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Imazio M. The 2023 new European guidelines on infective endocarditis: main novelties and implications for clinical practice. J Cardiovasc Med (Hagerstown) 2024; 25:718-726. [PMID: 38916201 PMCID: PMC11365601 DOI: 10.2459/jcm.0000000000001651] [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: 04/01/2024] [Revised: 05/13/2024] [Accepted: 05/19/2024] [Indexed: 06/26/2024]
Abstract
The 2023 European Society of Cardiology (ESC) guidelines for the management of infective endocarditis update the previous 2015 guidelines with main novelties in five areas: (1) antibiotic prevention for high-risk patients, and prevention measures for intermediate-risk and high-risk patients; (2) diagnosis with emphasis on multimodality imaging to assess cardiac lesions of infective endocarditis' (3) antibiotic therapy allowing an outpatient antibiotic treatment for stabilized, uncomplicated cases; (4) cardiac surgery with an emphasis on early intervention without delay for complicated cases; and (5) shared management decision by the endocarditis team. Most evidence came from observational studies and expert opinions. The guidelines strongly support a patient-centred approach with a shared decision process by a multidisciplinary team that should be implemented either in tertiary referral centres, becoming heart valve centres, and referral centres. A continuous sharing of data is warranted in the hospitals' network between heart valve centres, which are used for referrals for complicated cases of infective endocarditis, and referral centres, which should be able to manage uncomplicated cases of infective endocarditis.
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Affiliation(s)
- Massimo Imazio
- Department of Medicine (DMED), University of Udine
- Cardiothoracic Department, University Hospital Santa Maria della Misericordia, ASUFC, Udine, Italy
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2
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Bengtsson D, Jönsson B, Redfors B. Sterility and oxygenator function in pre-primed extracorporeal membrane oxygenation: A prospective clinical study. Resusc Plus 2024; 19:100680. [PMID: 38912528 PMCID: PMC11192786 DOI: 10.1016/j.resplu.2024.100680] [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: 04/09/2024] [Revised: 05/20/2024] [Accepted: 05/24/2024] [Indexed: 06/25/2024] Open
Abstract
Aim Minimizing cardiac arrest times is critical in extracorporeal cardiopulmonary resuscitation (ECPR). Pre-primed extra corporeal membrane oxygenator (ECMO) is used for this, but knowledge is limited to experimental studies. We prospectively investigated oxygenator function and sterility in dry plus wet pre-priming in a clinical setting. Methods This prospective clinical study included 107 ECMO circuits used at Sahlgrenska University Hospital between October 2019 and December 2021. Circuits underwent dry set-up, followed by wet priming when the previous wet-primed circuit was used. Sterility was assessed by culturing the priming solution. Oxygenator function parameters, including sweep gas flow, fraction of oxygen (FiO2), and oxygenator resistance, were analyzed at ECMO initiation and during treatment using linear mixed models. Results Median total set-up time was 14 days (range 0-97), with a median wet prime time of 6 days (range 0-57). 103 of 105 circuits with culture results were negative, two showed bacterial growth (coagulase-negative staphylococci and Cutibacterium acnes). Wet prime time did not significantly affect initial oxygenator function. Oxygenator resistance and FiO2 increased during ECMO treatment (0.035 mmHg/L min-1 (95 % confidence interval (CI) 0.015-0.055) P < 0.001, and 2.19 % (0.92-3.46) P = 0.009), but these changes were unrelated to wet prime time. Conclusion Wet pre-priming of ECMO circuits for up to 57 days did not affect oxygenator function. The low incidence of bacterial growth (1.9 %) suggests that pre-primed ECMO generally maintain sterility and can facilitate rapid ECPR initiation. However, bacterial growth highlights the need for caution in non-urgent cases. Culturing the circuit at initiation can mitigate this risk.
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Affiliation(s)
- Daniel Bengtsson
- Department of Perfusion, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Bodil Jönsson
- Institute of Biomedicine, Department of Infectious Diseases, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Region Västra Götaland, Sahlgrenska University Hospital, Department of Clinical Microbiology, Gothenburg, Sweden
| | - Bengt Redfors
- Department of Cardiothoracic Anesthesia and Intensive Care, Sahlgrenska University Hospital, Gothenburg, Sweden
- Department of Anesthesiology and Intensive Care Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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3
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Vergara PC, García C, Accini M, Franco L, Vanegas JM, Atehortúa S. Microbiological performance and adherence in blood culture protocols: The role of a second anaerobic bottle. Heliyon 2024; 10:e35615. [PMID: 39220915 PMCID: PMC11364271 DOI: 10.1016/j.heliyon.2024.e35615] [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: 03/11/2024] [Revised: 07/26/2024] [Accepted: 07/31/2024] [Indexed: 09/04/2024] Open
Abstract
Background Bacteremia represents high rates of morbidity and mortality, especially in developing countries, highlighting the need for a diagnostic method that allows prompt and appropriate patient treatment. This study compared microbiological performance and adherence of two blood culture protocols for the diagnosis of bacteremia. Methods Quasi-experimental study conducted between June 2022 and February 2023. Two blood culture protocols were evaluated. Protocol 1 included two aerobic bottles and one anaerobic bottle. Protocol 2 included two aerobic and two anaerobic bottles. Protocols were analyzed in three phases: evaluation of protocol 1 (Phase 1); evaluation of protocol 1 plus educational activities for healthcare staff (Phase 2) and evaluation of protocol 2 (Phase 3). Results 342 patients and 1155 blood culture bottles (732 aerobic and 423 anaerobic) were included. Positivity was 17.6 %, 22.8 % and 19.4 % in phases 1, 2 and 3, respectively. Among patients with bacteremia, 84.5 % had positive anaerobic bottles, with 9.9 % showing growth only in this bottle. The contamination rates were 1.9 %, 0.3 %, and 0.8 % for each phase, mainly in aerobic bottles. Median positivity time was 11 h for both bottes aerobic and anaerobic. Overall nursing adherence increased from 13.1 % in Phase 1, 25.9 % in Phase 2, and 28.1 % in Phase 3 (p = 0.009). Conclusions The findings indicate that adding a second anaerobic bottle does not enhance blood culture positivity. Rather than increasing bottle quantity, staff training might be a more effective approach to optimize results.
