Procalcitonin Level as a Surrogate for Catheter-Related Blood Stream Infection among Hemodialysis Patients

2017 ◽  
Vol 18 (6) ◽  
pp. 498-502 ◽  
Author(s):  
Mahmoud Hamada Imam ◽  
Eman Gamal
Keyword(s):  
Blood Culture ◽  
Positive Blood Culture ◽  
Blood Stream Infection ◽  
Positive Culture ◽  
Blood Stream ◽  
Hemodialysis Patients ◽  
Reactive Protein ◽  
Markers Of Inflammation ◽  
Spearman Correlation Test ◽  
Time Of Presentation

Introduction Catheter-related bloodstream infection (CRBSI) is a frequent complication among hemodialysis patients who usually are presented with nonspecific signs such as fever, rigors, and hypotension. Blood culture will take up to 5 days and antimicrobials will be started. Procalcitonin (PCT) is a valid marker in sepsis. Our goal in this study is to evaluate its usefulness as a diagnostic marker in detecting CRBSI among hemodialysis patients who present with suspected CRBSI. Patients and methods Thirty-one hemodialysis patients with suspected CRBSI were enrolled in this study. PCT level was measured at the time of presentation. Patients were divided into two groups according to blood culture results: positive and negative groups. PCT level and other markers for inflammation: white blood cell count (WBC), C-reactive protein (CRP), and ferritin were compared between the two groups. Statistical analysis of variables was performed using the t-test or Mann-Whitney test together with Spearman correlation test. Results Thirty-one patients had median age 44.7 ± 2.1 years. They comprised 16 males (52%) and 15 females (48%). Sixteen patients had a positive blood culture result while in 15 it was negative. PCT level was significantly higher in the positive blood culture group (40.0 ± -21.9) (95% confidence interval [CI] 28.4-51.8) while its level was 1.1 ± 1 (95% CI 0.54-1.8) in the negative blood culture group [t(15) = -7, p<0.001). In the positive culture group, there was a correlation between CRP and ferritin (r = -0.58, p = 0.01, n = 16), while no correlation between PCT and other markers of inflammation. Conclusions PCT is a useful marker for diagnosis of CRBSI among hemodialysis patients.

scholarly journals Frequency and Microbiological Profile of Catheter-Related Infections in Hemodialysis Patients Receiving Gentamicin as Antimicrobial Lock Therapy for Prophylaxis

2021 ◽  
Vol 4 (03) ◽  
Author(s):  
Sumbal Nasir Mahmood ◽  
Sabaa Asif ◽  
Muhammad Amim Anwar ◽  
Osama Kunwer Naveed
Keyword(s):  
Blood Culture ◽  
Blood Stream Infection ◽  
Blood Stream ◽  
Cross Sectional Study ◽  
Immunosuppressive Drugs ◽  
Hemodialysis Patients ◽  
Exit Site ◽  
Cross Sectional ◽  
Exit Site Infection ◽  
Antibiotic Lock

Antibiotic lock solution (ALS) in the lumen of catheter is a mean to decrease the possibility of catheter related blood stream infection (CRBSI). We conducted this study using Gentamicin as ALS to observe the frequency of catheter related infections (CRI) including CRBSI and exit site infection in this hemodialysis patients being dialyzed through tunneled and temporary hemodialysis catheters. Methods This descriptive, cross sectional study was conducted at Dr. Ziauddin Hospital, North Campus between January 2017- December 2017. Symptomatic patients for CRBSI were included in this study. Blood culture from the catheter ports and periphery and exit site swab if pus visible were sent for culture sensitivity.  Results Total 138 patients of either gender with age more than 18 years to less than 80 years were evaluated. 44.9% were male and mean age of patients was 58.79±14.05 years. 70.3% patients were diabetic for 15.61±4.61 years and 11.6% were using immunosuppressive drugs. The overall mean catheter duration was 22.27±14.39 days and mean hemodialysis duration was 25.32±44.31 weeks. Tunneled catheter was placed in 40.6% and 46.4% had femoral temporary catheters. Blood culture was done for 51 cases and 21.5% were positive. Tip culture was positive in 33.3% patients. In our study, 23.18% patients were found to have catheter related infections, out of which 61.5% were found with gentamicin resistance including colonization. Conclusion We report a high frequency of catheter related infections despite using ALS as prophylaxis, with predominant organisms being gram positives and a high incidence of gentamycin resistance.

