1
|
Akyıldız Ö, Beşli Y, Kocagöz AS. Yoğun bakım ünitesinde bakteriyemi tanısı ile takip edilen hastaların değerlendirilmesi. CUKUROVA MEDICAL JOURNAL 2019. [DOI: 10.17826/cumj.623795] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
|
2
|
Dargère S, Cormier H, Verdon R. Contaminants in blood cultures: importance, implications, interpretation and prevention. Clin Microbiol Infect 2018; 24:964-969. [DOI: 10.1016/j.cmi.2018.03.030] [Citation(s) in RCA: 76] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2017] [Revised: 03/17/2018] [Accepted: 03/20/2018] [Indexed: 11/24/2022]
|
3
|
Frickmann H, Hahn A, Skusa R, Mund N, Viehweger V, Köller T, Köller K, Schwarz NG, Becker K, Warnke P, Podbielski A. Comparison of the etiological relevance of Staphylococcus haemolyticus and Staphylococcus hominis. Eur J Clin Microbiol Infect Dis 2018; 37:1539-1545. [PMID: 29777490 DOI: 10.1007/s10096-018-3282-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2018] [Accepted: 05/10/2018] [Indexed: 01/19/2023]
Abstract
The study was performed to assess potential differences in the etiological relevance of two coagulase-negative staphylococci (CoNS), Staphylococcus haemolyticus and Staphylococcus hominis, in an observational single-center study. Over a 5-year interval, patients in whom there was detected S. haemolyticus or S. hominis of presumed etiological relevance were assessed for the primary endpoint death during hospital stay and the secondary endpoint transfer to an intensive care unit (ICU) after the detection of S. haemolyticus or S. hominis. Patients with S. haemolyticus or S. hominis died in 11.3% (50 out of 444) and 9.5% (60 out of 631) of cases, respectively, and were transferred to ICU after S. haemolyticus and S. hominis detection in 8.7% (19 out of 219) and 11.7% (44 out of 377) of cases, respectively. There was no significance for species-related influence on the primary outcome parameter (P > 0.1), while ICU transfers were more likely for patients with S. hominis detections (P = 0.016). Delayed diagnosis of both CoNS species was associated with an increased probability of death (P = 0.009). The study revealed comparable morbidity caused by S. haemolyticus and S. hominis identified in a clinically relevant context.
Collapse
Affiliation(s)
- Hagen Frickmann
- Department of Microbiology and Hospital Hygiene, Bundeswehr Hospital Hamburg, Bernhard Nocht Str. 74, 20359, Hamburg, Germany. .,Institute for Medical Microbiology, Virology and Hygiene, University Medicine Rostock, Schillingallee 70, 18057, Rostock, Germany.
| | - Andreas Hahn
- Institute for Microbiology, Charité - University Medicine Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - Romy Skusa
- Institute for Medical Microbiology, Virology and Hygiene, University Medicine Rostock, Schillingallee 70, 18057, Rostock, Germany
| | - Nils Mund
- Institute for Medical Microbiology, Virology and Hygiene, University Medicine Rostock, Schillingallee 70, 18057, Rostock, Germany
| | - Vivian Viehweger
- Institute for Medical Microbiology, Virology and Hygiene, University Medicine Rostock, Schillingallee 70, 18057, Rostock, Germany
| | - Thomas Köller
- Institute for Medical Microbiology, Virology and Hygiene, University Medicine Rostock, Schillingallee 70, 18057, Rostock, Germany
| | - Kerstin Köller
- Institute for Medical Microbiology, Virology and Hygiene, University Medicine Rostock, Schillingallee 70, 18057, Rostock, Germany
| | - Norbert Georg Schwarz
- Infectious Disease Epidemiology, Bernhard Nocht Institute for Tropical Medicine Hamburg, Bernhard Nocht Str. 74, 20359, Hamburg, Germany
| | - Karsten Becker
- Institute of Medical Microbiology, University Hospital Münster, Domagkstraße 10, 48149, Münster, Germany
| | - Philipp Warnke
- Institute for Medical Microbiology, Virology and Hygiene, University Medicine Rostock, Schillingallee 70, 18057, Rostock, Germany
| | - Andreas Podbielski
- Institute for Medical Microbiology, Virology and Hygiene, University Medicine Rostock, Schillingallee 70, 18057, Rostock, Germany
| |
Collapse
|
4
|
Karakullukçu A, Kuşkucu MA, Ergin S, Aygün G, Midilli K, Küçükbasmaci Ö. Determination of clinical significance of coagulase-negative staphylococci in blood cultures. Diagn Microbiol Infect Dis 2017; 87:291-294. [DOI: 10.1016/j.diagmicrobio.2016.12.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2016] [Revised: 11/29/2016] [Accepted: 12/09/2016] [Indexed: 01/01/2023]
|
5
|
Prävention von Infektionen, die von Gefäßkathetern ausgehen. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2017; 60:216-230. [DOI: 10.1007/s00103-016-2485-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
|
6
|
Vila J, Gómez MD, Salavert M, Bosch J. [Methods of rapid diagnosis in clinical microbiology: Clinical needs]. Enferm Infecc Microbiol Clin 2016; 35:41-46. [PMID: 27993417 DOI: 10.1016/j.eimc.2016.11.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2016] [Accepted: 11/16/2016] [Indexed: 11/30/2022]
Abstract
The diagnostic methods of infectious diseases should be fast, accurate, simple and affordable. The speed of diagnosis can play a crucial role in healing the patient, allowing the administration of appropriate antibiotic treatment. One aspect that increasingly determines the need for rapid diagnostic techniques is the increased rates of serious infections caused by multidrug resistant bacteria, which cause a high probability of error in the empirical treatment. Some of the conventional methods such as Gram staining or antigen detection can generate results in less than 1 hour but lack sensitivity. Today we are witnessing a major change in clinical microbiology laboratories with the technological advances such as molecular diagnostics, digital microbiology and mass spectrometry. There are several studies showing that these changes in the microbiological diagnosis reduce the generation time of the test results, which has an obvious clinical impact. However, if we look into the future, other new technologies which will cover the needs required for a rapid microbiological diagnosis are on the horizon. This review provides an in depth analysis of the clinical impact that the implementation of rapid diagnostic techniques will have on unmet clinical needs.