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Affiliation(s)
- Paula C. Vergara
- School of Health Sciences, Pontifical Bolivarian University, Medellín, Colombia
| | - Cristian García
- School of Health Sciences, Pontifical Bolivarian University, Medellín, Colombia
- Bolivarian University Clinic, Medellín, Colombia
- Cardiovid Clinic, Medellín, Colombia
| | - Melissa Accini
- School of Health Sciences, Pontifical Bolivarian University, Medellín, Colombia
| | - Liliana Franco
- School of Health Sciences, Pontifical Bolivarian University, Medellín, Colombia
- Cardiovid Clinic, Medellín, Colombia
| | - Johanna M. Vanegas
- School of Health Sciences, Pontifical Bolivarian University, Medellín, Colombia
| | - Santiago Atehortúa
- School of Health Sciences, Pontifical Bolivarian University, Medellín, Colombia
- Bolivarian University Clinic, Medellín, Colombia
- Pablo Tobón Uribe Hospital, Medellín, Colombia
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4
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Oldberg K, Rasmussen M. Make Modern Microbiology Matter More in the 2023 European Society of Cardiology Guidelines for the Management of Infective Endocarditis. Clin Infect Dis 2024; 79:336-338. [PMID: 38655671 PMCID: PMC11327790 DOI: 10.1093/cid/ciae222] [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: 02/14/2024] [Revised: 04/12/2024] [Accepted: 04/19/2024] [Indexed: 04/26/2024] Open
Abstract
The European Society of Cardiology (ESC) 2023 guidelines for the management of infective endocarditis (IE) stress that a multidisciplinary approach is needed to manage patients with IE. In our view, the guidelines do not include the relevant perspectives from modern microbiology. The diagnostic criteria for IE were changed in the ESC 2023 guidelines, and many IE-causing pathogens are either not clearly defined. Moreover, an improved understanding of the relationship between bacterial species and the risk for IE has not been implemented. The guidelines give detailed and, in our view, incorrect instructions about diagnostic testing in blood culture-negative IE without presenting proper evidence. Other important diagnostic aspects, such as the value of repeated blood cultures and incubation time for blood cultures, are not discussed. We believe that a multidisciplinary collaboration that include microbiologists would have improved these guidelines, and we hope for a future harmonization of diagnostic criteria for IE.
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Affiliation(s)
- Karl Oldberg
- Department of Clinical Sciences, Division of Infection Medicine, Lund University, Lund, Sweden
- Department of Clinical Microbiology, Infection Control and Prevention, Office for Medial Services, Lund, Sweden
| | - Magnus Rasmussen
- Department of Clinical Sciences, Division of Infection Medicine, Lund University, Lund, Sweden
- Division for Infectious Diseases, Skåne University Hospital, Lund, Sweden
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5
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Yu D, Ekwall-Larson A, Özenci V. Performance of T2Bacteria in relationship to blood cultures - a retrospective comparative study. Eur J Clin Microbiol Infect Dis 2024:10.1007/s10096-024-04916-6. [PMID: 39096321 DOI: 10.1007/s10096-024-04916-6] [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: 04/26/2024] [Accepted: 07/26/2024] [Indexed: 08/05/2024]
Abstract
PURPOSE Blood culture (BC) is the gold standard for diagnosing blood stream infections (BSI) but is limited by long turnaround times (TAT) and low detection rate. The T2 Magnetic Resonance method (T2MR) offers a rapid, culture-independent alternative. The objective of this study was to compare the performance of the T2Bacteria assay to BCs in a real-world setting. METHODS Retrospective comparative study consisting of T2Bacteria samples and BCs sampled within 72 h from the T2Bacteria sample. The primary outcome was detections by BC and T2Bacteria, respectively. The secondary outcome was difference in TAT. RESULTS In total, 640 episodes were included, consisting of 640 T2Bacteria samples and 2,117 BCs. A median of three BCs was collected for each T2Bacteria sample. Overall positivity was 101 (15.8%) by either method. In 29 (28.7%) episodes, both T2Bacteria and BC were concordantly positive. In discordant episodes, 46/101 (45.5%) episodes were T2Bacteria positive/BC negative and 26/101 (25.7%) were T2Bacteria negative/BC positive (McNemar χ2, p < 0,05). In T2Bacteria positive/BC negative episodes, eight had growth of the same microorganism in a non-BC culture. Median (IQR) TAT for BC was 35 h and 30 min (25 h 50 min - 45 h 24 min), compared to 21 h and 3 min (17 h 6 min - 27 h 30 m) for T2Bacteria (p < 0.001), with longer delays for samplings occurring outside work hours. CONCLUSIONS The study highlights a high discordance between T2Bacteria and BC and suggests complementary roles of the methods in BSI diagnostics. Furthermore, it is crucial to improve TAT by reducing preanalytical delays.
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Affiliation(s)
- David Yu
- Division of Clinical Microbiology, