scholarly journals Limited Clinical Utility of Follow-up Blood Cultures in Patients With Streptococcal Bacteremia: An Opportunity for Blood Culture Stewardship

2020 ◽  
Vol 7 (12) ◽  
Author(s):  
Emily A Siegrist ◽  
Minkey Wungwattana ◽  
Leyla Azis ◽  
Patricia Stogsdill ◽  
Wendy Y Craig ◽  
...  
Keyword(s):  
Blood Culture ◽  
Clinical Utility ◽  
Epidural Abscess ◽  
Vertebral Osteomyelitis ◽  
Blood Cultures ◽  
Inclusion Criteria ◽  
Streptococcal Species ◽  
Persistent Bacteremia ◽  
Polymicrobial Bacteremia

Abstract Background The value of positive follow-up blood cultures (FUBCs) in streptococcal bacteremia has not been well defined. Therefore, we explored the frequency of and risk factors for positive FUBC in a retrospective cohort of patients with streptococcal bacteremia. Methods Adults ≥18 years of age, admitted with at least 1 positive blood culture for Streptococcus spp between 2013 and 2018 followed by at least 1 FUBC, were potentially eligible. Positive FUBCs were defined as cultures positive for the same streptococcal species drawn >24 hours after the index culture. We excluded patients with polymicrobial bacteremia. We compared the characteristics of patients with and without a positive FUBC. Results In our single-center cohort, we identified 590 patients with streptococcal bacteremia, and 314 patients met inclusion criteria. Ten patients had FUBC with Streptococcus spp (3.2%), 4 (1.3%) had a contaminant identified, and 3 (1.0%) had a new pathogen isolated. Endocarditis (5 of 10 [50.0%] vs 35 of 304 [11.5%]), epidural abscess (2 of 10 [20%] vs 4 of 304 [1.3%]), and discitis or vertebral osteomyelitis (3 of 10 [30.0%] vs 14 of 304 [4.6%]) were associated with positive FUBC. Patients with positive FUBC had a longer median length of stay (12.9 vs 7.1 days, P = .004) and longer duration of antibiotic treatment (14.9 vs 43.2 days, P = .03). Conclusions Follow-up blood cultures among patients with streptococcal BSI are rarely positive. Clinicians could consider limiting follow-up blood cultures in patients at low risk for deep-seated streptococcal infections, persistent bacteremia, or endovascular infection.

Bacteremia With Otitis Media

PEDIATRICS ◽  
1991 ◽  
Vol 87 (1) ◽  
pp. 48-53 ◽  
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.

Investigation of aStreptococcus viridansPseudobacteremia Epidemic at a University Teaching Hospital

1989 ◽  
Vol 10 (9) ◽  
pp. 416-421 ◽  
Author(s):  
Deirdre L. Church ◽  
Heather E. Bryant
Keyword(s):  
Blood Culture ◽  
Teaching Hospital ◽  
Index Finger ◽  
Blood Cultures ◽  
University Teaching ◽  
Large Teaching Hospital ◽  
Disproportionate Number ◽  
Good Concordance ◽  
Contaminated Blood

AbstractFor several months in 1986, an outbreak of Streptococcus viridanspseudobacteremia occurred at a large teaching hospital. All sources of laboratory blood culture contamination were excluded. A retrospective epidemiological study indicated that one phlebotomist, “P,” collected a disproportionate number of the positive blood cultures. Further comparison of the paired blood culture results from the three months when the incidence was highest revealed a good concordance of results among all other phlebotomists (Kappa = 0.5), while P's results concurred with others less frequently than would be expected even by chance (Kappa < 0.0). Clinical follow-up showed that P did not routinely wear gloves while drawing blood and had eczema of the hands. Skin scrapings from the hands, right index finger/fingernail grew predominantlyS viridansspecies that were compatible with those recovered from contaminated blood cultures. This epidemic demonstrated the need for early detection of this source as a cause of nosocomial pseudobacteremia.

scholarly journals 332. Spinal Infections: Clinical and Microbiological Characteristics in our Urban Referral Health Center

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S237-S238
Author(s):  
Osakpolor Ogbebor ◽  
Rasha Abdulmassih ◽  
James D Como ◽  
Nitin Bhanot
Keyword(s):  
Epidural Abscess ◽  
Vertebral Osteomyelitis ◽  
Positive Culture ◽  
Data Retrieval ◽  
Blood Cultures ◽  
Ct Guided ◽  
Microbiological Characteristics ◽  
Pathogen Recovery ◽  
Culture Positive ◽  
Spinal Infections

