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Zhang J, Zhou Y, Zhong Z, Lv Y, Yang X, Liu X. Identification of mixed anaerobic infections after inguinal hernia repair based on metagenomic next-generation sequencing: A case report. Open Med (Wars) 2024; 19:20230887. [PMID: 38221930 PMCID: PMC10787303 DOI: 10.1515/med-2023-0887] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2023] [Revised: 12/01/2023] [Accepted: 12/07/2023] [Indexed: 01/16/2024] Open
Abstract
Infection following inguinal hernia repair (IHR) is uncommon. Rational use of antibiotics can significantly improve the prognosis of patients. However, accurately identifying the pathogen involved is usually challenging. This case report describes a patient who developed intermittent fever after undergoing open preperitoneal tension-free repair of a bilateral inguinal hernia. The scrotal fluid specimen was cultured and subjected to metagenomic next-generation sequencing (mNGS). Culture revealed the presence of Enterococcus faecalis (a facultative anaerobe). However, mNGS detected E. faecalis along with multiple anaerobic bacteria including Bacteroides thetaiotaomicron, Parabacteroides distasonis, and Levyella massiliensis. The patient was finally diagnosed with a mixed infection of E. faecalis and multiple anaerobes, and his condition was effectively controlled after timely adjustment of the antibiotic regimen. Treating postoperative infections with multiple concurrent conditions can be challenging. mNGS is valuable for the accurate diagnosis and treatment of infections, as it not only can further verify the culture results, but also assist clinicians in ruling out pulmonary infection caused by hematogenous dissemination after IHR in patients.
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Affiliation(s)
- Jun Zhang
- Department of Emergency Medicine, Ganzhou People’s Hospital, Ganzhou, 341000, China
| | - Yuming Zhou
- Department of Emergency Medicine, Ganzhou People’s Hospital, Ganzhou, 341000, China
| | - Zhenzhou Zhong
- Department of Emergency Medicine, Ganzhou People’s Hospital, Ganzhou, 341000, China
| | - Yan Lv
- Department of Scientific Affairs, Hugobiotech Co., Ltd., Beijing100176, China
| | - Xuying Yang
- Department of Scientific Affairs, Hugobiotech Co., Ltd., Beijing100176, China
| | - Xianghong Liu
- Department of Neurology, Ganzhou People’s Hospital, Ganzhou, 341000, China
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2
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Ligero-López J, Rubio-Mora E, Ruiz-Bastián MD, Quiles-Melero MI, Cacho-Calvo J, Cendejas-Bueno E. Antimicrobial susceptibility testing of anaerobic bacteria causing bacteremia: A 13-year (2010-2022) retrospective study in a tertiary hospital. Anaerobe 2023; 84:102803. [PMID: 37984560 DOI: 10.1016/j.anaerobe.2023.102803] [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: 09/02/2023] [Revised: 11/07/2023] [Accepted: 11/15/2023] [Indexed: 11/22/2023]
Abstract
Infections from anaerobic microorganisms result from breached mucosal barriers, posing a significant mortality risk. A retrospective study at Hospital Universitario La Paz (Madrid) from 2010 to 2022 analyzed 491 (6.17 %) anaerobic bacteremia cases out of 7956 significant bacteremia cases among 171,833 blood culture requests. Bacteroides fragilis was the most frequently isolated species (28.3 %), followed by Clostridium perfringens (13.6 %). B. fragilis showed good susceptibility to amoxicillin/ clavulanic acid (86 %), piperacillin/tazobactam (86 %), and metronidazole (87.7 %). In general, non-fragilis Bacteroides species showed low susceptibility to penicillin (7 %), amoxicillin (17.5 %), and clindamycin (64.9 %). Of our 13 non-perfringens Clostridium isolates, four exhibited resistance to penicillin and four showed resistance to clindamycin. Lactobacillus species were highly susceptible to antibiotics tested. Prevotella spp. showed low susceptibility to penicillin (20 %), amoxicillin (20 %), and clindamycin (40 %). The study contributes valuable data for monitoring and improving anaerobic bacteremia treatment.
