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Noh GY, Park YS, Kim SH, Song SA, Shin JH. Clinical usefulness of anaerobic blood culture in pediatric patients with bacteremia. Anaerobe 2023; 84:102804. [PMID: 37993055 DOI: 10.1016/j.anaerobe.2023.102804] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Revised: 09/23/2023] [Accepted: 11/12/2023] [Indexed: 11/24/2023]
Abstract
OBJECTIVES The purpose of this study is to evaluate the usefulness of anaerobic blood culture in pediatric patients by comparing the detection rate and distribution of bacteria between aerobic and anaerobic blood culture bottles. METHODS A retrospective analysis was conducted on 11,664 blood cultures obtained from children under the age of 14 between January 2013 and June 2020. The positive rate of total, aerobic, and anaerobic blood culture, as well as the species distribution of each blood culture bottle, were investigated. RESULTS The positive rate of blood culture was 2.4 % (N = 281). Among them, 67 (23.8 %), 85 (30.3 %) and 129 (45.9 %) organisms were grown in only aerobic, only anaerobic, and both blood culture bottles, respectively. Gram-positive cocci were cultured on both, only aerobic, and only anaerobic blood culture bottles in proportions of 46.4 %, 23.4 %, and 30.2 %, respectively. Gram-negative bacilli were cultured on both, only aerobic, and only anaerobic blood culture bottles in proportions of 58.5 %, 12,3 %, and 29.2 %, respectively. Gram-positive bacilli grew best in aerobic bottle only. There were seven strains of obligate anaerobes. CONCLUSION Because many facultative anaerobic bacteria are recognized primarily from anaerobic blood culture bottles, combining aerobic and anaerobic blood culture bottles might be beneficial in pediatric patients with suspected blood stream infection.
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Affiliation(s)
- Ga Young Noh
- Inje University College of Medicine, Busan, Republic of Korea
| | - Yoon Soo Park
- Inje University College of Medicine, Busan, Republic of Korea
| | - Si Hyun Kim
- Department of Clinical Laboratory Science, Semyung University, Jecheon, Republic of Korea
| | - Sae Am Song
- Department of Laboratory Medicine, Inje University College of Medicine, Busan, Republic of Korea
| | - Jeong Hwan Shin
- Department of Laboratory Medicine, Inje University College of Medicine, Busan, Republic of Korea; Paik Institute for Clinical Research, Inje University, Busan, Republic of Korea.
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2
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Friedrich B, Lyer S, Janko C, Unterweger H, Brox R, Cunningham S, Dutz S, Taccardi N, Bikker FJ, Hurle K, Sebald H, Lenz M, Spiecker E, Fester L, Hackstein H, Strauß R, Boccaccini AR, Bogdan C, Alexiou C, Tietze R. Scavenging of bacteria or bacterial products by magnetic particles functionalized with a broad-spectrum pathogen recognition receptor motif offers diagnostic and therapeutic applications. Acta Biomater 2022; 141:418-428. [PMID: 34999260 DOI: 10.1016/j.actbio.2022.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Revised: 12/21/2021] [Accepted: 01/03/2022] [Indexed: 11/19/2022]
Abstract
Sepsis is a dysregulated host response of severe bloodstream infections, and given its frequency of occurrence and high mortality rate, therapeutic improvements are imperative. A reliable biomimetic strategy for the targeting and separation of bacterial pathogens in bloodstream infections involves the use of the broad-spectrum binding motif of human GP-340, a pattern-recognition receptor of the scavenger receptor cysteine rich (SRCR) superfamily that is expressed on epithelial surfaces but not found in blood. Here we show that these peptides, when conjugated to superparamagnetic iron oxide nanoparticles (SPIONs), can separate various bacterial endotoxins and intact microbes (E. coli, S. aureus, P. aeruginosa and S. marcescens) with high efficiency, especially at low and thus clinically relevant concentrations. This is accompanied by a subsequent strong depletion in cytokine release (TNF, IL-6, IL-1β, Il-10 and IFN-γ), which could have a direct therapeutic impact since escalating immune responses complicates severe bloodstream infections and sepsis courses. SPIONs are coated with aminoalkylsilane and capture peptides are orthogonally ligated to this surface. The particles behave fully cyto- and hemocompatible and do not interfere with host structures. Thus, this approach additionally aims to dramatically reduce diagnostic times for patients with suspected bloodstream infections and accelerate targeted antibiotic therapy. STATEMENT OF SIGNIFICANCE: Sepsis is often associated with excessive release of cytokines. This aspect and slow diagnostic procedures are the major therapeutic obstacles. The use of magnetic particles conjugated with small peptides derived from the binding motif of a broad-spectrum mucosal pathogen recognition protein GP-340 provides a highly efficient scavenging platform. These peptides are not found in blood and therefore are not subject to inhibitory mechanisms like in other concepts (mannose binding lectine, aptamers, antibodies). In this work, data are shown on the broad bacterial binding spectrum, highly efficient toxin depletion, which directly reduces the release of cytokines. Host cells are not affected and antibiotics not adsorbed. The particle bound microbes can be recultured without restriction and thus be used directly for diagnostics.
