  
Broad Spectrum Antibiotics ◽  
Contamination Events

Background: Blood culture is a crucial diagnostic tool for healthcare systems, but false-positive results drain clinical resources, imperil patients with an increased length of stay (and associated hospital-acquired infection risk), and undermine global health initiatives when broad-spectrum antibiotics are administered unnecessarily. Considering emerging technologies that mitigate human error factors, we questioned historically acceptable rates of blood culture contamination, which prompted a need to promote and trial these technologies further. In a 3-month trial, 3 emergency departments in a midwestern healthcare system utilized an initial specimen diversion device (ISDD) to draw blood cultures to bring their blood culture contamination rate (4.4% prior to intervention) below the 3% benchmark recommended by the Clinical & Laboratory Standards Institute. Methods: All emergency department nursing staff received operational training on the ISDD for blood culture sample acquisition. From June through August 2019, 1,847 blood cultures were drawn via the ISDD, and 862 were drawn via the standard method. Results: In total, 16 contamination events occurred when utilizing the ISDD (0.9%) and 37 contamination events occurred when utilizing the standard method (4.3%). ISDD utilization resulted in an 80% reduction in blood culture contamination from the rate of 4.4% rate held prior to intervention. Conclusions: A midwestern healthcare system experienced a dramatic reduction in blood culture contamination across 3 emergency departments while pilot testing an ISDD, conserving laboratory and therapeutic resources while minimizing patient exposure to unnecessary risks and procedures. If the results obtained here were sustained and the ISDD utilized for all blood culture draws, nearly 400 contamination events could be avoided annually in this system. Reducing unnecessary antibiotic use in this manner will lower rates of associated adverse events such as acute kidney injury and allergic reaction, which are possible topics for further investigation. The COVID-19 pandemic has recently highlighted both the importance of keeping hospital beds available and the rampant carelessness with which broad-spectrum antibiotics are administered (escalating the threat posed by multidrug-resistant organisms). As more ambitious healthcare benchmarks become attainable, promoting and adhering to higher standards for patient care will be critical to furthering an antimicrobial stewardship agenda and to reducing treatment inequity in the field.Funding: NoDisclosures: None

Reducing the Contamination Rate and the Unnecessary Requesting of Blood Culture Test through Quality Improvement Project

2021 ◽  
Vol 30 (1) ◽  
pp. 87-91
Author(s):  
Tamer Mohamed ◽  
Ashraf A Askar ◽  
Jamila Chahed
Keyword(s):  
Quality Improvement ◽  
Blood Culture ◽  
Armed Forces ◽  
Blood Cultures ◽  
Quality Improvement Project ◽  
Contamination Rate ◽  
Improvement Project ◽  
Culture Test ◽  
Negative Results ◽  
Before And After

Background: Blood stream infections are major leading causes of morbidity and mortality in hospitalized patients. Increasing the awareness of the clinicians and nurses about the proper protocol of blood culture test is very important in reducing the contamination rate and the unnecessary requesting of blood culture. Objectives: to reduce the contamination rate and the unnecessary requesting of blood culture from different departments through implementation of hospital wide Quality Improvement Project (QIP). Methodology: Blood cultures were tested in the Microbiology Laboratory of Najran Armed Forces hospital, Saudi Arabia, in the period from June 2019 to July 2020 and their results were compared before and after the implementation of the QIP. Results: The comparison between the blood cultures results before and after QIP implementation showed statistically significant (19.6%) reduction in the contamination rate, (14%) reduction in the total number of blood culture requests and (11.6%) reduction in the negative results rate. Conclusion: The reduction in the total number, negative results and contamination rate of blood culture test after QIP implementation were considered as performance indicators that the recommendations of QIP were effective and implemented strictly.

Blood Culture Contamination in the Clinical Microbiology Laboratory of a Teaching Hospital

2019 ◽  
Vol 152 (Supplement_1) ◽  
pp. S133-S133
Author(s):  
Kemin Xu ◽  
Sarwat Gilani ◽  
Hank Wang ◽  
John Fallon
Keyword(s):  
Blood Culture ◽  
Teaching Hospital ◽  
Clinical Microbiology ◽  
Diagnostic Errors ◽  
Blood Cultures ◽  
Bacillus Species ◽  
Contamination Rate ◽  
Clinical Microbiology Laboratory ◽  
Current Guideline ◽  
Tertiary Teaching