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Affiliation(s)
- Jorge Ligero-López
- Clinical Microbiology Department, Hospital Universitario La Paz, IdiPaz, Madrid, Spain
| | - Eduardo Rubio-Mora
- Clinical Microbiology Department, Hospital Universitario La Paz, IdiPaz, Madrid, Spain
| | | | | | - Juana Cacho-Calvo
- Clinical Microbiology Department, Hospital Universitario La Paz, IdiPaz, Madrid, Spain
| | - Emilio Cendejas-Bueno
- Clinical Microbiology Department, Hospital Universitario La Paz, IdiPaz, Madrid, Spain; CIBERINFEC, Instituto de Salud Carlos III, Madrid, Spain.
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3
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Caméléna F, Péan de Ponfilly G, Pailhoriès H, Bonzon L, Alanio A, Poncin T, Lafaurie M, Dépret F, Cambau E, Godreuil S, Chenouard R, Le Monnier A, Jacquier H, Berçot B. Multicenter Evaluation of the FilmArray Blood Culture Identification 2 Panel for Pathogen Detection in Bloodstream Infections. Microbiol Spectr 2023; 11:e0254722. [PMID: 36519852 PMCID: PMC9927563 DOI: 10.1128/spectrum.02547-22] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Accepted: 11/18/2022] [Indexed: 12/23/2022] Open
Abstract
The FilmArray Blood Culture Identification 2 panel (BCID2; bioMérieux) is a fully automated PCR-based assay for identifying bacteria, fungi, and bacterial resistance markers in positive blood cultures (BC) in about 1 h. In this multicenter study, we evaluated the performance of the BCID2 panel for pathogen detection in positive BC. Conventional culture and BCID2 were performed in parallel at four tertiary-care hospitals. We included 152 positive BC-130 monomicrobial and 22 polymicrobial cultures-in this analysis. The BCID2 assay correctly identified 90% (88/98) of Gram-negative and 89% (70/79) of Gram-positive bacteria. Five bacterial isolates targeted by the BCID2 panel and recovered from five positive BC, including three polymicrobial cultures, were missed by the BCID2 assay. Fifteen isolates were off-panel organisms, accounting for 8% (15/182) of the isolates obtained from BC. The mean positive percent agreement between the BCID2 assay and standard culture was 97% (95% confidence interval, 95 to 99%), with agreement ranging from 67% for Candida albicans to 100% for 17 targets included in the BCID2 panel. BCID2 also identified the blaCTX-M gene in seven BC, including one for which no extended-spectrum β-lactamase (ESBL)-producing isolate was obtained in culture. However, it failed to detect ESBL-encoding genes in three BC. Two of the 18 mecA/C genes detected by the BCID2 were not confirmed. No carbapenemase, mecA/C, or MREJ targets were detected. The median turnaround time was significantly shorter for BCID2 than for culture. The BCID2 panel may facilitate faster pathogen identification in bloodstream infections. IMPORTANCE Rapid molecular diagnosis combining the identification of pathogens and the detection of antibiotic resistance genes from positive blood cultures (BC) can improve the outcome for patients with bloodstream infections. The FilmArray BCID2 panel, an updated version of the original BCID, can detect 11 Gram-positive bacteria, 15 Gram-negative bacteria, 7 fungal pathogens, and 10 antimicrobial resistance genes directly from a positive BC. Here, we evaluated the real-life microbiological performance of the BCID2 assay in comparison to the results of standard methods used in routine practice at four tertiary care hospitals.