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Affiliation(s)
- Bernhard Friedrich
- Department of Otorhinolaryngology, Head and Neck Surgery, Section of Experimental Oncology and Nanomedicine (SEON), Else Kröner-Fresenius-Stiftung-Professorship, Universitätsklinikum Erlangen, Germany
| | - Stefan Lyer
- Department of Otorhinolaryngology, Head and Neck Surgery, Section of Experimental Oncology and Nanomedicine (SEON), Else Kröner-Fresenius-Stiftung-Professorship, Universitätsklinikum Erlangen, Germany
| | - Christina Janko
- Department of Otorhinolaryngology, Head and Neck Surgery, Section of Experimental Oncology and Nanomedicine (SEON), Else Kröner-Fresenius-Stiftung-Professorship, Universitätsklinikum Erlangen, Germany
| | - Harald Unterweger
- Department of Otorhinolaryngology, Head and Neck Surgery, Section of Experimental Oncology and Nanomedicine (SEON), Else Kröner-Fresenius-Stiftung-Professorship, Universitätsklinikum Erlangen, Germany
| | - Regine Brox
- Department of Transfusion Medicine and Hemostaseology, Universitätsklinikum Erlangen, Germany
| | - Sarah Cunningham
- Department of Transfusion Medicine and Hemostaseology, Universitätsklinikum Erlangen, Germany
| | - Silvio Dutz
- Institute of Biomedical Engineering and Informatics (BMTI), Technische Universität Ilmenau, Germany
| | - Nicola Taccardi
- Institute of Chemical Reaction Engineering, Friedrich-Alexander-Universität (FAU) Erlangen-Nürnberg, Germany
| | - Floris J Bikker
- Department of Oral Biochemistry, Academic Center for Dentistry Amsterdam (ACTA), University of Amsterdam (UvA) and Vrije Universiteit Amsterdam (VU), the Netherlands
| | - Katrin Hurle
- GeoZentrum Nordbayern, Mineralogy, Friedrich-Alexander-Universität (FAU) Erlangen-Nürnberg, Germany
| | - Heidi Sebald
- Immunologie und Hygiene, Mikrobiologisches Institut - Klinische Mikrobiologie, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität (FAU) Erlangen-Nürnberg, Germany
| | - Malte Lenz
- Institute of Micro- and Nanostructure Research and Center for Nanoanalysis and Electron Microscopy (CENEM), Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Germany; Interdisciplinary Center for Nanostructure Films (IZNF), Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Germany
| | - Erdmann Spiecker
- Institute of Micro- and Nanostructure Research and Center for Nanoanalysis and Electron Microscopy (CENEM), Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Germany; Interdisciplinary Center for Nanostructure Films (IZNF), Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Germany
| | - Lars Fester
- Institute of Anatomy and Cell Biology Friedrich-Alexander-Universität (FAU) Erlangen-Nürnberg, Germany
| | - Holger Hackstein
- Department of Transfusion Medicine and Hemostaseology, Universitätsklinikum Erlangen, Germany
| | - Richard Strauß
- Department of Medicine 1, Universitätsklinikum Erlangen, Germany
| | - Aldo R Boccaccini
- Institute of Biomaterials, Department of Materials Science and Engineering, Friedrich-Alexander-Universität (FAU) Erlangen-Nürnberg, Germany
| | - Christian Bogdan
- Immunologie und Hygiene, Mikrobiologisches Institut - Klinische Mikrobiologie, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität (FAU) Erlangen-Nürnberg, Germany
| | - Christoph Alexiou
- Department of Otorhinolaryngology, Head and Neck Surgery, Section of Experimental Oncology and Nanomedicine (SEON), Else Kröner-Fresenius-Stiftung-Professorship, Universitätsklinikum Erlangen, Germany
| | - Rainer Tietze
- Department of Otorhinolaryngology, Head and Neck Surgery, Section of Experimental Oncology and Nanomedicine (SEON), Else Kröner-Fresenius-Stiftung-Professorship, Universitätsklinikum Erlangen, Germany.
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3
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Brink AJ, Centner CM, Opperman S. Microbiology Assessments in Critically Ill Patients. Semin Respir Crit Care Med 2022; 43:75-96. [PMID: 35172360 DOI: 10.1055/s-0041-1741018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
The prevalence of suspected or proven infections in critically ill patients is high, with a substantial attributable risk to in-hospital mortality. Coordinated guidance and interventions to improve the appropriate microbiological assessment for diagnostic and therapeutic decisions are therefore pivotal. Conventional microbiology follows the paradigm of "best practice" of specimen selection and collection, governed by laboratory processing and standard operating procedures, and informed by the latest developments and trends. In this regard, the preanalytical phase of a microbiological diagnosis is crucial since inadequate sampling may result in the incorrect diagnosis and inappropriate management. In addition, the isolation and detection of contaminants interfere with multiple intensive care unit (ICU) processes, which confound the therapeutic approach to critically ill patients. To facilitate bedside enablement, the microbiology laboratory should provide expedited feedback, reporting, and interpretation of results. Compared with conventional microbiology, novel rapid and panel-based diagnostic strategies have the clear advantages of a rapid turnaround time, the detection of many microorganisms including antimicrobial resistant determinants and thus promise substantial improvements in health care. However, robust data on the clinical evaluation of rapid diagnostic tests in presumed sepsis, sepsis and shock are extremely limited and more rigorous intervention studies, focusing on direct benefits for critically ill patients, are pivotal before widespread adoption of their use through the continuum of ICU stay. Advocating the use of these diagnostics without firmly establishing which patients would benefit most, how to interpret the results, and how to treat according to the results obtained, could in fact be counterproductive with regards to diagnostic "best practice" and antimicrobial stewardship. Thus, for the present, they may supplement but not yet supplant conventional microbiological assessments.
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Affiliation(s)
- Adrian John Brink
- Division of Medical Microbiology, Department of Pathology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa.,National Health Laboratory Service, Groote Schuur Hospital, Cape Town, South Africa
| | - Chad M Centner
- Division of Medical Microbiology, Department of Pathology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa.,National Health Laboratory Service, Groote Schuur Hospital, Cape Town, South Africa
| | - Stefan Opperman
- Division of Medical Microbiology, Department of Pathology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa.,National Health Laboratory Service, Green Point, Cape Town, South Africa
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4
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Gounassegarane D, Biswas R, Sastry AS, Tp E, Penumadu P, Raja K. Bacteremia due to obligate anaerobes following large bowel surgery in a tertiary care hospital in South India. Indian J Med Microbiol 2022; 40:309-310. [PMID: 35033391 DOI: 10.1016/j.ijmmb.2022.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Revised: 12/22/2021] [Accepted: 01/03/2022] [Indexed: 11/05/2022]
Abstract
In view of the rising incidence of Anaerobic bacteremia(AB), the use of anaerobic blood culture bottles have been recommended in addition to the aerobic blood culture bottles. The need to perform antimicrobial susceptibility testing(AST) for anaerobes has become mandatory owing to increasing metronidazole resistance. The frequency of AB following large bowel surgery and the metronidazole susceptibility for members of the Bacteroides fragilis group were determined. The incidence of AB was found to be 16%. Seventeen obligate anaerobes were isolated in total, of which B. fragilis was the most common. Two of twelve isolates of B. fragilis were resistant to metronidazole.