Abstract Objectives Blood culture is one of the most important tests performed in clinical microbiology laboratories. However, blood culture contamination remains a problematic cause of diagnostic errors for laboratory diagnosis and patient management. This aim of this study was to determine blood culture contamination rates and tendency at Westchester Medical Center (WMC), a tertiary teaching hospital in suburban New York City. Methods All blood culture tests at WMC received from January 2017 to December 2018, as well as some historical data from 2007 to 2014, were retrospectively retrieved. Blood culture contamination rates were determined according to the laboratory’s predefined criteria. Results From 2007 to 2014, a total of 209,750 blood cultures were performed with an average contamination rate of 1.6% (ranging from 0.4% to 3.5% monthly). The total numbers of blood cultures performed in 2017 and 2018 were 27,863 and 28,047, respectively. The overall positive rate of blood culture was 6.8% in 2017 and 7.6% in 2018. The contamination rate of blood culture was 0.6% in 2017 and 0.9% in 2018 with very few variations among different months of the year, which was significantly lower than that of the national benchmark (~2.5%) on blood culture contamination. The majority of contaminants were Staphylococcus epidermidis, accounting for 87% of source contamination, followed by Corynebacterium species (5.5%), Bacillus species and Micrococcus species (3.5% each), and Propionibacterium species (0.5%). Conclusion Adherence to current guideline on appropriate blood collection techniques and monthly monitoring and timely feedback to phlebotomists should be continued to keep a low contamination rate for blood culture, which is not only from the perspective of individual patient care but also from the standpoint of hospital epidemiology and public health.

scholarly journals HIV-Associated Mycobacterium tuberculosis Bloodstream Infection Is Underdiagnosed by Single Blood Culture

2018 ◽  
Vol 56 (5) ◽  
Author(s):  
David A. Barr ◽  
Andrew D. Kerkhoff ◽  
Charlotte Schutz ◽  
Amy M. Ward ◽  
Gerry R. Davies ◽  
...  
Keyword(s):  
South Africa ◽  
Mycobacterium Tuberculosis ◽  
Blood Culture ◽  
Confidence Interval ◽  
Bloodstream Infection ◽  
Diagnostic Yield ◽  
Blood Cultures ◽  
Prospective Evaluation ◽  
Content Type ◽  
Time Point

ABSTRACT We assessed the additional diagnostic yield for Mycobacterium tuberculosis bloodstream infection (BSI) by doing more than one tuberculosis (TB) blood culture from HIV-infected inpatients. In a retrospective analysis of two cohorts based in Cape Town, South Africa, 72/99 (73%) patients with M. tuberculosis BSI were identified by the first of two blood cultures during the same admission, with 27/99 (27%; 95% confidence interval [CI], 18 to 36%) testing negative on the first culture but positive on the second. In a prospective evaluation of up to 6 blood cultures over 24 h, 9 of 14 (65%) patients with M. tuberculosis BSI had M. tuberculosis grow on their first blood culture; 3 more patients (21%) were identified by a second independent blood culture at the same time point, and the remaining 2 were diagnosed only on the 4th and 6th blood cultures. Additional blood cultures increase the yield for M. tuberculosis BSI, similar to what is reported for nonmycobacterial BSI.

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

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.

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

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

scholarly journals A study of surgical site infections in a tertiary care hospital

2019 ◽  
Vol 6 (11) ◽  
pp. 3911 ◽  
Author(s):  
Ayush Jain ◽  
Anuradha Tolpadi ◽  
Bhupendra Chaudhary ◽  
Ansh Chaudhary ◽  
Ankita Misra
Keyword(s):  
Nosocomial Infections ◽  
Antimicrobial Agents ◽  
Tertiary Care Hospital ◽  
Tertiary Care ◽  
Laboratory Data ◽  
Surgical Site Infections ◽  
Health Concern ◽  
Care Hospital ◽  
Duration Of Surgery ◽  
Common Causes

Background: Health care-associated infections remain as an important public health concern. Surgical site infections (SSIs) are known to be one of the most common causes of nosocomial infections worldwide.Methods: A prospective observational study was conducted across 12 months (May 2018-April 2019) in a tertiary care hospital. The present study includes 223 patients who were undergoing clean and clean contaminated surgery in the hospital. Contaminated and dirty surgeries were excluded. The demographic data of the patient, diagnostic criteria used, associated risk factors, use of prophylactic antimicrobial agents, the type and duration of surgery, clinical evaluation of wound and laboratory data was collected. All the pus samples or wound swabs of clinically suspects of SSI cases received in the Department of Microbiology were inoculated and interpreted according to Centre for Disease Control and Infection guidelines.Results: The study included 223 patients who underwent surgery in the hospital. Amongst them 9 (4%) developed SSI. The incidence of SSI was 4.03%. There was a direct relationship observed between the occurrence of SSI and certain co-morbid conditions such as diabetes. It was also observed that prolonged surgeries above two hours and females were more predisposed to develop a surgical site infection.Conclusions: SSIs being one of the most common causes of nosocomial infections. It was also the most important factor responsible for significant morbidity, mortality, unwanted prolonged hospitalization and additional cost of treatment in surgical patients which can be reduced by strictly following the guidelines of infection control along with judicious and rational use of antibiotics.

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