Abstract Background There has been an increasing trend in spinal infections (SI) in the U.S. over recent years. We sought to characterize the clinical and microbiological characteristics of SI at our hospital. Methods We conducted a retrospective review of SI over a 3-year period (2016 - 2019) utilizing ICD codes for data retrieval. Search terms included vertebral osteomyelitis, discitis, and epidural abscess. SPSS was used to compute the data. Results Of the initially screened 254 patients, 166 were included for analysis. Pertinent demographics were: mean age 59 years, male (61.4%), obese (44.5%), diabetic (25%), and drug-users (20%). Lumbosacral involvement was most common (69.8%); epidural abscess was present in 51.8% of patients. 15.7% had existing hardware. Overall, 79.5% (132/166) of cases had a positive culture from at least one site: blood 56.6% (94/166), CT-guided 83.5% (56/67), and surgical 51.1% (24/47). Of those patients with negative blood cultures, 22% (16/72) had pathogen recovery by CT-guided methods and 33% (24/72) from surgical specimens. S aureus was the most common pathogen isolated at 53.7% (71/132): MSSA comprised 38.6% (51/132) and MRSA 15.2% (20/132). The mean CRP (8.46 vs 15.83 mg/dL; P&lt; 0.001), and WBC (9.08 vs 13.18 k/mcL; P&lt; 0.001) were higher in culture-positive as compared to culture-negative cases. Mean ESR and temperature more than 100.4 oF did not differ significantly between these two groups. The 8-week median recurrence rate was 11.4%, of which nearly half had index S aureus bacteremia. Frequency of organisms isolated Association of mean inflammatory markers with positive cultures Conclusion Our study affirmed that S aureus is the most common cause of SI, of which MSSA was predominant. Epidural abscess was encountered in a substantial fraction of our case population. Leukocytosis and elevated CRP tended to predict culture-positive infection, whereas ESR and fever did not. As recommended in the IDSA Vertebral Osteomyelitis guidelines, blood cultures were obtained in all cases, which yielded positive results in more than half of patients. Pathogen recovery was further improved to nearly 80% with supplemental deep tissue sampling, thus highlighting the opportunity to enhance microbiological diagnosis at our institution. Disclosures All Authors: No reported disclosures

scholarly journals Exophiala Dermatitidis Isolated From Blood In Patient With Steroid Use

2020 ◽  
Vol 154 (Supplement_1) ◽  
pp. S154-S155
Author(s):  
N Yurtsever ◽  
P Dougherty ◽  
S Condon ◽  
R Orsini ◽  
M Berman ◽  
...  
Keyword(s):  
Blood Culture ◽  
Positive Culture ◽  
Blood Cultures ◽  
Chronic Obstructive ◽  
Invasive Infection ◽  
Steroid Use ◽  
Obstructive Pulmonary Disease ◽  
Exophiala Dermatitidis ◽  
Asymptomatic Patients

Abstract Casestudy Exophiala dermatitidis is a dematiaceous mold that is associated with subcutaneous, central nervous system and pulmonary infections; osteomyelitis; and disseminated disease. Isolation of E. dermatitidis from patients with mild symptoms may be difficult to interpret whether is a contaminant or asymptomatic patient with serious infection. However, it is important to diagnose asymptomatic patients early in the stage because of up to 25% mortality rate. Results 77-year-old male with history of chronic obstructive pulmonary disease presented to his pulmonologist with cough. He was started on azithromycin and steroids. His cough worsened and he was transitioned to levofloxacin with continuation of steroid treatment. In addition, he developed fatigue, weakness, poor appetite, chills and nights sweat along with some urinary complaints. His chest X-ray showed infiltrates and he was diagnosed with left lower lung pneumonia and urinary tract infection and was treated with doxycycline and ciprofloxacin. Blood cultures were drawn. Additional past medical history was not significant. Blood culture became positive on day 4 of incubation. Gram stain showed yeast-like cells, but the blood culture multiplex PCR was negative. Serum cryptococcus antigen was negative. Three days later, a dark shiny olive-colored colony with dark obverse side was isolated. It grew at 42 C. Microscopic examination revealed hyaline and pigmented hyphae with brown conidia. It was identified as Exophiala dermatitidis and confirmed by the state public health laboratory. Blood cultures drawn after hospital admission remained negative. Patient’s symptoms improved with antibiotic treatment. Therefore the clinicians believed that the E. dermatitidis was a probable contaminant and patient was discharged with follow-up. During the follow-up process he developed respiratory infection with Coronavirus (HKU1, NL63, 229E, OC43). Follow-up continues. Conclusion Blood cultures are not sensitive for mold infection especially for an uncommon contaminant like E. dermatitidis, it may be difficult to decide whether a positive culture is a real result or not. Fungal antigen tests such as beta-D-glucan test may be helpful in distinguishing between invasive infection and contaminant. Additionally, we believe that in our case, steroid use could have caused a temporary immunosuppression and led to Exophiala dermatitidis infection.