scholarly journals Comparison of the Fully Automated FilmArray BCID Assay to a 4-Hour Culture Test Coupled to Mass Spectrometry for Day 0 Identification of Microorganisms in Positive Blood Cultures

2018 ◽  
Vol 2018 ◽  
pp. 1-6 ◽  
Author(s):  
Paul O. Verhoeven ◽  
Cyrille H. Haddar ◽  
Josselin Rigaill ◽  
Nathalie Fonsale ◽  
Anne Carricajo ◽  
...  
Keyword(s):  
Blood Culture ◽  
Positive Blood Culture ◽  
Blood Stream Infection ◽  
Blood Stream ◽  
Bacterial Identification ◽  
Maldi Tof Ms ◽  
Maldi Tof ◽  
Negative Results ◽  
Culture Identification ◽  
Tof Ms

Rapid bacterial identification of positive blood culture is important for adapting the antimicrobial therapy in patients with blood stream infection. The aim of this study was to evaluate the performance of the multiplex FilmArray Blood Culture Identification (BCID) assay by comparison to an in-house protocol based on MALDI-TOF MS identification of microcolonies after a 4-hour culture, for identifying on the same day the microorganisms present in positive blood culture bottles. One hundred and fifty-three positive bottles from 123 patients were tested prospectively by the 3 techniques of bacterial identification: 11 bottles yielding negative results by the 3 tests were considered false positive (7.2%). The reference MALDI-TOF MS technique identified 134 monomicrobial (87.6%) and 8 double infections (5.2%), which resulted in a total of 150 microorganisms. Globally, 137 (91.3%) of these 150 pathogens were correctly identified by the fully automated multiplex FilmArray BCID system at the species or genus level on day of growth detection, versus 117 (78.8%) by MALDI-TOF MS identification on nascent microcolonies after a 4-hour culture (P < 0.01). By combining the two approaches, 140 (93.5%) of the positive bottles were identified successfully at day 0. These results confirm the excellent sensitivity of the FilmArray BCID assay, notably in case of multimicrobial infection. Due to the limited number of targets included into the test, it must be coupled to another identification strategy, as that presented in this study relying on MALDI-TOF MS identification of microcolonies obtained after a very short culture period.

scholarly journals Rapid Identification of Pathogens in Positive Blood Culture of Patients with Sepsis: Review and Meta-Analysis of the Performance of the Sepsityper Kit

2015 ◽  
Vol 2015 ◽  
pp. 1-10 ◽  
Author(s):  
Nils G. Morgenthaler ◽  
Markus Kostrzewa
Keyword(s):  
Blood Culture ◽  
Antibiotic Therapy ◽  
Positive Blood Culture ◽  
Blood Stream Infection ◽  
Meta Analysis ◽  
Extraction Methods ◽  
Blood Stream ◽  
Rapid Identification ◽  
Maldi Tof

Sepsis is one of the leading causes of deaths, and rapid identification (ID) of blood stream infection is mandatory to perform adequate antibiotic therapy. The advent of MALDI-TOF Mass Spectrometry for the rapid ID of pathogens was a major breakthrough in microbiology. Recently, this method was combined with extraction methods for pathogens directly from positive blood cultures. This review summarizes the results obtained so far with the commercial Sepsityper sample preparation kit, which is now approved forin vitrodiagnostic use. Summarizing data from 21 reports, the Sepsityper kit allowed a reliable ID on the species level of 80% of 3320 positive blood culture bottles. Gram negative bacteria resulted consistently in higher ID rates (90%) compared to Gram positive bacteria (76%) or yeast (66%). No relevant misidentifications on the genus level were reported at a log(score)cut-off of 1.6. The Sepsityper kit is a simple and reproducible method which extends the MALDI-TOF technology to positive blood culture specimens and shortens the time to result by several hours or even days. In combination with antibiotic stewardship programs, this rapid ID allows a much faster optimization of antibiotic therapy in patients with sepsis compared to conventional workflows.