Collapse
Affiliation(s)
- Jordi Vila
- ISGlobal, Barcelona Ctr. Int. Health Res. (CRESIB), Hospital Clínic - Universitat de Barcelona, Barcelona, España; Servicio de Microbiología, Centro de Diagnóstico Biomédico, Hospital Clínic, Barcelona, España.
| | - María Dolores Gómez
- Servicio de Microbiología, Hospital Universitario y Politécnico La Fe, Valencia, España
| | - Miguel Salavert
- Unidad de Enfermedades Infecciosas, Hospital Universitario y Politécnico La Fe, Valencia, España
| | - Jordi Bosch
- ISGlobal, Barcelona Ctr. Int. Health Res. (CRESIB), Hospital Clínic - Universitat de Barcelona, Barcelona, España; Servicio de Microbiología, Centro de Diagnóstico Biomédico, Hospital Clínic, Barcelona, España
| |
Collapse
|
7
|
Safdar N, Maki DG. Lost in Translation. Infect Control Hosp Epidemiol 2016; 27:3-7. [PMID: 16418979 DOI: 10.1086/500282] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2005] [Accepted: 12/06/2005] [Indexed: 12/20/2022]
|
8
|
Fux CA, Uehlinger D, Bodmer T, Droz S, Zellweger C, Mühlemann K. Dynamics of Hemodialysis Catheter Colonization by Coagulase-Negative Staphylococci. Infect Control Hosp Epidemiol 2016; 26:567-74. [PMID: 16018433 DOI: 10.1086/502586] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
AbstractObjectives:Catheter colonization is a necessary but poorly characterized step in the pathogenesis of catheter-related infections. Colonization dynamics of central venous hemodialysis catheters were studied with emphasis on coagulase-negative staphylococci (CoNS) and their population genetics, antibiotic resistance, and biofilm formation. The homogeneity of CoNS colony morphotypes was evaluated.Design:Prospective, longitudinal study during 1,158 catheter-days with microbiological analysis of skin swabs, weekly catheter blood and brush samples, and catheter tips.Setting:Hemodialysis unit of a university hospital.Patients:Twenty-six patients with 24 non-tunneled and 5 tunneled catheters.Results:Nineteen (65.5%) of the catheters became colonized, 17 by CoNS. CoNS colonization of the inner lumen was observed in 17.2% of the catheters and was first detectable after 3 weeks. Colonization of the outer surface occurred in 44.8% of the catheters within a minimum of 2 weeks. PFGE of 53 CoNS revealed 10 clones and 20 unique isolates. Isolates from clones were more frequent in catheter blood and brush cultures than were unique isolates (41% vs 15%), were resistant to more antibiotics (median, 7 vs 2), and tended to more often carry theicaAgene (64.1% vs 40%). Four (23.5%) of the catheters showed colonization with a mixture of CoNS based on PFGE. The time from catheter insertion to such mixed CoNS colonization was longer than that for colonization with one CoNS PFGE pattern only (42 vs 25 days).Conclusions:Colonization of hemodialysis catheters is dominated by multidrug-resistant,icaA-positive CoNS clones. Mixed CoNS colonization occurs, but is delayed, suggesting a process of sequential superinfection (Infect Control Hosp Epidemiol2005;26:567-574).
Collapse
MESH Headings
- Adult
- Aged
- Aged, 80 and over
- Bacteremia/etiology
- Biofilms/growth & development
- Catheterization, Central Venous/adverse effects
- Catheterization, Central Venous/instrumentation
- Catheters, Indwelling/microbiology
- Coagulase
- Cross Infection/etiology
- DNA, Bacterial/analysis
- DNA, Bacterial/genetics
- Drug Resistance, Multiple, Bacterial
- Electrophoresis, Gel, Pulsed-Field
- Equipment Contamination/statistics & numerical data
- Equipment Design
- Female
- Hospitals, University
- Humans
- Male
- Microbial Sensitivity Tests
- Middle Aged
- Prospective Studies
- Renal Dialysis/adverse effects
- Renal Dialysis/instrumentation
- Staphylococcal Infections/etiology
- Staphylococcus/genetics
- Staphylococcus/growth & development
- Superinfection/etiology
- Switzerland
- Time Factors
Collapse
Affiliation(s)
- Christoph A Fux
- Institute for Infectious Diseases, University of Bern, Bern, Switzerland
| | | | | | | | | | | |
Collapse
|
9
|
Beekmann SE, Diekema DJ, Doern GV. Determining the Clinical Significance of Coagulase-Negative Staphylococci Isolated From Blood Cultures. Infect Control Hosp Epidemiol 2016; 26:559-66. [PMID: 16018432 DOI: 10.1086/502584] [Citation(s) in RCA: 120] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
AbstractBackground and Objective:Coagulase-negative staphylococci are both an important cause of nosocomial bloodstream infections and the most common contaminants of blood cultures. Judging the clinical significance of coagulase-negative staphylococci is vital but often difficult and can have a profound impact on an institution's bloodstream infection rates. Our objective was to develop an algorithm to assist in determining the clinical significance of coagulase-negative staphylococci.Design:A single experienced reviewer examined the medical records of 960 consecutive patients with positive blood cultures in a tertiary-care referral teaching hospital. Four hundred five of the cultures contained coagulase-negative staphylococci. A determination of clinical significance was made and the performances of various published algorithms that contained readily available clinical and laboratory data were compared.Results:Eighty-nine (22%) of the episodes were considered significant, whereas 316 were contaminants. Patients with bacteremia were significantly more likely to be neutropenic and exhibit signs of sepsis syndrome. The algorithm with the best combined sensitivity (62%) and specificity (91%) for determining the clinical significance of coagulase-negative staphylococci was defined as at least two blood cultures positive for coagulase-negative staphylococci within 5 days, or one positive blood culture plus clinical evidence of infection, which includes abnormal white blood cell count and temperature or blood pressure.Conclusion:Use of this algorithm could potentially reduce misclassification of nosocomial bloodstream infections and inappropriate use of vancomycin for positive blood cultures likely to represent contamination (Infect Control Hosp Epidemiol2005;26:559-566).
Collapse
Affiliation(s)
- Susan E Beekmann
- Division of Medical Microbiology, Department of Pathology, University of Iowa College of Medicine, Iowa City, Iowa, USA.
| | | | | |
Collapse
|
10
|
Senger SS, Saccozza ME, Yuce A. Compatibility of Pulsed-Field Gel Electrophoresis Findings and Clinical Criteria Commonly Used to Distinguish Between True Coagulase-Negative Staphylococcal Bacteremia and Contamination. Infect Control Hosp Epidemiol 2015; 28:992-6. [PMID: 17620249 DOI: 10.1086/518753] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2006] [Accepted: 12/28/2006] [Indexed: 11/03/2022]
Abstract
Objectives.To evaluate the specificity and sensitivity of the clinical criteria widely used to differentiate true coagulase-negative staphylococcal (CoNS) bacteremia from contamination, using pulsed-field gel electrophoresis (PFGE) as the reference test.Design.The study sample consisted of 79 CoNS isolates recovered from cultures of blood from 38 patients. Medical charts of the patients were reviewed for demographic and clinical information. The relatedness of CoNS strains recovered from 2 or more successive blood cultures was analyzed by PFGE. Patients from whom similar strains were recovered were assumed to have true bacteremia, whereas patients from whom different strains were recovered were considered to have contaminated blood cultures. The clinical criteria comprised Centers for Disease Control and Prevention (CDC) surveillance definitions for bloodstream infection (BSI), as well as an alternative criterion based on the presence of fever, the presence of leukocytosis, the absence of another recognized infection, and the recovery of CoNS from 2 or more successive blood cultures.Results.Nineteen (50%) of the 38 patients had bacteremia due to similar strains; the remaining patients had bacteremia due to different strains. Criterion 2a of the CDC definition for BSI had a sensitivity of 100% and a specificity of 31.6% for distinguishing between true bacteremia and contamination. CDC criterion 2b had a sensitivity of 78.9% and a specificity of 52.6%.Conclusions.Molecular typing correlated poorly with the clinical criteria for true bacteremia. In view of the limited applicability of clinical criteria, more studies are needed to improve them. Periodic cross-sectional studies based on PFGE findings might be useful to estimate local contamination rates in an institution, which in turn can be used to improve the accuracy of the clinical diagnosis of bacteremia.