scholarly journals 103. An Association Between Abnormal CSF Analysis and Inpatient Mortality in Cryptococcal Meningitis, a Tertiary Care Center Experience

2021 ◽  
Vol 8 (Supplement_1) ◽  
pp. S65-S65
Author(s):  
Jordan Resnick ◽  
Emad A Chishti ◽  
Mahesh Bhatt ◽  
Thein Myint
Keyword(s):  
Blood Culture ◽  
Cryptococcal Meningitis ◽  
Care Center ◽  
Tertiary Care ◽  
Blood Cultures ◽  
Tertiary Care Center ◽  
Inclusion Criteria ◽  
Inpatient Mortality ◽  
Csf Analysis ◽  
Survivor Group

Abstract Background Cryptococcal meningitis (CM) is a life-threatening condition that requires prompt recognition and management. With high morbidity in mind, we elected to compare the key CSF analysis, blood culture and serum cryptococcal antigen (CrAg) to prognosticate the probability of mortality in this population. Table 1. Comparison of demographics, serum and CSF analysis Methods We retrospectively reviewed all charts of patients admitted to our tertiary care center from 10/2005 to 10/2017. Inclusion criteria encompassed patients with positive CSF CrAg, positive CSF cultures, India ink, cytopathology, or CSF cell count &gt;5 with CNS symptoms, positive serum CrAg titer or blood cultures. Results Sixty patients who met the inclusion criteria were divided into the survivor (n=41) and the non-survivor (n=19) groups based on the inpatient mortality. There was no difference in age, sex, and immune status between the two groups. The median CSF nucleated cell counts in the non-survivor group was 39 cells/µL with median lymphocyte 59.5% whereas in the survivor group was 72 cells/µL with median lymphocyte 76% (P&lt; 0.001 and 0.04 respectively). The median CSF glucose was 27 mg/ml in the non-survivor compared to 35 mg/ml in the survivor group (P=0.02). Median CSF CrAg was higher at 1:1024 in the non-survivor group whereas the survivor group was 1:256 (P &lt; 0.01). CSF opening pressure (cm H2O), blood culture, and serum CrAg level were not statistically significant between the two groups. Conclusion Low CSF cell count, low glucose, and high CSF CrAg were independently associated with inpatient mortality in CM. This is in line with the prior findings. A novel finding in this study is significantly decreased median CSF lymphocyte % in the non-survivor group. Serum CrAg titer, positive blood cultures, and median CSF protein were not statistically significant between the two groups. However, a study with a larger sample size may be needed to confirm these findings. Disclosures All Authors: No reported disclosures

scholarly journals Timing of follow-up blood cultures for community-onset bacteremia

2019 ◽  
Vol 9 (1) ◽  
Author(s):  
Ching-Chi Lee ◽  
Chao-Yung Yang ◽  
Chih-Chia Hsieh ◽  
Ming-Yuan Hong ◽  
Chung-Hsun Lee ◽  
...  
Keyword(s):  
Prognostic Significance ◽  
Blood Cultures ◽  
Optimal Timing ◽  
High Morbidity ◽  
Prognostic Impact ◽  
Persistent Bacteremia ◽  
Multivariable Regression ◽  
Time Gap ◽  
Community Onset

Abstract Bacteremia is associated with high morbidity and mortality, but the utility and optimal timing of follow-up blood cultures (FUBCs) remain undefined. To assess the optimal timing of FUBCs related to appropriate antibiotic therapy (AAT), adults with community-onset bacteremia and FUBCs after bacteremia onset were retrospectively studied during the 6-year period in two hospitals. Based on the time gap between the initiation of AAT and FUBC sampling, 1,247 eligible patients were categorized as FUBCs prior to AAT (65 patients, 5.2%), 0–3 days (202, 16.2%), 3.1–6 days (470, 37.7%), 6.1–9 days (299, 24.0%), and ≥9 days (211, 16.9%) after AAT. The prognostic impact of the growth of the same bacteria in FUBCs on 30-day mortality was evidenced only in patients with FUBCs at 3.1–6 days after AAT (adjusted odds ratio [AOR], 3.75; P < 0.001), not in those with FUBCs prior to AAT (AOR, 2.86; P = 0.25), 0–3 days (AOR, 0.39; P = 0.08), 6.1–9 days (AOR, 2.19; P = 0.32), and ≥9 days (AOR, 0.41; P = 0.41) of AAT, after adjusting independent factors of 30-day mortality recognized by the multivariable regression in each category. Conclusively, persistent bacteremia in FUBCs added prognostic significance in the management of adults with community-onset bacteremia after 3.1–6 days of AAT.