Procalcitonin and Conventional Markers of Inflammation in Peritoneal Dialysis Patients and Peritonitis

2006 ◽  
Vol 26 (2) ◽  
pp. 240-248 ◽  
Author(s):  
Galip Guz ◽  
Bulent Colak ◽  
Kenan Hizel ◽  
Kadriye A. Reis ◽  
Yasemin Erten ◽  
...  
Keyword(s):  
Peritoneal Dialysis ◽  
Operating Characteristic ◽  
Characteristic Curve ◽  
Area Under The Curve ◽  
Hemodialysis Patients ◽  
Biochemical Tests ◽  
Reactive Protein ◽  
Markers Of Inflammation ◽  
Median Serum ◽  
Significant Difference

Objectives To determine the significance of a newly described marker of inflammation procalcitonin (PCT), and to investigate its relationship to conventional markers of inflammation, such as C-reactive protein (CRP), fibrinogen, and erythrocyte sedimentation rate (ESR), in patients on peritoneal dialysis (PD) and with peritonitis. Design A prospective, observational clinical study. Setting The Nephrology Division of a University-affiliated teaching hospital. Patients and Methods 51 consecutive patients on PD were included in the study. Of this number, 16 developed peritonitis during the observational period. Baseline PCT, CRP, and fibrinogen concentrations and ESR of 51 PD patients were determined at a time point (TB) prior to any evidence of infection. These results were compared with laboratory values from 74 hemodialysis patients and 34 nonuremic control subjects. All PD patients then were followed prospectively for evidence of peritonitis. In addition to routine blood tests, including hemoglobin and leukocyte count, and routine biochemical tests, blood samples were taken to measure PCT, CRP, and fibrinogen concentrations and ESR at the time (T0) when patients first were diagnosed with PD peritonitis and also on the 4th (T4) and the 14th (T14) days after treatment for peritonitis was initiated. PCT was assayed by immunoluminometry. Results No significant difference was observed between baseline median serum PCT concentrations in PD and hemodialysis patients; however, in both groups, baseline median PCT concentrations were significantly higher than those of nonuremic controls ( p < 0.05). The 16 patients on PD who developed peritonitis had 21 PD peritonitis episodes during the study period. The increased PCT concentration observed at T0 in PD peritonitis episodes decreased with therapy, and this change was statistically significant ( p < 0.05). In a receiver operating characteristic curve analysis for peritonitis, the area under the curve (AUC) for PCT was 0.80, which was significantly lower than the AUC for CRP and greater than the AUCs for fibrinogen and ESR. The sensitivity of PCT for peritonitis was lower than the sensitivity of conventional markers of inflammation; however, the specificity of PCT was higher. Conclusions Median serum PCT concentration in PD patients was significantly higher than in nonuremic controls but not hemodialysis patients. Serum PCT concentrations may serve as a useful adjunct to traditional markers of inflammation in detecting and monitoring inflammation and peritonitis in PD patients.

scholarly journals TEICOPLANIN RESISTANCE IN GRAM-POSITIVE BACTERIAL ISOLATE: AN EMERGING THREAT

2021 ◽  
pp. 136-139
Author(s):  
SATISH CHANDEL ◽  
PARAG SHARMA ◽  
PRATIK AKHANI ◽  
RAMESH AGRAWAL
Keyword(s):  
Blood Culture ◽  
Blood Stream Infection ◽  
Central India ◽  
Blood Stream ◽  
Diffusion Method ◽  
Gram Positive ◽  
Disk Diffusion Method ◽  
Gram Positive Bacteria ◽  
Antibiotic Susceptibility Test ◽  
The Future

Objectives: Development of antimicrobial resistance in microorganism isolated from blood stream infection constitutes a major concern about their treatment. Teicoplanin is a glycopeptide antibiotic used in the treatment of infection caused by Gram-positive bacteria. This study was planned to determine Teicoplanin resistance in the Central India and recommend policy changes for prevention of the future resistance to the higher antibiotics. Methods: A total of 1855 septicemia suspected blood samples were studied. The blood culture samples were processed and identified in the microbiology laboratory according to the Clinical and Laboratory Standards Institute guidelines. Antibiotic susceptibility test was done using Kirby B disk diffusion method. Results: About 39.5% of blood culture samples showed positive growth for organism. We observed high teicoplanin resistance (29.5%) among Gram-positive isolates, predominantly (53%) in the Enterococcus species. Conclusion: Teicoplanin resistance has emerged tremendously in the present study. Hence, attention is required about this serious issue otherwise very limited choice of antibiotics will be available for treating infections in the future.