Collapse
Affiliation(s)
- Suheyla Serin Senger
- Department of Infectious Diseases and Clinical Microbiology, Baskent University, Ankara, Turkey.
| | | | | |
Collapse
|
11
|
Clinical significance of methicillin-resistant coagulase-negative staphylococci obtained from sterile specimens. Diagn Microbiol Infect Dis 2014; 81:71-5. [PMID: 25312009 DOI: 10.1016/j.diagmicrobio.2014.09.019] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2014] [Revised: 09/10/2014] [Accepted: 09/21/2014] [Indexed: 11/23/2022]
Abstract
Distinguishing true coagulase-negative staphylococci bacteremia from contamination remains a challenge. We conducted a retrospective analysis of 183 patients with methicillin-resistant coagulase-negative staphylococci (MR-CoNS)-positive and methicillin-resistant Staphylococcus aureus-positive cultures obtained from sterile sites such as blood, synovial fluid, ascitic fluid, and cerebrospinal fluid. Of the 209 MR-CoNS isolates, 83 (39.7%) were considered infection associated, and 126 (60.3%) were considered contamination. MR-CoNS isolates cultured from synovial fluid were more likely to be infection associated (P = 0.009). The median interval from insertion of a central venous catheter to onset of infection tended to be longer in MR-CoNS infection cases than in methicillin-resistant S. aureus infection cases (41 days versus 14 days, P = 0.055). In conclusion, our results suggest that the proportion of cases of true MR-CoNS infection may be higher than previously reported.
Collapse
|
12
|
Ahlstrand E, Bäckman A, Persson L, Mölling P, Tidefelt U, Söderquist B. Evaluation of a PCR method to determine the clinical significance of blood cultures with Staphylococcus epidermidis in patients with hematological malignancies. APMIS 2013; 122:539-44. [PMID: 24106819 DOI: 10.1111/apm.12182] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2013] [Accepted: 08/18/2013] [Indexed: 11/24/2022]
Abstract
The aim was to investigate whether the detection and quantification of Staphylococcus epidermidis DNA in blood could distinguish S. epidermidis blood stream infections (BSIs) from blood culture contaminations in patients with hematological malignancies. The hld gene was chosen to identify S. epidermidis DNA and DNA in blood samples was detected by real-time PCR. Blood samples were obtained simultaneously with blood cultures positive for S. epidermidis (n = 30), during blood culture-negative episodes (n = 10) and episodes of bacteremia with other bacteria than S. epidermidis (n = 4) and from healthy blood donors (n = 10). In addition, DNA from S. epidermidis and a selection of other bacterial species were analyzed. Three different sets of criteria were used to classify episodes with positive blood cultures with S. epidermidis as BSIs or contaminations. All DNA preparations from S. epidermidis (n = 48) were hld-positive, but other bacterial species (n = 13) were negative. Sixteen (53%) of 30 blood samples from patients with blood cultures positive for S. epidermidis were hld-positive, but none of the controls. There was no clear association between a positive hld PCR and episodes interpreted as BSIs. In conclusion, hld PCR failed to distinguish S. epidermidis BSIs from blood culture contaminations in patients with hematological malignancies.
Collapse
Affiliation(s)
- Erik Ahlstrand
- Department of Medicine, Hematology, Örebro University Hospital, Örebro, Sweden; Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | | | | | | | | | | |
Collapse
|
13
|
Schnell D, Lécuyer H, Geeraerts T, Dumenil AS, Bille E, Mercier FJ, Benhamou D, Zahar JR. Preliminary evaluation of a new clinical algorithm to interpret blood cultures growing coagulase-negative staphylococci. ACTA ACUST UNITED AC 2013; 45:562-6. [PMID: 23373849 DOI: 10.3109/00365548.2013.765590] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Evaluating the clinical significance of blood cultures positive for coagulase-negative staphylococci (CoNS) is of critical importance since these microorganisms represent both the first contaminants of blood cultures and one of the leading causes of bloodstream infection (BSI). This prospective 2-centre study aimed to compare a previously reported algorithm to a clinical algorithm based on our experience. We identified 84 patients with CoNS-positive blood cultures. Twenty-seven (32%) were considered to have BSI according to our study algorithm. Thirty-seven (44%) patients were considered to have CoNS BSI according to the previously reported algorithm. The 2 algorithms isolated patients with similar rates of recurrences and hospital mortality. Our algorithm seemed to result in less diagnoses of CoNS BSI without harmful consequences compared to the previously reported algorithm. The impact on patient outcome and the inappropriate use of antibiotics deserves further investigation.
Collapse
Affiliation(s)
- David Schnell
- Université Paris 11, Faculté de Médecine - Assistance Publique Hôpitaux de Paris, CHU Antoine Beclère, Réanimation Chirurgicale, Département d'Anesthésie, Clamart, France
| | | | | | | | | | | | | | | |
Collapse
|
14
|
Elzi L, Babouee B, Vögeli N, Laffer R, Dangel M, Frei R, Battegay M, Widmer A. How to discriminate contamination from bloodstream infection due to coagulase-negative staphylococci: a prospective study with 654 patients. Clin Microbiol Infect 2012; 18:E355-61. [DOI: 10.1111/j.1469-0691.2012.03964.x] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
15
|
Evaluation of quantitative antibiotic susceptibility testing by Vitek 2 as a routine method to predict strain relatedness of coagulase-negative staphylococci isolated from blood cultures. J Clin Microbiol 2011; 49:3355-7. [PMID: 21795506 DOI: 10.1128/jcm.05130-11] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
To test the hypothesis that the strain relatedness of coagulase-negative staphylococci (CoNS) recovered from blood cultures can be inferred from automated antibiotic susceptibility testing (AST) results generated by Vitek 2, concordant or discordant AST results were compared with pulsed-field gel electrophoresis (PFGE) typing results for 119 CoNS blood culture isolate pairs. Concordant AST results were highly predictive of the strain relatedness of CoNS isolates.
