scholarly journals Pseudo-Outbreak ofKlebsiella oxytocaSpontaneous Bacterial Peritonitis Attributed to Contamination of Multidose Vials of Culture Medium Supplement

2014 ◽  
Vol 35 (2) ◽  
pp. 139-143 ◽  
Author(s):  
Federico Perez ◽  
Abhishek Deshpande ◽  
Sirisha Kundrapu ◽  
Andrea M. Hujer ◽  
Robert A. Bonomo ◽  
...  
Keyword(s):  
Blood Culture ◽  
Molecular Typing ◽  
Peritoneal Fluid ◽  
Culture Medium ◽  
Medical Center ◽  
Klebsiella Oxytoca ◽  
Clinical Findings ◽  
Medium Supplement ◽  
Cell Counts ◽  
Laboratory Procedures

Objective.To determine the source of a cluster ofKlebsiella oxytocaisolates cultured from peritoneal fluid of 3 patients with cirrhosis on a single day.Design.Outbreak investigation and before-after study.Setting.A Veterans Affairs medical center.Methods.Epidemiologic investigation, analysis of antimicrobial susceptibility testing results and molecular typing ofK. oxytocaisolates with repetitive sequence-based polymerase chain reaction (rep-PCR), review of microbiology laboratory procedures for processing peritoneal fluid cultures, and comparison of peritoneal fluid contamination rates 18 months before and after modification of laboratory procedures for culturing peritoneal fluid.Results.Each of the peritoneal fluid samples that grewK. oxytocawas inoculated into blood culture bottles by different clinicians at different hospital locations. None of the patients had clinical findings suggestive of peritonitis or elevated polymorphonuclear cell counts in peritoneal fluid (range, 3-25 cells/μL). Molecular typing with rep-PCR demonstrated that theK. oxytocaisolates were genetically related (greater than 95% similarity). Laboratory procedures included the routine addition of a culture medium supplement of yeast extract and dextrose from a multidose vial into blood culture bottles with peritoneal fluid. After discontinuing use of the culture medium supplement, there was a marked reduction in the number of peritoneal fluid cultures deemed as contaminants (14.3% vs 0.9%;P<.001).Conclusion.A pseudo-outbreak ofK. oxytocaperitonitis and high rates of contamination of peritoneal fluid were attributable to contamination of a multidose culture medium supplement. This article highlights the importance of discouraging the use of multidose vials in all clinical settings.

Pseudo-outbreak ofBrevundimonas diminutaAttributed to Contamination of Culture Medium Supplement

2017 ◽  
Vol 38 (5) ◽  
pp. 598-601 ◽  
Author(s):  
Rachael A. Lee ◽  
Stephen A. Moser ◽  
Martha Long ◽  
Susan L. Butler ◽  
Jennifer F. Whiddon ◽  
...  
Keyword(s):  
Molecular Typing ◽  
Culture Medium ◽  
Infect Control Hosp ◽  
Epidemiological Investigation ◽  
Medium Supplement ◽  
Brevundimonas Diminuta

We report an epidemiological investigation of a cluster ofBrevundimonas diminutaisolates cultured from sterile sites. Inoculation of supplement medium yielded growth ofB. diminuta. Molecular typing indicated likely contamination of the lot. NoB. diminutawas further isolated after replacement of the supplement with a new lot number.Infect Control Hosp Epidemiol2017;38:598–601

scholarly journals Pituitary abscess in an HIV-1-infected patient

2017 ◽  
Vol 5 ◽  
pp. 2050313X1770137
Author(s):  
Hiroyuki Yamazaki ◽  
Masayuki Kobayashi ◽  
Anamaria Daniela Sarca ◽  
Akifumi Takaori-Kondo
Keyword(s):  
Central Nervous System Infection ◽  
Clinical Findings ◽  
Endocrine Function ◽  
Visual Field Defects ◽  
Magnetic Resonance Imaging Scan ◽  
Pituitary Abscess ◽  
Laboratory Findings ◽  
Cell Counts ◽  
Disturbance Of Consciousness ◽  
Hiv 1