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Affiliation(s)
- Dhanalakshmi Gounassegarane
- Department of Microbiology, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India.
| | - Rakhi Biswas
- Department of Microbiology, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India.
| | - Apurba Sankar Sastry
- Department of Microbiology, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India.
| | - Elamurugan Tp
- Department of General Surgery, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India.
| | - Prasanth Penumadu
- Department of Surgical Oncology, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India.
| | - Kalayarasan Raja
- Department of Surgical Gastroenterology, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India.
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5
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Neonatal blood culture inoculant volume: feasibility and challenges. Pediatr Res 2021; 90:1086-1092. [PMID: 33824451 PMCID: PMC8492767 DOI: 10.1038/s41390-021-01484-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Revised: 03/04/2021] [Accepted: 03/04/2021] [Indexed: 01/30/2023]
Abstract
BACKGROUND Clinicians often express concerns about poor sensitivity of blood cultures in neonates resulting from inadequate inoculant volumes. Our objective was to determine the inoculant volume sent for neonatal sepsis evaluations and identify areas of improvement. METHODS Single-center prospective observational study of infants undergoing sepsis evaluation. Blood volume was determined by clinician documentation over 21 months, and additionally by weighing culture bottles during 12 months. Adequate volume was defined as ≥1 mL total inoculant per evaluation. For first-time evaluations, local guidelines recommend sending an aerobic-anaerobic pair with 1 mL inoculant in each. RESULTS There were 987 evaluations in 788 infants. Clinicians reported ≥1 mL total inoculant in 96.9% evaluations. Among 544 evaluations where bottles were weighed, 93.4% had ≥1 mL total inoculant. Very low birth weight infants undergoing evaluations >7 days after birth had the highest proportion of inadequate inoculants (14.4%). Only 3/544 evaluations and 26/1011 bottles had total inoculant <0.5 mL. Ninety evaluations had <1 mL in both aerobic and anaerobic bottles despite a total inoculant volume that allowed inoculation of ≥1 mL in one of the bottles. CONCLUSIONS Obtaining recommended inoculant volumes is feasible in majority of neonates. Measuring inoculant volumes can focus improvement efforts and improve test reliability. IMPACT Clinicians express concern about the unreliability of neonatal blood cultures because of inadequate inoculant volume. We investigated over 900 evaluations and found >90% of evaluations have ≥1 mL inoculant. Monitoring adequacy of blood culture technique can identify areas of improvement and may allay concerns about blood culture reliability. Current recommendations for adequate inoculant volume for blood cultures are met in a majority of neonates. Areas of improvement include preterm late-onset sepsis evaluations and distribution techniques during inoculation.
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6
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Yang Y, Zhang Q, Hu H, Zhang W, Lu T. Bloodstream infection caused by Bacteroides caccae in a patient with renal hypertension: a case report. J Int Med Res 2021; 49:3000605211047277. [PMID: 34704482 PMCID: PMC8554563 DOI: 10.1177/03000605211047277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Bacteroides caccae is an anaerobic bacterium with a reportedly high isolation rate; however, it rarely causes bloodstream infections. Patients with hypertension are at increased risk of developing anaerobic bacterial infection. In this study, we report a case of bacteremia caused by B. caccae in a patient with renal hypertension and gastrointestinal hemorrhage. This study describes the clinical manifestations of bloodstream infection involving B. caccae to provide guidance for laboratory technicians and clinicians. A 42-year-old Chinese man was admitted for gastrointestinal hemorrhage and subsequently diagnosed with anaerobic blood infection. The pathogenic bacteria isolated from anaerobic blood culture bottles were identified as B. caccae by using an automatic bacterial identification instrument and mass spectrometry (MS). B. caccae is an intestinal opportunistic pathogen that can invade the intestinal mucosa and cause anaerobic bloodstream infection. Two or more sets of blood cultures and MS identification can greatly improve the positive detection rate of blood cultures of anaerobic bacteria. Furthermore, the increased drug resistance of anaerobic bacteria necessitates drug sensitivity tests for anaerobic bacteria in many hospitals. Thus, the early prevention and control of primary diseases with appropriate diagnoses and timely anti-infection therapies are necessary to reduce B. caccae bloodstream infection.