Collapse
|
16
|
Oud L. Community-acquired meningitis due to Staphylococcus capitis in the absence of neurologic trauma, surgery, or implants. Heart Lung 2011; 40:467-71. [PMID: 21411150 DOI: 10.1016/j.hrtlng.2010.09.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2010] [Revised: 08/06/2010] [Accepted: 09/10/2010] [Indexed: 01/05/2023]
Abstract
Community-acquired meningitis due to coagulase-negative staphylococci in adults has been rarely reported and generally develops in patients with ventricular shunts or after neurosurgery or neurotrauma. Staphylococcus capitis is a rare cause of adult meningitis. We describe a patient with community-acquired meningitis due to S. capitis, in the absence of traditional risk factors, with atypical presentation.
Collapse
Affiliation(s)
- Lavi Oud
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Texas Tech University Health Sciences Center at the Permian Basin, Odessa, Texas 79763, USA.
| |
Collapse
|
17
|
Rodríguez-Baño J, de Cueto M, Retamar P, Gálvez-Acebal J. Current management of bloodstream infections. Expert Rev Anti Infect Ther 2010; 8:815-29. [PMID: 20586566 DOI: 10.1586/eri.10.49] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Bloodstream infection (BSI) is a frequent complication of invasive infections. The presence of bacteremia has therapeutic and prognostic implications. Here we review recent changes in the epidemiology, diagnosis and treatment of BSI (excluding candidemia). The evidence of the impact of healthcare-association in many community-onset episodes and the increase in drug-resistant pathogens causing BSI in the community and hospitals is reviewed. The emergence of molecular methods as an alternative tool for the diagnosis of BSI and novel aspects of clinical management, particularly of some multidrug-resistant organisms. Several quality indicators related to the diagnosis and management of bacteremia in hospitals are proposed.
Collapse
Affiliation(s)
- Jesús Rodríguez-Baño
- Unidad Clínica de Enfermedades Infecciosas y Microbiología, Hospital Universitario Virgen Macarena, Avda Dr Fedriani 3, 41009 Sevilla, Spain.
| | | | | | | |
Collapse
|
18
|
Al Wohoush I, Rivera J, Cairo J, Hachem R, Raad I. Comparing clinical and microbiological methods for the diagnosis of true bacteraemia among patients with multiple blood cultures positive for coagulase-negative staphylococci. Clin Microbiol Infect 2010; 17:569-71. [PMID: 20854425 DOI: 10.1111/j.1469-0691.2010.03372.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
We assessed the accuracy of the Centers for Disease Control and Prevention (CDC) clinical criteria as well as other microbiological methods for the diagnosis of coagulase-negative staphylococci bacteraemia. The CDC clinical criteria had low accuracy, which can be improved by speciation, particularly if the patient had more than two positive blood cultures.
Collapse
Affiliation(s)
- I Al Wohoush
- Department of Infectious Diseases, Infection Control and Employee Health, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | | | | | | | | |
Collapse
|
19
|
Abstract
The potential to automate at least part of the surveillance process for health care-associated infections was seen as soon as hospitals began to implement computer systems. Progress toward automated surveillance has been ongoing for the last several decades. But as more information becomes available electronically in the healthcare setting, the promise of electronic surveillance for healthcare-associated infections has become closer to reality. Although true fully automated surveillance is not here yet, significant progress is being made at a number of centers for electronic surveillance of central catheter-associated bloodstream infections, ventilator-associated pneumonia, and other healthcare-associated infections. We review the progress that has been made in this area and issues that need to be addressed as surveillance systems are implemented, as well as promising areas for future development.
Collapse
|
20
|
Soga Y, Maeda Y, Ishimaru F, Tanimoto M, Maeda H, Nishimura F, Takashiba S. Bacterial substitution of coagulase-negative staphylococci for streptococci on the oral mucosa after hematopoietic cell transplantation. Support Care Cancer 2010; 19:995-1000. [PMID: 20535502 DOI: 10.1007/s00520-010-0923-9] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2009] [Accepted: 05/20/2010] [Indexed: 01/02/2023]
Abstract
PURPOSE Coagulase-negative staphylococci (CoNS) are frequently isolated from blood cultures of hematopoietic cell transplantation (HCT) patients. Generally, the use of central venous catheters is recognized as a significant risk factor for CoNS infection, while the impact of CoNS infection from oral ulcerative mucositis, which occurs frequently in HCT, may be underestimated. Here, we examined the bacteria on the buccal mucosa after HCT. METHODS Sixty-one patients were examined for bacteria on the buccal mucosa routinely once a week from 1 week before to 3 weeks after allogeneic HCT. Subjects were divided into groups with short and long periods of antibiotic use, and differences in bacterial substitution were evaluated. The relationships between type of HCT (conventional HCT or RIST) and bacterial substitution were also evaluated. RESULTS The changes in detection frequencies of CoNS and α-streptococci from before to 3 weeks after HCT were significant (P < 0.05, χ (2) test): 14.5-53.3% and 92.7-53.1%, respectively. Significant bacterial substitution of CoNS for streptococci was observed in the long-term antibiotic use group (P < 0.05, χ (2) test), but also occurred in cases with short-term or no antibiotic use. No relationships between type of HCT (conventional HCT or RIST) were observed. CONCLUSION Bacterial substitution of CoNS for streptococci occurred frequently on the buccal mucosa after HCT. In addition to antibiotic use, environmental factors may be involved in bacterial substitution. It is important to consider the presence of oral mucositis in CoNS infection after HCT.
Collapse
Affiliation(s)
- Yoshihiko Soga
- Department of Pathophysiology-Periodontal Science, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Kita-ku, Okayama, 700-8525, Japan
| | | | | | | | | | | | | |
Collapse
|
21
|
Clonal Diversity in Episodes with Multiple Coagulase-Negative Staphylococcus Bloodstream Isolates Suggesting Frequent Contamination. Infection 2008; 37:256-60. [DOI: 10.1007/s15010-008-8020-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2008] [Accepted: 05/05/2008] [Indexed: 11/27/2022]
|
22
|
Vandercam B, Jeumont S, Cornu O, Yombi JC, Lecouvet F, Lefèvre P, Irenge LM, Gala JL. Amplification-based DNA analysis in the diagnosis of prosthetic joint infection. J Mol Diagn 2008; 10:537-43. [PMID: 18832459 DOI: 10.2353/jmoldx.2008.070137] [Citation(s) in RCA: 65] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Microbiological cultures are moderately sensitive for diagnosing prosthetic joint infection (PJI). This study was conducted to determine whether amplification-based DNA methods applied on intraoperative samples could enhance PJI diagnosis compared with culture alone in routine surgical practice. Revision arthroplasty was performed for suspected PJI (n = 41) and osteoarthrosis control (n = 28) patients, and a diagnosis of PJI was confirmed in 34 patients. Amplification by polymerase chain reaction was performed on both 16S ribosomal DNA universal target genes and femA Staphylococcus-specific target genes. Species identification was achieved through amplicon sequencing. Amplification of the femA gene led to subsequent testing for methicillin resistance by amplification of the mecA gene. Microbiological and molecular assays identified a causative organism in 22 of 34 patients (64.7%) and in 31 of 34 patients (91.2%), respectively. In 18 of the 22 culture-positive patients, molecular and microbiological results were concordant for bacterial genus, species, and/or methicillin resistance. Bacterial agents were identified only by molecular methods in nine PJI patients, including seven who were receiving antibiotics at the time of surgery and one with recent but not concomitant antibiotherapy. DNA-based methods were found to effectively complement microbiological methods, without interfering with existing procedures for sample collection, for the identification of causative pathogens from intraoperative PJI samples, especially in patients with recent or concomitant antibiotherapy.