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Affiliation(s)
- François Caméléna
- Département de Bactériologie, Groupe Hospitalier Saint-Louis-Lariboisière-Fernand Widal, Assistance Publique-Hôpitaux de Paris, Paris, France
- Université Paris Cité and Université Sorbonne Paris Nord, INSERM, IAME, Paris, France
| | - Gauthier Péan de Ponfilly
- Service de Microbiologie clinique, Groupe hospitalier Paris Saint Joseph, Paris, France
- Institut Micalis UMR 1319, Université Paris-Saclay, INRAe, AgroParisTech, Châtenay Malabry, France
| | - Hélène Pailhoriès
- Laboratoire de Bactériologie, Institut de Biologie en Santé, Centre Hospitalier Universitaire d’Angers, Laboratoire HIFIH, UPRES EA3859, SFR ICAT 4208, Université d’Angers, Angers, France
| | - Lucas Bonzon
- Laboratoire de Bactériologie, Centre Hospitalier Universitaire de Montpellier et MIVEGEC, UMR IRD-CNRS-Université de Montpellier, Montpellier, France
| | - Alexandre Alanio
- Laboratoire de Parasitologie-Mycologie, Groupe Hospitalier Saint-Louis-Lariboisière-Fernand Widal, Assistance Publique-Hôpitaux de Paris, Paris, France
- Institut Pasteur, Université Paris Cité, CNRS, Unité de Mycologie Moléculaire, UMR2000, Paris, France
| | - Thibaut Poncin
- Département de Bactériologie, Groupe Hospitalier Saint-Louis-Lariboisière-Fernand Widal, Assistance Publique-Hôpitaux de Paris, Paris, France
- Université Paris Cité and Université Sorbonne Paris Nord, INSERM, IAME, Paris, France
| | - Matthieu Lafaurie
- Département des Maladies Infectieuses et Tropicales, Groupe Hospitalier Saint-Louis-Lariboisière-Fernand Widal, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - François Dépret
- Département d’Anesthésie et Réanimation chirurgicale et brûlés, Groupe Hospitalier Saint-Louis-Lariboisière-Fernand Widal, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Emmanuel Cambau
- Université Paris Cité and Université Sorbonne Paris Nord, INSERM, IAME, Paris, France
- Laboratoire de mycobactériologie spécialisée et de référence, Laboratoire associé du Centre National de Référence des mycobactéries et résistance des mycobactéries aux antituberculeux, Groupe Hospitalier Saint-Louis-Lariboisière-Fernand Widal, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Sylvain Godreuil
- Laboratoire de Bactériologie, Centre Hospitalier Universitaire de Montpellier et MIVEGEC, UMR IRD-CNRS-Université de Montpellier, Montpellier, France
| | - Rachel Chenouard
- Laboratoire de Bactériologie, Institut de Biologie en Santé, Centre Hospitalier Universitaire d’Angers, Laboratoire HIFIH, UPRES EA3859, SFR ICAT 4208, Université d’Angers, Angers, France
| | - Alban Le Monnier
- Service de Microbiologie clinique, Groupe hospitalier Paris Saint Joseph, Paris, France
- Institut Micalis UMR 1319, Université Paris-Saclay, INRAe, AgroParisTech, Châtenay Malabry, France
| | - Hervé Jacquier
- Département de Bactériologie, Groupe Hospitalier Saint-Louis-Lariboisière-Fernand Widal, Assistance Publique-Hôpitaux de Paris, Paris, France
- Université Paris Cité and Université Sorbonne Paris Nord, INSERM, IAME, Paris, France
| | - Béatrice Berçot
- Département de Bactériologie, Groupe Hospitalier Saint-Louis-Lariboisière-Fernand Widal, Assistance Publique-Hôpitaux de Paris, Paris, France
- Université Paris Cité and Université Sorbonne Paris Nord, INSERM, IAME, Paris, France
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Soedarmono P, Diana A, Tauran P, Lokida D, Aman AT, Alisjahbana B, Arlinda D, Tjitra E, Kosasih H, Merati KTP, Arif M, Gasem MH, Susanto NH, Lukman N, Sugiyono RI, Hadi U, Lisdawati V, Tchos KGF, Neal A, Karyana M. The characteristics of bacteremia among patients with acute febrile illness requiring hospitalization in Indonesia. PLoS One 2022; 17:e0273414. [PMID: 36074783 PMCID: PMC9455855 DOI: 10.1371/journal.pone.0273414] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Accepted: 08/09/2022] [Indexed: 11/19/2022] Open
Abstract