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Affiliation(s)
- Yang Yang
- Clinical Laboratory Center, Jiangsu Taizhou People's Hospital, Taizhou, Jiangsu, P. R. China
| | - Qingfang Zhang
- Clinical Laboratory Center, Jiangsu Taizhou People's Hospital, Taizhou, Jiangsu, P. R. China
| | - Haitao Hu
- Clinical Laboratory Center, Jiangsu Taizhou People's Hospital, Taizhou, Jiangsu, P. R. China
| | - Wenyun Zhang
- Clinical Laboratory Center, Jiangsu Taizhou People's Hospital, Taizhou, Jiangsu, P. R. China
| | - Taohong Lu
- Clinical Laboratory Center, Jiangsu Taizhou People's Hospital, Taizhou, Jiangsu, P. R. China
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7
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Stoneham S, Schilling W, San Francisco A, Llewelyn M. Twelve year analysis of aerobic-only blood cultures for routine detection of bacteraemia. J Hosp Infect 2020; 104:592-596. [DOI: 10.1016/j.jhin.2019.11.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2019] [Accepted: 11/28/2019] [Indexed: 10/25/2022]
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8
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Lafaurie M, d'Anglejan E, Donay JL, Glotz D, Sarfati E, Mimoun M, Legrand M, Oksenhendler E, Bagot M, Valade S, Bercot B, Molina JM. Utility of anaerobic bottles for the diagnosis of bloodstream infections. BMC Infect Dis 2020; 20:142. [PMID: 32059701 PMCID: PMC7023744 DOI: 10.1186/s12879-020-4854-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2019] [Accepted: 02/06/2020] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Obligate anaerobes usually account for less than 10% of bacteria recovered from blood cultures (BC). The relevance of routine use of the anaerobic bottle is under debate. The aim of this study was to evaluate the utility of anaerobic bottles for the diagnosis of bloodstream infections (BSI). METHODS We conducted a 6-month, retrospective, monocentric study in a tertiary hospital. All positive BC were grouped into a single episode of bacteremia when drawn within 7 consecutive days. Bacteremia were classified into contaminants and BSI. Charts of patients with BSI due to obligate anaerobes were studied. RESULTS A total of 19,739 blood cultures were collected, 2341 of which (11.9%) were positive. Anaerobic bottles were positive in 1528 (65.3%) of all positive BC but were positive alone (aerobic bottles negative) in 369 (15.8%). Overall 1081 episodes of bacteremia were identified, of which 209 (19.3%) had positive anaerobic bottles alone. The majority 126/209 (60.3%) were contaminants and 83 (39.7%) were BSI. BSI due to facultative anaerobes, obligate aerobes and obligate anaerobes were identified in 67 (80.7%), 3 (3.6%) and 13 (15.7%) of these 83 episodes, respectively. BSI due to obligate anaerobic bacteria were reported in 9 patients with gastro-intestinal disease, in 3 with febrile neutropenia and in 1 burned patient. CONCLUSIONS Anaerobic bottles contributed to the diagnosis of a significant number of episodes of bacteremia. Isolated bacteria were mostly contaminants and non-obligate anaerobic pathogens. Rare BSI due to obligate anaerobes were reported mainly in patients with gastro-intestinal disorders and during febrile neutropenia.
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Affiliation(s)
- M Lafaurie
- Department of Infectious Diseases, Saint-Louis Hospital, Paris, University of Paris Diderot Paris 7, Sorbonne Paris Cité, INSERM U941, Paris, France. .,Department of Infectious Diseases, Saint-Louis Hospital, Assistance Publique des Hôpitaux de Paris, 1 avenue Claude Vellefaux, Paris, 75010, France.
| | - E d'Anglejan
- Department of Infectious Diseases, Saint-Louis Hospital, Paris, University of Paris Diderot Paris 7, Sorbonne Paris Cité, INSERM U941, Paris, France
| | - J L Donay
- Laboratory of Microbiology, Saint-Louis Hospital, Paris, France
| | - D Glotz
- Nephrology Unit, Saint-Louis Hospital, Paris, France
| | - E Sarfati
- Department of Digestive and Emergency Surgery, Saint-Louis Hospital, Paris, France
| | - M Mimoun
- Department of Plastic Surgery, Saint-Louis Hospital, Paris, France
| | - M Legrand
- Department of Anesthesiology, Critical Care and Burn Unit, St-Louis hospital, University Paris Diderot, Paris, France
| | - E Oksenhendler
- Department of Clinical Immunopathology, Saint-Louis Hospital, Paris, France
| | - M Bagot
- Dermatology Department, Saint-Louis Hospital, Paris, France
| | - S Valade
- Intensive Care Unit, Saint-Louis Hospital, Paris, France
| | - B Bercot
- Laboratory of Microbiology, Saint-Louis Hospital, Paris, France
| | - J M Molina
- Department of Infectious Diseases, Saint-Louis Hospital, Paris, University of Paris Diderot Paris 7, Sorbonne Paris Cité, INSERM U941, Paris, France
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9
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Ombelet S, Barbé B, Affolabi D, Ronat JB, Lompo P, Lunguya O, Jacobs J, Hardy L. Best Practices of Blood Cultures in Low- and Middle-Income Countries. Front Med (Lausanne) 2019; 6:131. [PMID: 31275940 PMCID: PMC6591475 DOI: 10.3389/fmed.2019.00131] [Citation(s) in RCA: 66] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2019] [Accepted: 05/29/2019] [Indexed: 12/25/2022] Open
Abstract
Bloodstream infections (BSI) have a substantial impact on morbidity and mortality worldwide. Despite scarcity of data from many low- and middle-income countries (LMICs), there is increasing awareness of the importance of BSI in these countries. For example, it is estimated that the global mortality of non-typhoidal Salmonella bloodstream infection in children under 5 already exceeds that of malaria. Reliable and accurate diagnosis of these infections is therefore of utmost importance. Blood cultures are the reference method for diagnosis of BSI. LMICs face many challenges when implementing blood cultures, due to financial, logistical, and infrastructure-related constraints. This review aims to provide an overview of the state-of-the-art of sampling and processing of blood cultures, with emphasis on its use in LMICs. Laboratory processing of blood cultures is relatively straightforward and can be done without the need for expensive and complicated equipment. Automates for incubation and growth monitoring have become the standard in high-income countries (HICs), but they are still too expensive and not sufficiently robust for imminent implementation in most LMICs. Therefore, this review focuses on "manual" methods of blood culture, not involving automated equipment. In manual blood cultures, a bottle consisting of a broth medium supporting bacterial growth is incubated in a normal incubator and inspected daily for signs of growth. The collection of blood for blood culture is a crucial step in the process, as the sensitivity of blood cultures depends on the volume sampled; furthermore, contamination of the blood culture (accidental inoculation of environmental and skin bacteria) can be avoided by appropriate antisepsis. In this review, we give recommendations regarding appropriate blood culture sampling and processing in LMICs. We present feasible methods to detect and speed up growth and discuss some challenges in implementing blood cultures in LMICs, such as the biosafety aspects, supply chain and waste management.