Collapse
Affiliation(s)
- Bernard Vandercam
- Division of Infectious Diseases, St-Luc's University Hospital, Université catholique de Louvain, Brussels, Belgium
| | | | | | | | | | | | | | | |
Collapse
|
23
|
Zingg W, Cartier-Fässler V, Walder B. Central venous catheter-associated infections. Best Pract Res Clin Anaesthesiol 2008; 22:407-21. [DOI: 10.1016/j.bpa.2008.05.007] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
|
24
|
Abstract
Coagulase-negative staphylococci (CoNS) are the main cause of catheter-related infections, especially among immunosuppressed and neutropenic patients, as well as a source of bacterial contamination in blood cultures. Using biochemical identification and pulsed-field gel electrophoresis (PFGE), we sought to identify possible clonal isolates of bacteremia in patients with central lines in an oncology ward (OW), with comparison to isolates that were recovered by venipuncture from an adult emergency room (ER). A total of 243 CoNS isolates were identified to species level from the OW (126) and ER (117), with Staphylococcus epidermidis isolates being the most common (OW, 79.4%; ER, 45.3%). PFGE demonstrated a predominant clone of S. epidermidis (major subtype A) which was 35.5 times more likely (odds ratio [OR] = 35.5; 95% confidence interval [CI] = 4.7 to 267.0; P < 0.00001) to be present in the OW versus the ER. These (CoNS or major subtype A) isolates were more frequently resistant to gentamicin (OR = 2.83; 95% CI = 1.23 to 6.53; P = 0.016) and less frequently resistant to trimethoprim-sulfamethoxazole (OR = 0.38; 95% CI = 0.18 to 0.80; P = 0.013). Subset analysis of S. epidermidis isolates 2 years after the study period showed the persistence of the clone of major subtype A within the OW. This study demonstrates the presence of a predominant clone among central line isolates from an OW that is not present in CoNS venipuncture isolates from an ER.
Collapse
|
25
|
The Effect of Infectious Diseases Consultation on the Use of Vancomycin in Patients With 2 Positive Blood Cultures for Coagulase-Negative Staphylococci. INFECTIOUS DISEASES IN CLINICAL PRACTICE 2008. [DOI: 10.1097/ipc.0b013e31815a5695] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
|
26
|
Locke BJ, Lowy FD. Use of colony morphology to characterize carriage profiles of coagulase negative staphylococci. Eur J Clin Microbiol Infect Dis 2007; 26:895-9. [PMID: 17885774 DOI: 10.1007/s10096-007-0387-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
The absence of a reliable method to distinguish among coagulase negative staphylococcal strains in mixed culture hinders elucidation of colonization traits and precise tracking of colonization. This study examined whether colonial morphology could be used to correctly identify coagulase negative staphylococcal strains in mixed cultures. Staphylococci were isolated from nasal and hand cultures of ten subjects at 0 and 3 months. Samples were initially screened for the predominant coagulase negative staphylococcal strain by colonial morphology. The strains were subsequently identified by phenotypic and biochemical testing. Pulsed field gel electrophoresis demonstrated that the morphologic criteria correctly grouped the strains in 91.1% (41/45) of samples. This study suggests that colonial morphology is a reliable method for the initial characterization of coagulase negative staphylococcal strains. This approach has potential value for epidemiological studies that involve establishing links between commensal flora and their potential role as pathogens in subsequent clinical infections.
Collapse
Affiliation(s)
- B J Locke
- Division of Infectious Diseases, Department of Medicine, Columbia University, College of Physicians & Surgeons, 630 West 168th Street, New York, NY 10032, USA
| | | |
Collapse
|
27
|
Abstract
Blood culture contamination represents an ongoing source of frustration for clinicians and microbiologists alike. Ambiguous culture results often lead to diagnostic uncertainty in clinical management and are associated with increased health care costs due to unnecessary treatment and testing. A variety of strategies have been investigated and employed to decrease contamination rates. In addition, numerous approaches to increase our ability to distinguish between clinically significant bacteremia and contamination have been explored. In recent years, there has been an increase in the application of computer-based tools to support infection control activities as well as provide clinical decision support related to the management of infectious diseases. Finally, new approaches for estimating bacteremia risk which have the potential to decrease unnecessary blood culture utilization have been developed and evaluated. In this review, we provide an overview of blood culture contamination and describe the potential utility of a variety of approaches to improve both detection and prevention. While it is clear that progress is being made, fundamental challenges remain.
Collapse
Affiliation(s)
- Keri K Hall
- Department of Internal Medicine, Division of Infectious Diseases, University of Virginia Health System, Charlottesville, VA 22908, USA.
| | | |
Collapse
|
28
|
Lok CE. Avoiding trouble down the line: the management and prevention of hemodialysis catheter-related infections. Adv Chronic Kidney Dis 2006; 13:225-44. [PMID: 16815229 DOI: 10.1053/j.ackd.2006.04.009] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Over the last 2 decades, hemodialysis catheter use has increased. Annually, approximately 30% of patients using a central venous catheter (CVC) experience a septic or bacteremic episode and are subsequently at risk of its associated long-term complications and mortality. Because of the serious clinical and financial impact of hemodialysis catheter-related bacteremias (HCRIs), standardized, validated definitions based on the hemodialysis patient population are necessary in order to better diagnose, monitor, and report HCRI for patient quality assurance and research purposes. The pathophysiology of HCRI involves a complex interaction between a triad that consists of the host patient, the infecting microorganism, and the vehicle catheter. Although the microorganism contribution in the pathogenesis of HCRI is likely most important, certain patient and catheter-related characteristics may be more amenable to manipulation. The key to managing HCRI is on prophylaxis against the initial microorganism catheter adherence and subsequent biofilm development. General and specific prophylactic maneuvers directed at both an intravascular and extraluminal route of microorganism entry are discussed including antibiotic- and silver-impregnated catheters and dressings, subcutaneous access devices, and topical prophylaxis at the exit site. In addition to systemic antibiotic use, the 3 methods of HRCI treatment using catheter salvage, guidewire exchange, and concurrent antibiotic lock are compared. The outcome and complications of HCRI may be serious and highlight the importance of careful, continual infection surveillance. Although the use of a multidisciplinary hemodialysis infection control team is desirable, staffing education and physician feedback have been shown to improve adherence to infection control guidelines and reduce HCRI.