Blood culturing remains the "gold standard" for bloodstream infection (BSI) diagnosis, but the method is inaccessible to many developing countries due to high costs and insufficient resources. To better understand the utility of blood cultures among patients in Indonesia, a country where blood cultures are not routinely performed, we evaluated data from a previous cohort study that included blood cultures for all participants. An acute febrile illness study was conducted from July 2013 to June 2016 at eight major hospitals in seven provincial capitals in Indonesia. All participants presented with a fever, and two-sided aerobic blood cultures were performed within 48 hours of hospital admission. Positive cultures were further assessed for antimicrobial resistance (AMR) patterns. Specimens from participants with negative culture results were screened by advanced molecular and serological methods for evidence of causal pathogens. Blood cultures were performed for 1,459 of 1,464 participants, and the 70.6% (1,030) participants that were negative by dengue NS1 antigen test were included in further analysis. Bacteremia was observed in 8.9% (92) participants, with the most frequent pathogens being Salmonella enterica serovar Typhi (41) and Paratyphi A (10), Escherichia coli (14), and Staphylococcus aureus (10). Two S. Paratyphi A cases had evidence of AMR, and several E. coli cases were multidrug resistant (42.9%, 6/14) or monoresistant (14.3%, 2/14). Culture contamination was observed in 3.6% (37) cases. Molecular and serological assays identified etiological agents in participants having negative cultures, with 23.1% to 90% of cases being missed by blood cultures. Blood cultures are a valuable diagnostic tool for hospitalized patients presenting with fever. In Indonesia, pre-screening patients for the most common viral infections, such as dengue, influenza, and chikungunya viruses, would maximize the benefit to the patient while also conserving resources. Blood cultures should also be supplemented with advanced laboratory tests when available.
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Affiliation(s)
- Pratiwi Soedarmono
- Faculty of Medicine, Universitas Indonesia/ Dr. Cipto Mangunkusumo Hospital, Jakarta, Indonesia
| | - Aly Diana
- Indonesia Research Partnership on Infectious Disease (INA-RESPOND), Jakarta, Indonesia
- Department of Public Health, Faculty of Medicine, Universitas Padjadjaran, Sumedang, Indonesia
| | - Patricia Tauran
- Faculty of Medicine, Universitas Hasanuddin/ Dr. Wahidin Sudirohusodo Hospital, Makassar, Indonesia
| | - Dewi Lokida
- Tangerang District Hospital, Tangerang, Banten, Indonesia
| | - Abu Tholib Aman
- Faculty of Medicine, Public Heath, and Nursing, Universitas Gadjah Mada/ Dr. Sardjito Hospital, Yogyakarta, Indonesia
| | - Bachti Alisjahbana
- Department of Internal Medicine, Faculty of Medicine, Universitas Padjadjaran/ Dr Hasan Sadikin Hospital, Bandung, Indonesia
| | - Dona Arlinda
- National Institute of Health Research and Development (NIHRD), Ministry of Health Republic of Indonesia, Jakarta, Indonesia
| | - Emiliana Tjitra
- National Institute of Health Research and Development (NIHRD), Ministry of Health Republic of Indonesia, Jakarta, Indonesia
| | - Herman Kosasih
- Indonesia Research Partnership on Infectious Disease (INA-RESPOND), Jakarta, Indonesia
| | | | - Mansyur Arif
- Faculty of Medicine, Universitas Hasanuddin/ Dr. Wahidin Sudirohusodo Hospital, Makassar, Indonesia
| | | | - Nugroho Harry Susanto
- Indonesia Research Partnership on Infectious Disease (INA-RESPOND), Jakarta, Indonesia
| | - Nurhayati Lukman
- Indonesia Research Partnership on Infectious Disease (INA-RESPOND), Jakarta, Indonesia
| | - Retna Indah Sugiyono
- Indonesia Research Partnership on Infectious Disease (INA-RESPOND), Jakarta, Indonesia
| | - Usman Hadi
- Faculty of Medicine, Universitas Airlangga/ Dr. Soetomo Hospital, Surabaya, Indonesia
| | - Vivi Lisdawati
- Sulianti Saroso Infectious Disease Hospital, Jakarta, Indonesia
| | - Karine G. Fouth Tchos
- National Institute of Allergy and Infectious Disease (NIAID), National Institutes of Health, Bethesda, Maryland, United States of America
| | - Aaron Neal
- National Institute of Allergy and Infectious Disease (NIAID), National Institutes of Health, Bethesda, Maryland, United States of America
| | - Muhammad Karyana
- Indonesia Research Partnership on Infectious Disease (INA-RESPOND), Jakarta, Indonesia
- National Institute of Health Research and Development (NIHRD), Ministry of Health Republic of Indonesia, Jakarta, Indonesia
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5
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Wen H, Wang W, Xie S, Sun Q, Liang Y, Wen B, Liu Y, Sun L, Zhang Z, Cao J, Liu X, Niu X, Ouyang Z, Dong N, Zhao J. Effects of Blood Culture Aerobic/Anaerobic Bottle Collection Patterns from Both Sides of the Body on Positive Blood Culture Rate and Time-to-Positivity. Infect Drug Resist 2022; 15:2995-3004. [PMID: 35711514 PMCID: PMC9197171 DOI: 10.2147/idr.s358675] [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] [Received: 02/10/2022] [Accepted: 05/27/2022] [Indexed: 11/23/2022] Open
Abstract