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Affiliation(s)
- Sien Ombelet
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium.,Department of Microbiology and Immunology, KULeuven, Leuven, Belgium
| | - Barbara Barbé
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
| | - Dissou Affolabi
- Centre National Hospitalier Universitaire-Hubert Koutoucou Maga, Cotonou, Benin
| | | | - Palpouguini Lompo
- Clinical Research Unit of Nanoro, Institut de Recherche en Science de la Santé, Nanoro, Burkina Faso
| | - Octavie Lunguya
- National Institute for Biomedical Research, Kinshasa, Democratic Republic of the Congo.,Department of Medical Biology, Cliniques Universitaires, Université de Kinshasa, Kinshasa, Democratic Republic of the Congo
| | - Jan Jacobs
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium.,Department of Microbiology and Immunology, KULeuven, Leuven, Belgium
| | - Liselotte Hardy
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
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Peeters M, Ombelet S, Chung P, Tsoumanis A, Lim K, Long L, De Smet B, Kham C, Teav S, Vlieghe E, Phe T, Jacobs J. Slow growth of Burkholderia pseudomallei compared to other pathogens in an adapted blood culture system in Phnom Penh, Cambodia. J Med Microbiol 2019; 68:1159-1166. [PMID: 31188093 DOI: 10.1099/jmm.0.001011] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
PURPOSE Burkholderia pseudomallei is a key pathogen causing bloodstream infections at Sihanouk Hospital Center of Hope, Phnom Penh, Cambodia. Here, visual instead of automated detection of growth of commercial blood culture bottles is done. The present study assessed the performance of this system. METHODOLOGY Blood culture sets, consisting of paired adult aerobic and anaerobic bottles (bioMérieux, FA FAN 259791 and FN FAN 252793) were incubated in a standard incubator for 7 days after reception. Each day, the bottle growth indicator was visually inspected for colour change indicating growth. Blind subculture was performed from the aerobic bottle at day 3. RESULTS From 2010 to 2015, 11 671 sets representing 10 389 suspected bloodstream infection episodes were documented. In 1058 (10.2 %) episodes, pathogens grew; they comprised Escherichia coli (31.7 %), Salmonella Paratyphi A (13.9 %), B. pseudomallei (8.5 %), Staphylococcus aureus (7.8 %) and Klebsiella pneumoniae (7.0 %). Blind subculture yielded 72 (4.1 %) pathogens, mostly (55/72, 76.4 %) B. pseudomallei. Cumulative proportions of growth at day 2 were as follows: E. coli: 85.0 %, Salmonella Paratyphi A: 85.0 %, K. pneumoniae: 76.3 % and S. aureus: 52.2 %; for B. pseudomallei, this was only 4.0 %, which increased to 70.1 % (70/99) at day 4 mainly by detection on blind subculture (55/99). Compared to the anaerobic bottles, aerobic bottles had a higher yield and a shorter time-to-detection, particularly for B. pseudomallei. CONCLUSIONS Visual inspection for growth of commercial blood culture bottles in a low-resource setting provided satisfactory yield and time-to-detection. However, B. pseudomallei grew slowly and was mainly detected by blind subculture. The aerobic bottle outperformed the anaerobic bottle.
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Affiliation(s)
- Marjan Peeters
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
| | - Sien Ombelet
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
- Department of Microbiology and Immunology, KU Leuven, Leuven, Belgium
| | - Panha Chung
- Sihanouk Hospital Centre of HOPE, Phnom Penh, Cambodia
| | - Achilleas Tsoumanis
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
| | - Kruy Lim
- Sihanouk Hospital Centre of HOPE, Phnom Penh, Cambodia
| | - Leng Long
- Sihanouk Hospital Centre of HOPE, Phnom Penh, Cambodia
| | - Birgit De Smet
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
| | - Chun Kham
- Sihanouk Hospital Centre of HOPE, Phnom Penh, Cambodia
| | - Syna Teav
- Sihanouk Hospital Centre of HOPE, Phnom Penh, Cambodia
| | - Erika Vlieghe
- Unit of Internal Medicine and Infectious Diseases, University Hospital Antwerp, Antwerp, Belgium
| | - Thong Phe
- Sihanouk Hospital Centre of HOPE, Phnom Penh, Cambodia
| | - Jan Jacobs
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
- Department of Microbiology and Immunology, KU Leuven, Leuven, Belgium
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Mukhopadhyay S, Puopolo KM. Relevance of Neonatal Anaerobic Blood Cultures: New Information for an Old Question. J Pediatric Infect Dis Soc 2018; 7:e126-e127. [PMID: 29165632 DOI: 10.1093/jpids/pix095] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2017] [Accepted: 10/05/2017] [Indexed: 11/13/2022]
Affiliation(s)
- Sagori Mukhopadhyay
- Division of Neonatology, Children's Hospital of Philadelphia, and University of Pennsylvania Perelman School of Medicine
| | - Karen M Puopolo
- Division of Neonatology, Children's Hospital of Philadelphia, and University of Pennsylvania Perelman School of Medicine
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Abstract
BACKGROUND Anaerobic bacteremia is rare in children and current recommendations advocate against the routine use of anaerobic cultures in children. However, the incidence of anaerobic bacteremia and the utility of anaerobic blood cultures in children have not been assessed in recent years. Our pediatric emergency department (PED) policy still supports the use of both aerobic and anaerobic blood cultures in all cases of suspected bacteremia. This allowed us to re-evaluate the yield of anaerobic cultures in PED settings. METHODS Retrospective data of all blood cultures taken in the PED in a single tertiary center from 2002 to 2016 were collected. The incidence and characteristics of children with positive anaerobic blood cultures were assessed. Risk factors for anaerobic bacteremia were defined. RESULTS Of the 68,304 blood culture sets taken during the study period, 971 (1.42%) clinically significant positive cultures were found. Pathogenic obligatory anaerobic bacteria were isolated in 33 (0.05%) cultures. The leading risk factors for anaerobic bacteremia were head and neck abscess and intra-abdominal infection. Of all the true positive cultures, 187 (22%) were only detected in the anaerobic culture and would have otherwise been missed. CONCLUSIONS True anaerobic bacteremia is extremely rare in children admitted to the PED. Nevertheless, using anaerobic cultures may increase the overall yield of blood cultures.