Evaluation of the Association of Bacteraemia with the Severity of Neutropenia

2017 ◽  
Vol 1 (01) ◽  
pp. 13-15
Author(s):  
Md. Kamrul Hasan ◽  
Amin Lutful Kabir ◽  
Adnan Hasan Masud ◽  
Md. Mahbubur Rahman
Keyword(s):  
Blood Culture ◽  
Febrile Neutropenia ◽  
Blood Stream Infection ◽  
Prophylactic Antibiotic ◽  
Blood Stream ◽  
Febrile Episode ◽  
Severe Neutropenia ◽  
Management Algorithm ◽  
Blood Culture Positivity ◽  
Neutropenic Patients

Background: Blood culture is a part of management algorithm in febrile neutropenia. However, the incidence of positive result of blood culture is decreasing and the spectrum of the causative microbial is changing over time. Objective: The objective of this study was to see the incidence of bacteraemia and its association with the severity of neutropenia. Methodology: Based on naturally occurring blood stream infection, we evaluated 47 febrile neutropenic patients using blood culture to see the incidence of bacteraemia during the period between October 2009 and October 2010. Results: The overall rate of blood culture positivity was 17% (8/47). It was found to be significantly higher in 32% (8/25) (p = 0.014) of patients with very severe neutropenia, 26.9% (7/26) (p = 0.044) positivity was found when blood culture was done on the first day of febrile episode and 41.7% (5/12) (P = 0.008) in the absence of prophylactic antibiotic. Conclusion: Blood culture was found to be a valuable tool for the evaluation of bacteraemia and should be used in all cases of febrile neutropenia.

HISTOPLASMOSIS IN CHILDREN

PEDIATRICS ◽  
1964 ◽  
Vol 33 (6) ◽  
pp. 894-903
Author(s):  
Robert B. Tesh ◽  
Martha H. Shacklette ◽  
Fred H. Diercks ◽  
Daniel Hirschl
Keyword(s):  
Blood Culture ◽  
Amphotericin B ◽  
Positive Blood Culture ◽  
Clinical Studies ◽  
Blood Stream ◽  
Sulfa Drugs ◽  
Serologic Tests ◽  
Disseminated Histoplasmosis ◽  
Pulmonary Histoplasmosis ◽  
Progressive Disseminated Histoplasmosis

Two cases of children with disseminated histoplasmosis and four with acute pulmonary histoplasmosis are presented. The unreliability of basing a diagnosis on the skin and serologic tests early in the course of the disease is stressed. A plea for cultures in those cases clinically suspected of having histoplasmosis is made. A positive blood culture obtained from one child with the acute pulmonary form of the disease lends evidence to the belief that in many cases of acute histoplasmosis, the organism is temporarily disseminated by the blood stream. Two cases of progressive, disseminated histoplasmosis, treated with sulfonamides are presented. This suggests that certain of the sulfa drugs are effective in the treatment of disseminated histoplasmosis, and that controlled clinical studies comparing the effectiveness of sulfa with Amphotericin B are needed.

Bacterial Aetiology of Bloodstream Infection and Antimicrobial Resistance Pattern in a Tertiary Hospital of Northern Bangladesh: Analysis of Current Situation

2020 ◽  
Vol 4 (02) ◽  
pp. 33-38
Author(s):  
M. Morsed Zaman Miah ◽  
Md. About Rafi ◽  
Md. Azizul Haque ◽  
Md. Kh. Faisal Alam
Keyword(s):  
Staphylococcus Aureus ◽  
Blood Stream Infection ◽  
Positive Culture ◽  
Blood Stream ◽  
Salmonella Typhi ◽  
Resistance Rate ◽  
Resistance Pattern ◽  
Coagulase Negative Staphylococci ◽  
Sensitivity Pattern ◽  
Bacterial Aetiology