Collapse
Affiliation(s)
- Charmaine E Lok
- Department of Medicine, Division of Nephrology, University Health Network-Toronto General Hospital and University of Toronto, Toronto, Ontario, Canada.
| |
Collapse
|
29
|
Persson L, Strid H, Tidefelt U, Söderquist B. Phenotypic and genotypic characterization of coagulase-negative staphylococci isolated in blood cultures from patients with haematological malignancies. Eur J Clin Microbiol Infect Dis 2006; 25:299-309. [PMID: 16786376 DOI: 10.1007/s10096-006-0129-8] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Coagulase-negative staphylococci are the predominant aetiological agents in bacteraemic patients hospitalized for haematological malignancies. The aim of this study was to determine whether differences exist in the prevalence of icaAB genes and in the phenotypic and/or genotypic pattern between blood isolates of coagulase-negative staphylococci, interpreted as representing true bacteraemia, and contaminant isolates from patients with haematological malignancies. Eighty-two isolates representing true bacteraemia and 47 contaminant isolates were found among 76 patients. The most prevalent species in both groups of patients was Staphylococcus epidermidis (n=103; 80%). Biochemical typing using the Phene Plate system and genotyping using pulsed-field gel electrophoresis showed a tendency towards a more homogeneous pattern among isolates causing true bacteraemia compared with contaminant isolates. Two major genotypic groups of S. epidermidis were found in both the true bacteraemia group and the contaminant group, with concordant pulsotypes found as well. These groups may comprise isolates carrying specific virulence factors, but the prevalence of the icaAB genes did not differ between the true bacteraemia group and the contaminant group. No significant difference was seen between the two study groups regarding clinical symptoms or complications, use of central venous catheter, and levels of absolute neutrophil count or C-reactive protein.
Collapse
Affiliation(s)
- L Persson
- Department of Infectious Diseases, Orebro University Hospital, 701 85, Orebro, Sweden.
| | | | | | | |
Collapse
|
30
|
Citton R, Pittiruti M, Cauda R, Tacconelli E. Old and new tools in the diagnosis of central venous catheter-related bloodstream infections: is there a role for brushing? J Vasc Access 2006; 5:10-2. [PMID: 16596532 DOI: 10.1177/112972980400500102] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Bloodstream infections (BSIs) are the third most common nosocomial infections. Catheters and other medical devices are the first exogenous causes of preventable infections in hospital. The estimated attributable mortality for catheter-associated BSI ranges from 1-35%, mainly depending on etiological agents and underlying disease. In considering this, it is necessary to reduce central venous catheter- (CVC)-related BSI prevalence and to obtain a rapid and accurate method for an early diagnosis. This review indicates the advantages and the disadvantages of old and new tools for the early diagnosis of CVC-related BSIs.
Collapse
Affiliation(s)
- R Citton
- Department of Infectious Diseases, Catholic University, Rome, Italy
| | | | | | | |
Collapse
|
31
|
Kallel H, Dammak H, Mahjoubi F, Bahloul M, Turki E, Chelly H, Rekik N, Hammami A, Bouaziz M. [Contamination of blood cultures drawn from central vein catheter and peripheral venipuncture. Prospective study of 75 pairs]. ACTA ACUST UNITED AC 2006; 54:44-8. [PMID: 16376178 DOI: 10.1016/j.patbio.2005.02.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2004] [Accepted: 02/09/2005] [Indexed: 10/25/2022]
Abstract
OBJECTIVE To determine the frequency of contamination, the sensitivity, specificity, and predictive values of cultures done with blood drawn through a central venous catheter or peripheral venipuncture. DESIGN Prospective cohort study of critical ill medical surgical intensive care patients in whom samples for paired culture were drawn through a central venous catheter or peripheral venipuncture during a period of 8 months (from August 1st 2001 to Mars 31st 2002). RESULTS During the study period, 75-paired cultures were studied. Fifteen peripheral blood cultures (20%) and 27 central blood cultures (36%) were positive and 6 peripheral blood cultures (8%) and 15 central blood cultures (20%) were contaminated (P=0.034). The organism most commonly responsible for contamination was Coagulase Negative Staphylococcus (16% of central blood cultures and 6.7% of peripheral blood cultures). The frequency of contamination was of 42.9% for blood cultures drawn through a femoral central venous catheter, of 10% for jugular, and of 19% for subclavian central venous catheter (P=0.22). For catheter draws compared with peripheral venipuncture, sensitivity was 100 and 75%, specificity was 76.2 and 90.5%, positive predictive value was 44.4 and 60% and negative predictive value was 100 and 95%. CONCLUSION Cultures of blood drawn through a catheter are more sensible and less specific than those obtained from a peripheral venipuncture and the organism most commonly responsible for contamination of blood cultures is Coagulase Negative Staphylococcus.
Collapse
Affiliation(s)
- H Kallel
- Service de réanimation médicale, CHU Habib Bourguiba, route El-Ain, km 1, 3029 Sfax, Tunisie.
| | | | | | | | | | | | | | | | | |
Collapse
|
32
|
Costa SF, Barone AA, Miceli MH, van der Heijden IM, Soares RE, Levin AS, Anaissie EJ. Colonization and molecular epidemiology of coagulase-negative Staphylococcal bacteremia in cancer patients: a pilot study. Am J Infect Control 2006; 34:36-40. [PMID: 16443091 DOI: 10.1016/j.ajic.2005.10.007] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Controversy surrounds the source (skin vs mucosa) of coagulase-negative staphylococci (CoNS) bacteremia in cancer patients. Determining the source of this infection has clinical and epidemiologic implications. OBJECTIVE To determine the source(s) of CoNS bacteremia in cancer patients. METHODS Between November 1998 and October 2000, cultures of nasal and rectal mucosa and skin at central venous catheter (CVC) sites were obtained in 62 patients (66 episodes) with CoNS-positive blood culture(s). Bacteremia was classified as true, indeterminate, or unlikely on the basis of clinical and microbiologic findings. Molecular relatedness of strains isolated from the blood and from colonized sites of patients with true and those with unlikely bacteremia was examined using pulsed-field gel electrophoresis (PFGE). RESULTS CoNS colonization was present in 55 episodes (83%). The nasal mucosa was the most frequently colonized site (86%), followed by rectal mucosa (40%) and skin at site of CVC insertion (38%) (P < .001). Colonization at > or =1 site was common. True and unlikely bacteremia accounted for 11 and 10 episodes, respectively, with the remaining 45 episodes considered undetermined or had negative surveillance cultures. Among patients with true bacteremia, 6 mucosal isolates and only 1 skin isolate were related by PFGE to the blood isolate recovered from the same patient. CONCLUSION Mucosa is the most common site of CoNS colonization and is the likely source of CoNS bacteremia in cancer patients.