Objectives: Pituitary abscess is a rare occurrence among pituitary conditions, but one which carries life-threatening potential. An immunocompromised status is a risk factor for the development of a pituitary abscess; however, literature describes only one case among HIV-infected patients. Methods and results: We present here a case of pituitary abscess in an HIV-1-positive patient, who demonstrated a shock status, disturbance of consciousness and generalized skin rash with laboratory findings of hypovolemia, acute inflammatory reaction and blood electrolyte abnormality. We first diagnosed the dermal manifestation as atypical generalized zoster, however, the other clinical findings could not be explained by VZV infection only. Combination with anamnesis, head magnetic resonance imaging scan and endocrine function test helped us to diagnose pituitary abscess. Although the etiology of the pituitary abscess could not be detected, the patient was successfully treated with antibiotics but followed by panhypopituitarism as sequela. Conclusion: A pituitary abscess should be considered in HIV-infected patients with endocrinological abnormalities, visual field defects, and central nervous system infection signs or symptoms, regardless of CD4 T-cell counts.

scholarly journals 301. Penicillin Versus Cefazolin or Anti-staphylococcal Penicillins for Penicillin-Susceptible Staphylococcus aureus Bacteremia

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S149-S149
Author(s):  
Mohammed Aldhaeefi ◽  
Jeffrey Pearson ◽  
Sanjat Kanjilal ◽  
Brandon Dionne
Keyword(s):  
Staphylococcus Aureus ◽  
Blood Culture ◽  
Positive Blood Culture ◽  
Medical Center ◽  
Academic Medical Center ◽  
Similar Distribution ◽  
Clinical Failure ◽  
Staphylococcus Aureus Bacteremia ◽  
Definitive Therapy ◽  
Significant Difference

Abstract Background Staphylococcus aureus bacteremia is a significant cause of mortality. Penicillin (PCN) may have a role in the treatment of penicillin-susceptible Staphylococcus aureus (PSSA) bacteremia as it has a narrower spectrum of activity than cefazolin and is better tolerated than antistaphylococcal penicillins (ASPs). The aim of this study is to evaluate the safety and effectiveness of PCN versus cefazolin or ASPs in the treatment of PSSA bacteremia. Methods This is a single-center, retrospective study at a tertiary academic medical center. All patients with a PSSA blood culture from January 1, 2012 to September 1, 2019 were screened. Patients were excluded if they were treated with a definitive antibiotic (defined as antimicrobial therapy received 72 hours after positive blood culture) other than the study comparators, or if they received combination antibiotic therapy &gt;72 hours from the initial positive blood culture result. The primary outcome was 60-day clinical failure, which was a composite endpoint of change in antibiotic after 72 hours of definitive therapy, recurrence of PSSA bacteremia, infection-related readmission, or all-cause mortality. Results Of 277 patients with PSSA bacteremia, 101 patients were included in the study; 62 (61%) were male and 11 (11%) had a β-lactam allergy. At baseline, 40 patients (40%) had hardware, 25 (25%) had an intravenous line, 6 (6%) were on dialysis, and 4 (4%) had active IV drug use, with similar distribution across antibiotic groups. Penicillin was the most common antibiotic used (Table 1). There was a significant difference among groups with respect to the 60-day clinical failure (log-rank p=0.019). In terms of unadjusted 60-day clinical failure, penicillin had similar outcomes to cefazolin (95% CI -0.29 to 0.104, p=0.376), however, it had statistically significant better outcomes in comparison to the ASPs, nafcillin or oxacillin (95% CI 0.023 to 0.482, p=0.031) (Table 1). Table 1. 60-day outcomes of PSSA bacteremia Conclusion Penicillin is effective and safe in the treatment of PSSA bacteremia and may be preferable to antistaphylococcal penicillins Disclosures All Authors: No reported disclosures

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

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&lt;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