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Abstract
Alteration in the host microbiome at skin and mucosal surfaces plays a role in the function of the immune system, and may predispose immunocompromised patients to infection. Because obligate anaerobes are the predominant type of bacteria present in humans at skin and mucosal surfaces, immunocompromised patients are at increased risk for serious invasive infection due to anaerobes. Laboratory approaches to the diagnosis of anaerobe infections that occur due to pyogenic, polymicrobial, or toxin-producing organisms are described. The clinical interpretation and limitations of anaerobe recovery from specimens, anaerobe-identification procedures, and antibiotic-susceptibility testing are outlined. Bacteriotherapy following analysis of disruption of the host microbiome has been effective for treatment of refractory or recurrent Clostridium difficile infection, and may become feasible for other conditions in the future.
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Affiliation(s)
- Deirdre L Church
- Departments of Pathology & Laboratory Medicine and Medicine, University of Calgary, and Division of Microbiology, Calgary Laboratory Services, Calgary, Alberta, Canada T2N 1N4
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14
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Chang J, Park JS, Park S, Choi B, Yoon NS, Sung H, Kim MN. Impact of monitoring blood volume in the BD BACTEC™ FX blood culture system: virtual volume versus actual volume. Diagn Microbiol Infect Dis 2015; 81:89-93. [DOI: 10.1016/j.diagmicrobio.2014.11.001] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2014] [Revised: 10/10/2014] [Accepted: 11/02/2014] [Indexed: 10/24/2022]
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15
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Contribution of the BacT/Alert MB Mycobacterium bottle to bloodstream infection surveillance in Thailand: added yield for Burkholderia pseudomallei. J Clin Microbiol 2015; 53:910-4. [PMID: 25588650 DOI: 10.1128/jcm.02008-14] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Community-acquired bloodstream infections cause substantial morbidity and mortality worldwide, but microbiology capacity and surveillance limitations have challenged good descriptions of pathogen distribution in many regions, including Southeast Asia. Active surveillance for bloodstream infections has been conducted in two rural Thailand provinces for >7 years. Blood specimens were divided into two culture bottles, one optimized for aerobic growth (F bottle) and a second for enhanced growth of mycobacteria (MB bottle), and processed with the BactT/Alert 3D system. Because the routine use of MB culture bottles is resource intensive (expensive and requires prolonged incubation), we assessed the added yield of MB bottles by comparing the proportion of pathogens detected by MB versus that by F bottles from 2005 to 2012. Of 63,066 blood cultures, 7,296 (12%) were positive for at least one pathogen; the most common pathogens were Escherichia coli (28%), Burkholderia pseudomallei (11%), Klebsiella pneumoniae (9%), and Staphylococcus aureus (6%). Two bottles improved the yield overall, but the added yield attributable to the MB bottles was limited to a few pathogens. In addition to the detection of mycobacteria and some fungi, MB bottles improved the detection of B. pseudomallei (27% [MB] versus 8% [F]; P < 0.0001), with added benefit if therapy was initiated prior to the blood culture. The targeted use of MB bottles is warranted for patients at risk for mycobacterial and fungal infections and for infection with B. pseudomallei, a common cause of septicemia in Thailand.
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16
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Technical improvements in culturing blood. Methods Mol Biol 2015; 1237:35-46. [PMID: 25319777 DOI: 10.1007/978-1-4939-1776-1_4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Blood culture is a laboratory test where a blood specimen, taken from a patient, is inoculated into bottles containing culture media to determine if infection-causing microorganisms (bacteria or fungi) have invaded the patient's bloodstream. This test is an important investigation with major implications for the diagnosis and treatment of patients with bloodstream infections and possible sepsis. Moreover, blood culture will also provide the etiologic agent for antimicrobial susceptibility testing, enabling optimization of antibiotic therapy with significant impact on the outcome of the disease. Even if the potential benefices of blood culture are well known, critical factors mainly in pre- and post-analytical phases can reduce the clinical value of this test.
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17
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Gori E, Callea E, Alberani F, Orlando L. Microbial monitoring and methods of sample collection: a GITMO survey (Gruppo Trapianto di Midollo Osseo). Ecancermedicalscience 2014; 8:421. [PMID: 24834116 PMCID: PMC3998655 DOI: 10.3332/ecancer.2014.421] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2013] [Indexed: 11/06/2022] Open
Abstract
The collection of microbiological samples represents an important aspect of care both for doctors as well as nurses. It is important to recognise and identify some key points, to avoid performing ‘unnecessary’ or ‘incorrect’ sampling, which may give useless or even misleading results, these are: the moment at which the sample is collected, the collection method and timing (if indicated). The comparison between the various nursing members of the Italian National bone marrow transplant group (GITMO), showed diversity of practice across all fields. A formal survey was therefore conducted within GITMO centres looking at the methods of microbiological sample collection. These results were compared with the literature, and in addition to the lack of homogeneity of practice within the centres, a lack of compliance with the recommendations was also observed. To evaluate the effectiveness of this survey in highlighting awareness of this issue and the presence of relevant guidelines, the questionnaire was repeated (with the same centres responding), which demonstrated no major changes in care practices.
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Affiliation(s)
- Erica Gori
- Institute of Haematology and Medical Oncology 'L&A Seragnòli', Bologna, Italy
| | | | - Francesca Alberani
- Institute of Haematology and Medical Oncology 'L&A Seragnòli', Bologna, Italy
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18
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Passerini R, Cassatella MC, Salvatici M, Bottari F, Mauro C, Radice D, Sandri MT. Recovery and time to growth of isolates in blood culture bottles: Comparison of BD Bactec Plus Aerobic/F and BD Bactec Plus Anaerobic/F bottles. ACTA ACUST UNITED AC 2014; 46:288-93. [DOI: 10.3109/00365548.2013.876510] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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19
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Shoji K, Komuro H, Watanabe Y, Miyairi I. The utility of anaerobic blood culture in detecting facultative anaerobic bacteremia in children. Diagn Microbiol Infect Dis 2013; 76:409-12. [PMID: 23747032 DOI: 10.1016/j.diagmicrobio.2013.05.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2013] [Revised: 05/02/2013] [Accepted: 05/02/2013] [Indexed: 11/15/2022]
Abstract
Routine anaerobic blood culture is not recommended in children because obligate anaerobic bacteremia is rare in the pediatric population. However, a number of facultative anaerobic bacteria can cause community and hospital acquired infections in children and the utility of anaerobic blood culture for detection of these organisms is still unclear. We conducted a retrospective analysis of all blood culture samples (n = 24,356) at a children's hospital in Japan from October 2009 to June 2012. Among the samples that had paired aerobic and anaerobic blood cultures, 717 samples were considered clinically significant with 418 (58%) organisms detected from both aerobic and anaerobic cultures, 167 (23%) detected only from aerobic culture and 132 (18%) detected only from anaerobic culture. While most facultative anaerobes were detectable by aerobic culture, over 25% of Enterobacteriaceae and 15% of Staphylococcus sp. were detected from anaerobic cultures bottles only, suggesting its potential role in selected settings.