Background Although the principles for blood cultures (BCs) guidelines provide a recommendation for collection patterns, the complexity of clinical practice occasionally prompts clinicians to adopt non-standard collection patterns. Here, we investigate the influences of different BC collection patterns on detection of pathogens. Methods The BC collection patterns of 96 hospitals were surveyed online. And a retrospective study of BC data from a tertiary hospital was conducted. Results The results showed that 53.1% of hospitals adopted the recommended patterns. Among the 1439 episodes of true-positive BCs, 67.4% were found in both the left- and right-sided bottles; 58.2% were found in both aerobic and anaerobic bottles. Conclusion The present study suggested that the rate of standard collection patterns of blood culture was low and the non-standard collection patterns were associated with decreased detection of pathogens. Simultaneous collection of blood on the left and right sides was recommended as an effective pattern of BC collection.
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Affiliation(s)
- Hainan Wen
- The Second Hospital of Hebei Medical University, Shijiazhuang, Hebei, People's Republic of China
| | - Weigang Wang
- The Second Hospital of Hebei Medical University, Shijiazhuang, Hebei, People's Republic of China.,Hebei Provincial Center for Clinical Laboratories, Shijiazhuang, Hebei, People's Republic of China
| | - Shoujun Xie
- Department of Laboratory, the Affiliated Hospital of Chengde Medical university, Chengde, Hebei, People's Republic of China
| | - Qian Sun
- The Second Hospital of Hebei Medical University, Shijiazhuang, Hebei, People's Republic of China
| | - Yueyi Liang
- Department of Laboratory, the Affiliated Hospital of Chengde Medical university, Chengde, Hebei, People's Republic of China
| | - Baojiang Wen
- The Second Hospital of Hebei Medical University, Shijiazhuang, Hebei, People's Republic of China.,Hebei Provincial Center for Clinical Laboratories, Shijiazhuang, Hebei, People's Republic of China
| | - Yanchao Liu
- Department of Laboratory, the Affiliated Hospital of Chengde Medical university, Chengde, Hebei, People's Republic of China
| | - Lihong Sun
- Department of Laboratory, the Affiliated Hospital of Chengde Medical university, Chengde, Hebei, People's Republic of China
| | - Zongwei Zhang
- Department of Laboratory, the Affiliated Hospital of Chengde Medical university, Chengde, Hebei, People's Republic of China
| | - Jing Cao
- The Second Hospital of Hebei Medical University, Shijiazhuang, Hebei, People's Republic of China.,Hebei Provincial Center for Clinical Laboratories, Shijiazhuang, Hebei, People's Republic of China
| | - Xiaoxuan Liu
- The Second Hospital of Hebei Medical University, Shijiazhuang, Hebei, People's Republic of China.,Hebei Provincial Center for Clinical Laboratories, Shijiazhuang, Hebei, People's Republic of China
| | - Xiaoran Niu
- The Second Hospital of Hebei Medical University, Shijiazhuang, Hebei, People's Republic of China.,Hebei Provincial Center for Clinical Laboratories, Shijiazhuang, Hebei, People's Republic of China
| | - Zirou Ouyang
- The Second Hospital of Hebei Medical University, Shijiazhuang, Hebei, People's Republic of China.,Hebei Provincial Center for Clinical Laboratories, Shijiazhuang, Hebei, People's Republic of China
| | - Ning Dong
- The Second Hospital of Hebei Medical University, Shijiazhuang, Hebei, People's Republic of China.,Hebei Provincial Center for Clinical Laboratories, Shijiazhuang, Hebei, People's Republic of China
| | - Jianhong Zhao
- The Second Hospital of Hebei Medical University, Shijiazhuang, Hebei, People's Republic of China.,Hebei Provincial Center for Clinical Laboratories, Shijiazhuang, Hebei, People's Republic of China
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6
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Fabre V, Carroll KC, Cosgrove SE. Blood Culture Utilization in the Hospital Setting: a Call for Diagnostic Stewardship. J Clin Microbiol 2022; 60:e0100521. [PMID: 34260274 PMCID: PMC8925908 DOI: 10.1128/jcm.01005-21] [Citation(s) in RCA: 26] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