Collapse
Affiliation(s)
- Silvia F Costa
- Nosocomial Infection Control Committee; Laboratório de Bacteriologia Médica (LIM54), Hospital das Clínicas da Universidade de São Paulo, Brazil
| | | | | | | | | | | | | |
Collapse
|
33
|
Trick WE, Zagorski BM, Tokars JI, Vernon MO, Welbel SF, Wisniewski MF, Richards C, Weinstein RA. Computer algorithms to detect bloodstream infections. Emerg Infect Dis 2004; 10:1612-20. [PMID: 15498164 PMCID: PMC3320282 DOI: 10.3201/eid1009.030978] [Citation(s) in RCA: 116] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
We compared manual and computer-assisted bloodstream infection surveillance for adult inpatients at two hospitals. We identified hospital-acquired, primary, central-venous catheter (CVC)-associated bloodstream infections by using five methods: retrospective, manual record review by investigators; prospective, manual review by infection control professionals; positive blood culture plus manual CVC determination; computer algorithms; and computer algorithms and manual CVC determination. We calculated sensitivity, specificity, predictive values, plus the kappa statistic (kappa) between investigator review and other methods, and we correlated infection rates for seven units. The kappa value was 0.37 for infection control review, 0.48 for positive blood culture plus manual CVC determination, 0.49 for computer algorithm, and 0.73 for computer algorithm plus manual CVC determination. Unit-specific infection rates, per 1,000 patient days, were 1.0-12.5 by investigator review and 1.4-10.2 by computer algorithm (correlation r = 0.91, p = 0.004). Automated bloodstream infection surveillance with electronic data is an accurate alternative to surveillance with manually collected data.
Collapse
Affiliation(s)
- William E Trick
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA.
| | | | | | | | | | | | | | | |
Collapse
|
34
|
Lecouvet F, Irenge L, Vandercam B, Nzeusseu A, Hamels S, Gala JL. The etiologic diagnosis of infectious discitis is improved by amplification-based DNA analysis. ACTA ACUST UNITED AC 2004; 50:2985-94. [PMID: 15457468 DOI: 10.1002/art.20462] [Citation(s) in RCA: 64] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
OBJECTIVE Blood cultures and cultures of disc material are required to identify and treat bacterial agents responsible for septic spondylodiscitis, but these methods have limited sensitivities. We undertook this study to compare nonculture amplification-based DNA analysis with conventional culture of disc aspirate. METHODS Nineteen patients with spondylodiscitis, including 11 with a history of spinal surgery, presented with negative blood cultures and underwent percutaneous disc or epidural abscess puncture for bacterial diagnosis. Amplification by polymerase chain reaction was performed on 16S ribosomal DNA universal target genes and femA staphylococci-specific target genes in all patients, and on the upstream p34 mycobacterial gene in 1 patient. Species identification relied on amplicon sequencing and comparison with templates from GenBank. Amplification of the femA gene led to subsequent testing for methicillin resistance by amplification of the mecA gene. Further assessment using a staphylococci- and methicillin resistance-specific DNA array was performed on 3 samples. RESULTS Microbiologic and molecular assays identified the causative organism in 14 of 19 patients (74%) and 19 of 19 patients (100%), respectively. In culture-positive patients, DNA-based and microbiologic results were highly correlated. Five agents (Staphylococcus simulans, Staphylococcus sciuri, Brucella species, Actinomyces israelii, and Mycobacterium tuberculosis complex) were identified only by DNA-based methods. In 1 sample, Corynebacterium jeikeium and coagulase-negative Staphylococcus were both cultured, whereas DNA analysis identified only Staphylococcus hominis. CONCLUSION DNA-based methods are highly sensitive and specific. They can usefully complement standard microbiologic methods for identifying the cause of infectious spondylodiscitis and contribute to species-specific therapeutic orientation in patients with negative blood and disc aspirate cultures.
Collapse
Affiliation(s)
- Frédéric Lecouvet
- Saint Luc University Hospital, Université Catholique de Louvain, Brussels, Belgium
| | | | | | | | | | | |
Collapse
|
35
|
Krause R, Haberl R, Wölfler A, Daxböck F, Auner HW, Krejs GJ, Wenisch C, Reisinger EC. Molecular typing of coagulase-negative staphylococcal blood and skin culture isolates to differentiate between bacteremia and contamination. Eur J Clin Microbiol Infect Dis 2003; 22:760-3. [PMID: 14605936 DOI: 10.1007/s10096-003-1005-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
In order to determine whether a blood culture positive for coagulase-negative staphylococci (CNS) represents bacteremia or contamination, a prospective study was conducted using molecular typing to analyze CNS blood culture isolates and corresponding CNS skin isolates collected after skin disinfection from 431 subjects. CNS bacteremia was not found in any of the 301 subjects not suspected of having bacteremia. In 130 patients suspected of having bacteremia, the rate of actual CNS bacteremia was 6%. The overall rate of CNS blood culture contamination was 1%. Chart analysis showed good agreement between our microbiological definitions of bacteremia and the clinical definitions previously published. Bacteremia and contamination can be differentiated using pulsed-field gel electrophoresis and molecular typing of CNS isolates obtained from cultures of blood and corresponding skin samples.
Collapse
Affiliation(s)
- R Krause
- Division of Infectious Diseases, Department of Internal Medicine, University Medical Center, Auenbruggerplatz 15, 8036 Graz, Austria.
| | | | | | | | | | | | | | | |
Collapse
|
36
|
Haimi-Cohen Y, Shafinoori S, Tucci V, Rubin LG. Use of incubation time to detection in BACTEC 9240 to distinguish coagulase-negative staphylococcal contamination from infection in pediatric blood cultures. Pediatr Infect Dis J 2003; 22:968-74. [PMID: 14614369 DOI: 10.1097/01.inf.0000095195.60494.ba] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Growth of coagulase-negative staphylococci (CoNS) in a blood culture indicates infection or contamination. Differentiation may be difficult in pediatric patients from whom only a single blood culture is commonly obtained. METHODS We evaluated the use of the incubation time to detection of growth [time to positive (TTP)] of CoNS in a continuously monitored blood culture system (BACTEC Peds/F bottles in BACTEC 9240) to differentiate infection from contamination. Three groups of febrile pediatric patients with blood cultures growing CoNS were identified: Group 1, children with vascular catheter-associated bloodstream infection; Group 2, previously healthy children with a contaminant; Group 3, chronically ill children with a contaminant. RESULTS The median TTP for blood cultures from the 17 infection episodes, 11 h [mean, 13.2 h; 95% confidence interval (CI), 11.4 to 17.7], was significantly shorter than either the 30 episodes in the previously healthy group with contaminant, median 19 h (mean, 22.7 h; 95% CI 19.5 to 26.2; P < 0.0001) or the 12 episodes in the chronically ill group with contaminant, median 24 h (mean, 35.2 h; 95% CI 17.2 to 53.1; P < 0.0001). A TTP of < or =15 h had a positive predictive value of 84% for diagnosis of infection. A TTP of > or =22 h had a positive predictive value of 87% for diagnosis of contaminant. CONCLUSION In our experience the TTP was a useful adjunctive test to determine the clinical significance of isolation of CoNS from a blood culture from a pediatric patient.