Evaluation of the new improved BHI-lysis blood culture medium for the BCB roche system

1991 ◽  
Vol 10 (8) ◽  
pp. 620-624 ◽  
Author(s):  
P. Rohner ◽  
H. Burkardt ◽  
H. Dreismann ◽  
R. Auckenthaler
Keyword(s):  
Blood Culture ◽  
Culture Medium

EARLY MANIFESTATIONS OF THE CARDIOVASCULAR DISORDERS IN MARFAN SYNDROME

PEDIATRICS ◽  
1961 ◽  
Vol 27 (2) ◽  
pp. 255-268
Author(s):  
A. C. Papaioannou ◽  
M. H. Agustsson ◽  
B. M. Gasul
Keyword(s):  
Marfan Syndrome ◽  
Venous Return ◽  
Heart Defects ◽  
Main Pulmonary Artery ◽  
Clinical Findings ◽  
Early Age ◽  
Cardiac Lesions ◽  
Laboratory Procedures ◽  
General Aspects ◽  
Cardiac Catheterizations

We have studied four children varying in age from 5 months to 26 months with typical features of Marfan syndrome. Aside from the routine clinical and laboratory procedures, phonocardiograms, cardiac catheterizations, angiocardiograms and retrograde aortograms were performed. All patients had demonstrable aneurysms of the aortic sinuses of Valsalva and dilatation of the ascending aorta and of the main pulmonary artery. One case had a partial anomalous venous return to the innominate vein. The phonocardiograms demonstrated accentuated pulmonic closures, mid or late systolic murmurs and in one case an apical pansystolic murmur. The anomalies found at necropsy in one infant at the age of 12 days and other congenital heart defects in three older patients are reported. The general aspects of the disease are discussed and a review of the associated cardiac lesions in previously reported cases is presented. Attention is called to the minimal clinical findings of serious underlying cardiac lesions at a very early age, which can only be demonstrated by angiocardiography and retrograde aortography. To our knowledge these are the youngest patients in whom these cardiovascular lesions were demonstrated during life.

scholarly journals Evidence-based Implementation of Free Phenytoin Therapeutic Drug Monitoring

2000 ◽  
Vol 46 (8) ◽  
pp. 1132-1135 ◽  
Author(s):  
Martha Burt ◽  
David C Anderson ◽  
Julie Kloss ◽  
Fred S Apple
Keyword(s):  
Therapeutic Drug Monitoring ◽  
Drug Monitoring ◽  
Medical Center ◽  
Clinical Findings ◽  
Therapeutic Monitoring ◽  
Therapeutic Drug ◽  
Clinical Indicator ◽  
Interindividual Variations ◽  
Data Points ◽  
Pharmacologically Active

Abstract Background: The majority of laboratories measure total phenytoin concentration for therapeutic drug monitoring. However, there are substantial interindividual variations in free phenytoin concentrations, the pharmacologically active component. Methods: We describe the process and data used to implement monitoring of free phenytoin only in an urban medical center. Over a 6-week period, total and free phenytoin concentrations were measured, clinical charts reviewed, and indications for alterations in the percentage of free phenytoin fraction were determined. Results: Of the 189 phenytoin requests from 139 patients, 136 data points were analyzed. Free phenytoin concentrations were 6.8–35.3%, with 50% outside the expected range of 8–12%. Clinical indications likely responsible for variations were hypoalbuminemia, drug interactions, uremia, pregnancy, and age. Overall, 30% of patients demonstrated a discrepancy between therapeutic, subtherapeutic, or supratherapeutic concentrations between free and total phenytoin concentrations. The largest discordance (53%) occurred in the patient group with free phenytoin &lt;8% or &gt;12%. Conclusions: This study supports previous clinical findings that monitoring total phenytoin is not as reliable as free phenytoin as a clinical indicator for therapeutic and nontherapeutic concentrations. Thus, we recommend that therapeutic monitoring should use free phenytoin concentrations only.

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