scholarly journals Risk Factors for Positive Follow-Up Blood Cultures in Gram-Negative Bacilli Bacteremia: Implications for Selecting Who Needs Follow-Up Blood Cultures

2020 ◽  
Vol 7 (4) ◽  
Author(s):  
Hayato Mitaka ◽  
Tessa Gomez ◽  
Young Im Lee ◽  
David C Perlman
Keyword(s):  
Risk Factors ◽  
Cohort Study ◽  
Blood Culture ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Multivariate Logistic Regression Analysis ◽  
Blood Cultures ◽  
Gram Negative ◽  
Intravascular Devices

Abstract Background The value of follow-up blood cultures (FUBCs) to document clearance of bacteremia due to Gram-negative bacilli (GNB) has not been well established. Although previous studies suggested that the yield of FUBCs for GNB bacteremia is low, it remains to be elucidated for whom FUBC may be beneficial and for whom it is unnecessary. Methods A retrospective cohort study was performed at 4 acute care hospitals to identify risk factors for positive FUBCs with GNB bacteremia and to better guide clinicians’ decisions as to which patients may or may not benefit from FUBCs. Participants included adult patients with GNB bacteremia who had FUBCs and were admitted between January 2017 and December 2018. The primary outcomes were the factors associated with positive FUBCs and the yield of FUBCs with and without the factors. Results Of 306 patients with GNB bacteremia who had FUBCs, 9.2% (95% confidence interval, 6.2%–13.0%) had the same GNB in FUBCs. In the multivariate logistic regression analysis, end-stage renal disease on hemodialysis, intravascular device, and bacteremia due to extended-spectrum β-lactamase or carbapenemase-producing organism were identified as independent predictors of positive FUBCs with GNB bacteremia. Approximately 7 FUBCs and 30 FUBCs were needed for patients with ≥1 or no risk factors, respectively, to yield 1 positive result. SummaryThis multi-site retrospective cohort study found that among patients with gram-negative bacilli (GNB) bacteremia, having ESRD on hemodialysis, intravascular devices, or bacteremia due to multi-drug resistant GNB were each independently associated with having a positive follow-up blood culture. Conclusions Follow-up blood culture may not be necessary for all patients with GNB bacteremia and has the highest yield in patients with 1 or more risk factors.

scholarly journals 290. Impact of follow up blood cultures on outcomes of patients with gram-negative bloodstream infections

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S145-S145
Author(s):  
Rajiv G Amipara ◽  
Hana R Winders ◽  
Julie Ann Justo ◽  
P B Bookstaver ◽  
Joseph Kohn ◽  
...  
Keyword(s):  
South Carolina ◽  
Blood Culture ◽  
Proportional Hazards ◽  
Bloodstream Infections ◽  
Cox Proportional Hazards ◽  
Blood Cultures ◽  
Gram Negative ◽  
Source Of Infection

Abstract Background Importance of follow up blood cultures (FUBC) for Staphylococcus aureus bloodstream infections (BSI) is well known, but the role of FUBC in gram-negative BSI remains controversial. This retrospective cohort study examined the association between obtaining FUBC and mortality in patients with gram-negative BSI. Methods Adults with first episodes of community-onset monomicrobial BSI due to gram-negative bacilli hospitalized at Prisma Health-Midlands hospitals in Columbia, South Carolina, USA from January 1, 2010 to June 30, 2015 were identified. Patients who died or were discharged from hospital within 72 hours of collection of index blood culture were excluded to minimize impact of survival and selection biases on results, respectively. FUBC were defined as repeat blood cultures obtained between 24 and 96 hours from initial positive blood culture. Cox proportional hazards regression model was used to examine association between obtaining FUBC and 28-day all-cause mortality. Results Among 766 patients with gram-negative BSI, 219 (28.6%) had FUBC obtained and 15 of 219 (6.8%) FUBC were persistently positive. Overall, median age was 67 years, 438 (57%) were women, 457 (60%) had urinary source of infection, and 426 (56%) had BSI due to Escherichia coli. Mortality was significantly lower in patients who had FUBC obtained than in those who did not have FUBC (6.3% vs. 11.7%, log-rank p=0.03). Obtaining FUBC was independently associated with reduced mortality (hazards ratio [HR] 0.49, 95%CI: 0.25–0.90) after adjustments for age (HR 1.35 per decade, 95% CI: 1.13–1.61), cancer (HR 5.90, 95% CI: 3.53–9.84), Pitt bacteremia score (HR 1.38 per point, 95% CI: 1.26–1.50), and inappropriate empirical antimicrobial therapy (HR 2.37, 95% CI: 1.17–4.39). Conclusion Obtaining FUBC was associated with improved survival in hospitalized patients with gram-negative BSI. These observations are consistent with the results of recent publications from Italy and North Carolina supporting utilization of FUBC in the management of gram-negative BSI. Disclosures Julie Ann Justo, PharmD, MS, BCPS-AQ ID, bioMerieux (Speaker’s Bureau)TRC Healthcare (Speaker’s Bureau)