Collapse
Affiliation(s)
- Yishai Haimi-Cohen
- Division of Infectious Diseases, Department of Pediatrics, Schneider Children's Hospital, Long Island Jewish Medical Center, North Shore/Long Island Jewish Health System, New Hyde Park, NY, USA
| | | | | | | |
Collapse
|
37
|
Seifert H, Cornely O, Seggewiss K, Decker M, Stefanik D, Wisplinghoff H, Fätkenheuer G. Bloodstream infection in neutropenic cancer patients related to short-term nontunnelled catheters determined by quantitative blood cultures, differential time to positivity, and molecular epidemiological typing with pulsed-field gel electrophoresis. J Clin Microbiol 2003; 41:118-23. [PMID: 12517836 PMCID: PMC149641 DOI: 10.1128/jcm.41.1.118-123.2003] [Citation(s) in RCA: 99] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
To determine the rate of catheter-related bloodstream infection (CRBSI) among cases of primary bloodstream infection (BSI) in febrile neutropenic cancer patients with short-term nontunnelled catheters, quantitative paired blood cultures (Isolator) from the central venous catheter (CVC) and peripheral vein were obtained between November 1999 and January 2001. Bactec blood culture bottles were obtained to determine the differential time to positivity (DTP). CRBSI was defined as a quantitative blood culture ratio of >5:1 (CVC versus peripheral) with proven identity of isolates from positive peripheral and CVC blood cultures as confirmed by pulsed-field gel electrophoresis. Forty-nine episodes of primary BSI were detected among 235 cancer patients with febrile neutropenia. Of these, 18 episodes (37%) were CRBSI and 31 (63%) were BSI with an unknown portal of entry. Coagulase-negative staphylococci were present in nine cases of CRBSI (50%). The identity of isolates from peripheral and CVC blood cultures was confirmed in all cases. Earlier positivity (>2 h) of CVC-drawn versus peripheral blood cultures was observed in 18 of 22 CRBSI-associated blood cultures (sensitivity, 82%; specificity, 88%; positive predictive value, 75%; negative predictive value, 92%). In summary, CRBSI accounted for 37% of cases of primary BSI in this population of neutropenic cancer patients. DTP compares favourably with quantitative blood cultures for the diagnosis of CRBSI and may be particularly useful for patients in whom catheter salvage is highly desirable.
Collapse
Affiliation(s)
- Harald Seifert
- Institute of Medical Microbiology, Immunology and Hygiene, University of Cologne, Cologne, Germany.
| | | | | | | | | | | | | |
Collapse
|
38
|
Petinaki E, Miriagou V, Tzouvelekis LS, Hatzi F, Legakis NJ, Maniatis AN. Evaluation of an anti-PBP 2a slide latex agglutination test in coagulase-negative staphylococci isolated in Greek hospitals. Diagn Microbiol Infect Dis 2002; 42:279-82. [PMID: 12007447 DOI: 10.1016/s0732-8893(01)00362-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Oxacillin resistance was examined in 258 coagulase-negative staphylococci from Greek hospitals. mecA DNA was detected in 168 isolates, which were also resistant to oxacillin by agar dilution and disk diffusion, according to the current NCCLS breakpoints. Both methods exhibited a relatively low specificity misclassifying 21 and 19 of the 90 mecA-negative isolates respectively as oxacillin resistant. In contrast, an anti-PBP 2a latex agglutination test, applied after induction by oxacillin, correctly classified 163 mecA-positive (sensitivity 97%) and 88 mecA-negative isolates (specificity 97.7%).
Collapse
Affiliation(s)
- E Petinaki
- Department of Microbiology, Medical School, University of Thessaly, Larissa, Greece
| | | | | | | | | | | |
Collapse
|
39
|
Abstract
Intravascular devices (IVDs) are widely used in modern day health care. Unfortunately, their use is associated with substantial risk of bloodstream infection (BSI) and sepsis, with increased hospitalization and hospital mortality. IVDs are the most common cause of nosocomial BSI. The wider use of new methodologies for diagnosis of IVD-related infection should allow earlier and more focused therapy and, especially, improve the accuracy of surveillance. Of all nosocomial infections, IVD-related BSIs are most amendable to prevention.
Collapse
|
40
|
Sharma M, Riederer K, Johnson LB, Khatib R. Molecular analysis of coagulase-negative Staphylococcus isolates from blood cultures: prevalence of genotypic variation and polyclonal bacteremia. Clin Infect Dis 2001; 33:1317-23. [PMID: 11565071 DOI: 10.1086/322673] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2000] [Revised: 04/09/2001] [Indexed: 11/03/2022] Open
Abstract
Fifty-seven coagulase-negative Staphylococcus isolates from 22 inpatients who had > or =2 blood cultures that were positive for Staphylococcus within 24 hours were analyzed to determine the frequency of polyclonal bacteremia. Patients were considered to have bacteremia (14 patients) or contamination of sample (8 patients) on the basis of clinical criteria. Nine colonies were randomly selected from each blood culture and genotyped by means of SmaI digestion/pulsed-field gel electrophoresis. Relatedness was determined by calculation of the Dice coefficient of banding-pattern similarity (S(AB)). Analysis of bacteremic isolates demonstrated the presence of a single species in 35 of 41 blood cultures, 1 related variant in 5 blood cultures (87%-92% S(AB)), and an unrelated strain in 1 blood culture (79% S(AB)). Analysis of contaminated samples demonstrated the presence of a single strain in 10 of 16 blood cultures and 1-3 variants (28%-97% S(AB)) in the remainder. Genotype diversity was significantly more common in the contaminated samples (P=.036). Almost all coagulase-negative Staphylococcus bacteremias were monoclonal.
Collapse
Affiliation(s)
- M Sharma
- Department of Medicine, St. John Hospital and Medical Center, Detroit, MI 48236, USA
| | | | | | | |
Collapse
|