There has been significant progress in detection of bloodstream pathogens in recent decades with the development of more sensitive automated blood culture detection systems and the availability of rapid molecular tests for faster organism identification and detection of resistance genes. However, most blood cultures in clinical practice do not grow organisms, suggesting that suboptimal blood culture collection practices (e.g., suboptimal blood volume) or suboptimal selection of patients to culture (i.e., blood cultures ordered for patients with low likelihood of bacteremia) may be occurring. A national blood culture utilization benchmark does not exist, nor do specific guidelines on when blood cultures are appropriate or when blood cultures are of low value and waste resources. Studies evaluating the potential harm associated with excessive blood cultures have focused on blood culture contamination, which has been associated with significant increases in health care costs and negative consequences for patients related to exposure to unnecessary antibiotics and additional testing. Optimizing blood culture performance is important to ensure bloodstream infections (BSIs) are diagnosed while minimizing adverse events from overuse. In this review, we discuss key factors that influence blood culture performance, with a focus on the preanalytical phase, including technical aspects of the blood culture collection process and blood culture indications. We highlight areas for improvement and make recommendations to improve current blood culture practices among hospitalized patients.
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Affiliation(s)
- Valeria Fabre
- Department of Medicine, Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- Department of Antimicrobial Stewardship, The Johns Hopkins Hospital, Baltimore, Maryland, USA
| | - Karen C. Carroll
- Department of Pathology, Division of Medical Microbiology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Sara E. Cosgrove
- Department of Medicine, Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- Department of Antimicrobial Stewardship, The Johns Hopkins Hospital, Baltimore, Maryland, USA
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7
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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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8
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An Improvement in Diagnostic Blood Culture Conditions Allows for the Rapid Detection and Isolation of the Slow Growing Pathogen Yersinia pestis. Pathogens 2022; 11:pathogens11020255. [PMID: 35215198 PMCID: PMC8874391 DOI: 10.3390/pathogens11020255] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Revised: 02/13/2022] [Accepted: 02/14/2022] [Indexed: 01/27/2023] Open
Abstract
Plague, caused by the human pathogen Yersinia pestis, is a severe and rapidly progressing lethal disease that has caused millions of deaths globally throughout human history and still presents a significant public health concern, mainly in developing countries. Owing to the possibility of its malicious use as a bio-threat agent, Y. pestis is classified as a tier-1 select agent. The prompt administration of an effective antimicrobial therapy, essential for a favorable patient prognosis, requires early pathogen detection, identification and isolation. Although the disease rapidly progresses and the pathogen replicates at high rates within the host, Y. pestis exhibits a slow growth in vitro under routinely employed clinical culturing conditions, complicating the diagnosis and isolation. In the current study, the in vitro bacterial growth in blood cultures was accelerated by the addition of nutritional supplements. We report the ability of calcium (Ca+2)- and iron (Fe+2)-enriched aerobic blood culture media to expedite the growth of various virulent Y. pestis strains. Using a supplemented blood culture, a shortening of the doubling time from ~110 min to ~45 min could be achieved, resulting in increase of 5 order of magnitude in the bacterial loads within 24 h of incubation, consequently allowing the rapid detection and isolation of the slow growing Y. pestis bacteria. In addition, the aerobic and anaerobic blood culture bottles used in clinical set-up were compared for a Y. pestis culture in the presence of Ca+2 and Fe+2. The comparison established the superiority of the supplemented aerobic cultures for an early detection and achieved a significant increase in the yields of the pathogen. In line with the accelerated bacterial growth rates, the specific diagnostic markers F1 and LcrV (V) antigens could be directly detected significantly earlier. Downstream identification employing MALDI-TOF and immunofluorescence assays were performed directly from the inoculated supplemented blood culture, resulting in an increased sensitivity and without any detectable compromise of the accuracy of the antibiotic susceptibility testing (E-test), critical for subsequent successful therapeutic interventions.