Background: The objective of the present study was to identify the causative organisms of blood stream infection (BSI) and their resistance pattern to different antibiotics as well as prevalence of multi drug resistant (MDR) organisms in this region. This retrospective study included blood culture reports from 1899 suspected bacteraemia patients. Culture was done using BACT/Alert machine followed by culture on MacConkey (MC) agar, chocolate agar and blood agar plates. Isolated organisms were identified using standard laboratory procedures. Results: Total 383 bacterial isolates were yielded (rate of positive culture 20.2%). Staphylococcus aureus (41.8%) and Escherichia coli (41.8%) were most frequently isolated gram positive and gram-negative organisms respectively. Other commonly isolated organisms were Salmonella typhi (10.7%) and coagulase negative Staphylococci (CoNS) (3.9%). More than 90% isolated organisms were multidrug resistant. Salmonella typhi (95.1%) and Staphylococcus aureus (91.2%) showed most frequently isolated MDR strains. All the organisms showed high resistance rate against commonly used antibiotics like azithromycin, ciprofloxacin, and trimethoprim/sulfamethoxazole. Amoxycillin and clavulanic acid combination, cloxacillin and linezolid were sensitive against Staphylococcus aureus. Ceftriaxone as well as amikacin remained a sensitive drug to treat Salmonella typhi. Carbapenems and nitrofurantoin were mostly sensitive against all isolated organisms. Conclusion: Rational use of antibiotics based on regional epidemiology of causative organisms and sensitivity pattern can preserve the potentiality of available antibiotics and reduce the burden of MDR pathogens.

Unintended Benefit to the Donor of Bacterial Screening of Platelets, Pheresis Donations.

Blood ◽  
2004 ◽  
Vol 104 (11) ◽  
pp. 4092-4092
Author(s):  
Ram M. Kakaiya ◽  
Colleen A. Aronson ◽  
Janine B. Keene
Keyword(s):  
Antibiotic Treatment ◽  
Blood Stream Infection ◽  
Positive Culture ◽  
Blood Stream ◽  
Streptococcus Viridans ◽  
Subaortic Stenosis ◽  
Culture Bottle ◽  
Aerobic Culture ◽  
Pic Line ◽  
Dental Work

Abstract Background: Our blood center began routine screening of Single Donor Platelets, Pheresis (SDP) for bacteria on December 15, 2003 using aerobic culture bottles with the BacT Alert® 3D System. SDP units are held a minimum of 24 hours prior to sampling and then are labeled and released while the culture bottles are incubated for five days. Case Study: A 77-year old female donated a SDP and concurrent Plasma. Pre-donation platelet count was 328 x103/μL and hemoglobin level was 15.0 g/dL. Collection was uneventful with no error codes received from the equipment. Sample for was obtained on day-1, inoculated in an aerobic culture bottle, and incubated. The inoculated bottle showed growth of bacteria at 19.6 hours of the culture period. SDP had not been distributed and was recultured. Repeat culture was performed on day-2 and it also showed growth at 13.4 hours. The concurrent plasma was thawed and cultured and did not show any growth. A gram stain of the positive culture bottle revealed gram-positive cocci in chains that were later identified as Streptococcus viridans. The donor was notified of the culture results. The donor denied any skin rash or infection, sore throat, fractures, heart or lung conditions. She denied fever, chills or any acute illness. Her chronic conditions included hypertension treated with Lisinopril. She was also receiving thyroid replacement for hypothyroidism and Asiphex for gastro esophageal reflux disease (GERD). She denied any GI or GU symptoms. The culture results were mailed to the donor so that she could share them with her personal physician. The donor is a frequent apheresis donor and has donated 54 SDPs over the past seven years. Three previous donations immediately prior to the current donation were found to be negative after 5-day culture. On day 18, the donor felt weak and tired but without fever or other symptoms and she went to see her physician. The physician obtained a blood culture that grew bacteria the next day. Further testing identified the organism as Streptococcus salivarius, a viridans species. Donor was then hospitalized for five days to begin intravenous Ceftriaxone. Further antibiotic treatment was given at home via a peripherally inserted central (PIC) line. The donor had a three-year history of a benign heart murmur. The PIC line was removed with the completion of the antibiotic treatment on day 65. The donor remained asymptomatic throughout the treatment. Two trans-thoracic and two trans-esophageal echocardiograms were negative for bacterial endocarditis. However, mild idiopathic hypertrophic subaortic stenosis was discovered. The donor had dental work done two months prior to the time the bacteremia was found. However, she had one SDP donation that was culture negative after the dental work. The cause of the donor’s bacteremia remains obscure. Discussion: Although the screening of Platelets, Pheresis is for the protection of the patient who will receive the product, this case shows that the detection of the bacteria also may benefit the donor. In our case, aymptomatic Streptococcus viridans bacteremia would not have been recognized if it were not detected by culturing her SDP. The donor was grateful for the information that lead to the early detection of blood stream infection that resulted in successful treatment. The donor continues to ask that she be able to donate when eligible.

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