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Affiliation(s)
- Kensuke Shoji
- Department of Medical Subspecialties, Division of Infectious Diseases, National Center for Child Health and Development, Tokyo, Japan.
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20
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Chiueh TS, Lee SY, Tang SH, Lu JJ, Sun JR. Predominance of EnterobacteriaceaeIsolates in Early Positive Anaerobic Blood Culture Bottles in BacT/Alert System. J Clin Lab Anal 2013; 27:113-20. [DOI: 10.1002/jcla.21571] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2012] [Accepted: 12/14/2012] [Indexed: 11/08/2022] Open
Affiliation(s)
| | - Shih-Yi Lee
- Division of Clinical Microbiology; Department of Pathology and Laboratory Medicine; Taipei Veterans General Hospital; Taiwan
| | - Sheng-Hui Tang
- Division of Clinical Pathology; Department of Pathology; National Defense Medical Center and Tri-Service General Hospital; Taipei; Taiwan
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21
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Tarai B, Das P, Kumar D, Budhiraja S. Comparative evaluation of paired blood culture (aerobic/aerobic) and single blood culture, along with clinical importance in catheter versus peripheral line at a tertiary care hospital. Indian J Med Microbiol 2012; 30:187-92. [PMID: 22664435 DOI: 10.4103/0255-0857.96689] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
PURPOSE Paired blood culture (PBC) is uncommon practice in hospitals in India, leading to delayed and inadequate diagnosis. Also contamination remains a critical determinant in hampering the definitive diagnosis. OBJECTIVES To establish the need of PBC over single blood culture (SBC) along with the degree of contamination, this comparative retrospective study was initiated. MATERIALS AND METHODS We processed 2553 PBC and 4350 SBC in BacT/ALERT 3D (bioMerieux) between October 2010 and June 2011. The positive cultures were identified in VITEK 2 Compact (bioMerieux). True positivity and contaminants were also analyzed in 486 samples received from catheter and peripheral line. RESULTS Out of 2553 PBC samples, positivity was seen in 350 (13.70%). In 4350 SBC samples, positivity was seen in 200 samples (4.59%). In PBC true pathogens were 267 (10.45%) and contaminants were 83 (3.25%), whereas in SBC 153 (3.51%) were true positives and contaminants were 47 (1.08%). Most of the blood cultures (99.27 %) grew within 72 h and 95.8% were isolated within 48 h. In 486 PBCs received from catheter/periphery (one each), catheter positivity was found in 85 (true positives were 48, false positives 37). In peripheral samples true positives were 50 and false positives were 8. CONCLUSION Significantly higher positive rates were seen in PBCs compared with SBCs. Automated blood culture and identification methods significantly reduced the time required for processing of samples and also facilitated yield of diverse/rare organisms. Blood culture from catheter line had higher false positives than peripheral blood culture. Thus every positive result from a catheter must be correlated with clinical findings and requires further confirmation.
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Affiliation(s)
- B Tarai
- Max Super Speciality Hospital,(West Block), 1, Press Enclave Road, Saket, New Delhi - 110 017, India
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The preanalytical optimization of blood cultures: a review and the clinical importance of benchmarking in 5 Belgian hospitals. Diagn Microbiol Infect Dis 2012; 73:1-8. [PMID: 22578933 DOI: 10.1016/j.diagmicrobio.2012.01.009] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2011] [Revised: 01/12/2012] [Accepted: 01/14/2012] [Indexed: 01/22/2023]
Abstract
Bloodstream infections remain a major challenge in medicine. Optimal detection of pathogens is only possible if the quality of preanalytical factors is thoroughly controlled. Since the laboratory is responsible for this preanalytical phase, the quality control of critical factors should be integrated in its quality control program. The numerous recommendations regarding blood culture collection contain controversies. Only an unambiguous guideline permits standardization and interlaboratory quality control. We present an evidence-based concise guideline of critical preanalytical determinants for blood culture collection and summarize key performance indicators with their concomitant target values. In an attempt to benchmark, we compared the true-positive rate, contamination rate, and collected blood volume of blood culture bottles in 5 Belgian hospital laboratories. The true-positive blood culture rate fell within previously defined acceptation criteria by Baron et al. (2005) in all 5 hospitals, whereas the contamination rate exceeded the target value in 4 locations. Most unexpected, in each of the 5 laboratories, more than one third of the blood culture bottles were incorrectly filled, irrespective of the manufacturer of the blood culture vials. As a consequence of this shortcoming, one manufacturer recently developed an automatic blood volume monitoring system. In conclusion, clear recommendations for standardized blood culture collection combined with quality control of critical factors of the preanalytical phase are essential for diagnostic blood culture improvement.