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9
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Morel G, Mulier G, Ghrenassia E, Abdel Nabey M, Tandjaoui Y, Kouatchet A, Platon L, Pène F, Moreau AS, Seguin A, Contou D, Sonneville R, Rousset D, Picard M, Dumas G, Mokart D, Megarbane B, Voiriot G, Oddou I, Azoulay E, Biard L, Zafrani L. Non-C. difficile Clostridioides Bacteremia in Intensive Care Patients, France. Emerg Infect Dis 2021; 27:1840-1849. [PMID: 34153220 PMCID: PMC8237868 DOI: 10.3201/eid2707.203471] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Article Summary: This multicenter study focusing on critically ill patients showed a strong relationship between hemolysis and mortality. Usually responsible for soft tissue infections, Clostridioides species can also cause bacteremia, life-threatening infections often requiring intensive care unit (ICU) admission. We conducted a multicenter retrospective study to investigate Clostridioides bacteremia in ICUs to describe the clinical and biologic characteristics and outcomes in critically ill patients. We identified 135 patients with Clostridioides bacteremia, which occurred almost exclusively (96%) in patients with underlying conditions. Septic shock and digestive symptoms were the hallmarks of Clostridioides bacteremia in the ICU. We identified 16 different species of Clostridioides, among which C. perfringens accounted for 31% of cases. Despite the high sensitivity of Clostridioides to common antimicrobial drugs, mortality rates were high: 52% for ICU patients and 71% overall at 3 months. In multivariate analysis, the most important factor associated with increased risk for death was the presence of hemolysis. Clostridioides bacteremia often leads to multiple organ failures, which have high mortality rates.
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GAJDÁCS MÁRIÓ, URBÁN EDIT. Relevance of anaerobic bacteremia in adult patients: A never-ending story? Eur J Microbiol Immunol (Bp) 2020; 10:64-75. [PMID: 32590337 PMCID: PMC7391379 DOI: 10.1556/1886.2020.00009] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Accepted: 04/19/2020] [Indexed: 11/30/2022] Open
Abstract
Obligate anaerobic bacteria are considered important constituents of the microbiota of humans; in addition, they are also important etiological agents in some focal or invasive infections and bacteremia with a high level of mortality. Conflicting data have accumulated over the last decades regarding the extent in which these pathogens play an intrinsic role in bloodstream infections. Clinical characteristics of anaerobic bloodstream infections do not differ from bacteremia caused by other pathogens, but due to their longer generation time and rigorous growth requirements, it usually takes longer to establish the etiological diagnosis. The introduction of matrix-assisted laser desorption-ionization time-of-flight mass spectrometry (MALDI-TOF MS) has represented a technological revolution in microbiological diagnostics, which has allowed for the fast, accurate and reliable identification of anaerobic bacteria at a low sample cost. The purpose of this review article is to summarize the currently available literature data on the prevalence of anaerobic bacteremia in adults for physicians and clinical microbiologists and to shed some light on the complexity of this topic nowadays.
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Affiliation(s)
- MÁRIÓ GAJDÁCS
- Department of Pharmacodynamics and Biopharmacy, Faculty of Pharmacy, University of Szeged, Eötvös utca 6., Szeged, 6720, Hungary
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- Department of Public Health, Faculty of Medicine, University of Szeged, Dóm tér 10., Szeged, 6720, Hungary
- Institute for Translational Medicine, Medical School, University of Pécs, Szigeti út 12., Pécs, 7624, Hungary
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