scholarly journals 1039. Surveillance Blood Cultures Associated With Decreased Mortality in Gram-Negative Bacteremia

2018 ◽  
Vol 5 (suppl_1) ◽  
pp. S310-S311
Author(s):  
Stacey A Maskarinec ◽  
David Van Duin ◽  
Felicia Ruffin ◽  
Vance G Fowler Jr ◽  
Joshua T Thaden
Keyword(s):  
Blood Culture ◽  
Hospital Mortality ◽  
Positive Blood Culture ◽  
Blood Cultures ◽  
Statistical Testing ◽  
Chi Square ◽  
Gram Negative ◽  
Staphylococcus Aureus Bacteremia ◽  
Gram Negative Bacteremia ◽  
Persistent Bacteremia

Abstract Background Prior studies have suggested that surveillance blood cultures (SBCs) may not be indicated in the setting of Gram-negative bacteremia (GNB). However, it is unclear how particular microbial species influence the need for SBCs in GNB. Methods We conducted a prospective cohort study of inpatients at Duke with Staphylococcus aureus bacteremia (SAB) and GNB from 2002–2015. Patients who died &lt;24 hours from the first positive blood culture were excluded. Patients provided written informed consent. SBCs were defined as a blood culture drawn from 24 hours to 7 days from initial positive blood culture. Persistent bacteremia was defined as a positive SBC with the same organism. Statistical testing included Fishers exact and chi-square tests. Results There were 2856 episodes of bacteremia over the study period (SAB: 1,147 [40%]; GNB: 1,709 [60%]). SBCs were drawn in 87% (1,003/1,147) of SAB patients and 64% (1,097/1,709) of GNB patients. SBC rates varied by GNB species (P &lt; 0.001), being more commonly drawn for those patients with Pseudomonas bacteremia (128/159 [80%]) than those with Escherichia bacteremia (377/592 [62%]). In GNB, acquisition of SBCs, regardless of positivity, was associated with decreased in-hospital mortality (177/1,173 [15%] vs. 109/536 [20%]; P = 0.008). The in-hospital mortality benefit associated with SBCs varied with GNB species, including Pseudomonas (30/128 [23%] vs. 14/31 [45%]; P = 0.02) and Escherichia (33/377 [9%] vs. 37/215 [17%]; P = 0.003). In-hospital mortality in those with SAB was also lower when SBCs were drawn (143/1003 [14%] vs. 46/144 [32%]; P = 0.0001) (figure). In GNB, positive SBCs, relative to negative SBCs, was associated with increased in-hospital mortality (44/217 [20%] vs. 133/956 [14%]; P = 0.02). Persistent bacteremia occurred in 49% (494/1003) of SAB patients and 20% (217/1097) of GNB patients with SBCs. Persistent bacteremia risk differed by GNB species (P = 0.004), and was highest among those with Stenotrophomonas maltophilia (9/19 [47%]) or Serratia (24/76 [31%]). Conclusion Acquisition of SBCs in patients with GNB was associated with decreased mortality, and this was driven in part by species-specific differences. Disclosures D. Van Duin, achaogen: Scientific Advisor, Consulting fee. shionogi: Scientific Advisor, Consulting fee. Allergan: Scientific Advisor, Consulting fee. Astellas: Scientific Advisor, Consulting fee. Neumedicine: Scientific Advisor, Consulting fee. Roche: Scientific Advisor, Consulting fee. T2 Biosystems: Scientific Advisor, Consulting fee. V. G. Fowler Jr., Merck, Cerexa/Actavis, Pfizer, Advanced Liquid Logis, NIH, MedImmune, Basilea, Karius, Contrafect, Regneron, Genentech, Affinergy, Locus, Medical Surface, Inc., Achaogen, Astellas, Arsanis, Bayer, Cubist, Debiopharm, Durata, Grifols, Medicines Co, Novartis: Collaborator, Consultant and Scientific Advisor, Consulting fee, Research grant and Research support.

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