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Ringwood T, Murphy BP, Drummond N, Buckley JF, Coveney AP, Redmond HP, Power JP, Fanning S, Prentice MB. Current evidence for human yersiniosis in Ireland. Eur J Clin Microbiol Infect Dis 2012; 31:2969-81. [DOI: 10.1007/s10096-012-1649-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2012] [Accepted: 05/10/2012] [Indexed: 12/13/2022]
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Riedel S, Carroll KC. Blood cultures: key elements for best practices and future directions. J Infect Chemother 2010; 16:301-16. [PMID: 20490596 DOI: 10.1007/s10156-010-0069-1] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2010] [Indexed: 01/09/2023]
Abstract
Bloodstream infections (BSI) cause significant morbidity and mortality among populations worldwide. Blood cultures (BCs) are regarded as the "gold standard" for diagnosis of bacteremia and are among the most important functions of the clinical microbiology laboratory. Significant changes in the methods and techniques of obtaining BCs have occurred since the first inception of BCs into clinical practice. Aside from significant improvements of established, conventional technology, new assays for diagnosis of bacteremia and fungemia, particularly those involving molecular techniques, are now available. BCs must be collected under sterile conditions and guidelines for appropriate collection, processing, and results reporting of BCs have been established. This review provides comprehensive information on optimal BC practices for laboratories, utilizing traditional approaches and emerging technology. As laboratories and clinicians must appreciate the key factors affecting the use of these techniques, improved communication between laboratory personnel and clinicians regarding such elements as duration of incubation, workup of contaminants and critical action value reporting will greatly improve the diagnostic approach to BSI.
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Affiliation(s)
- Stefan Riedel
- Division of Microbiology, Department of Pathology, Johns Hopkins Bayview Medical Center, 4940 Eastern Avenue, Baltimore, MD 21224, USA.
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Detection of bacterial and yeast species with the Bactec 9120 automated system with routine use of aerobic, anaerobic, and fungal media. J Clin Microbiol 2008; 46:4029-33. [PMID: 18923011 DOI: 10.1128/jcm.01014-08] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
During the period 2006 and 2007, all blood cultures required by four units at high infective risk and most of those required by other units of the University Hospital of Palermo, Palermo, Italy were performed using a Bactec 9120 automated blood culture system with a complete set of Plus Aerobic/F, Plus Anaerobic/F, and Mycosis IC/F bottles. The aim of the study was to enable the authors to gain firsthand experience of the culture potentialities of the three different media, to obtain information regarding the overall and specific recovery of bacteria and yeasts from blood cultures in the hospital, and to reach a decision as to whether and when to utilize anaerobic and fungal bottles. Although very few bloodstream infections (1.8%) were associated with obligate anaerobes, the traditional routine use of anaerobic bottles was confirmed because of their usefulness, not only in the detection of anaerobes, but also in that of gram-positive cocci and fermentative gram-negative bacilli. In this study, Mycosis IC/F bottles detected 77.4% of all the yeast isolates, 87.0% of yeasts belonging to the species Candida albicans, and 45.7% of nonfermentative gram-negative bacilli resistant to chloramphenicol and tobramycin. In order to improve the diagnosis of fungemia in high-risk patients, the additional routine use of fungal bottles was suggested when, as occurred in the intensive-care unit and in the hematology unit of the University Hospital of Palermo, high percentages of bloodstream infections are associated with yeasts, and/or antibiotic-resistant bacteria and/or multiple bacterial isolates capable of inhibiting yeast growth in aerobic bottles.
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Assessing how many blood cultures are needed for detecting bloodstream infections. J Clin Microbiol 2008; 46:1155-6; author reply 1156. [PMID: 18326835 DOI: 10.1128/jcm.02406-07] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Qian Q, Eichelberger K, Kirby JE. Rapid identification of Staphylococcus aureus in blood cultures by use of the direct tube coagulase test. J Clin Microbiol 2007; 45:2267-9. [PMID: 17522280 PMCID: PMC1932990 DOI: 10.1128/jcm.00369-07] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Direct tube coagulase testing for identification of Staphylococcus aureus from BACTEC culture broth showed a sensitivity, a specificity, and positive and negative predicative values of 34%, 100%, 100%, and 80.2% with 2 h of incubation and 65%, 98.7, 99.7%, and 88.6% with 4 h of incubation. Anaerobic blood culture contributed significantly to the detection of S. aureus.
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Affiliation(s)
- Qinfang Qian
- Division of Laboratory and Transfusion Medicine, Department of Pathology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts 02215, USA.
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28
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Brecher ME, Hay SN, Rothenberg SJ. Monitoring of apheresis platelet bacterial contamination with an automated liquid culture system: a university experience. Transfusion 2003; 43:974-8. [PMID: 12823759 DOI: 10.1046/j.1537-2995.2003.00438.x] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND With 4 million platelet units transfused per year in the United States and with the current estimate of bacteria contamination rate in PLT units, it would be expected that 2000 to 4000 bacterially contaminated units are transfused and associated with 333 to 1000 cases of clinical sepsis. STUDY DESIGN AND METHODS Apheresis platelets were sampled on Day 2 of storage (collection day=Day 0) and issue (or following outdate, Days 6-8) using a sterile connection device (SCD) to attach a sampling bag. Using aseptic technique and a laminar flow hood, bottles were inoculated and placed onto an automated liquid culture system (BacT/ALERT 3D Microbial Detection System) for 7 days. RESULTS A total of 2397 apheresis PLT units were sampled. A triple apheresis collection was reactive within 14 hours of the Day 2 sampling (aerobic bottles) and the bags were removed from inventory. Staphylococcus epidermidis was identified in all three contaminated bags. Two double-apheresis collections were found to be contaminated with Proprionibacterium sp. after 6 days of incubation but had been transfused to four patients without discernible clinical sequelae. There was one false-positive aerobic bottle and one false-positive anaerobic result due to inadvertent contamination of a bottle. Thus, the overall true-positive rate was 7 of 2397 apheresis units (0.29%) with a true-positive rate for aerobic organisms of 0.13% and an anaerobic true-positive rate of 0.17%. The false-positive rate was 2 out of 4794 samplings (0.04%) or 2 out of 9588 bottles (0.02%). CONCLUSION This preliminary data suggests that the use of a SCD, aseptic technique, and a laminar flow hood is associated with a low rate of contamination. In no case did an issue (or outdate) detect contamination that was not detected by the Day 2 culture. Additional surveillance is necessary before we can conclude that a Day 2 sterile culture is truly predictive of an issue (or outdate) sterile culture. Bacterial culture surveillance of PLTs would be expected to save lives and may facilitate an extension in PLT storage.
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Affiliation(s)
- M E Brecher
- University of North Carolina, Chapel Hill, North Carolina 27514, USA.
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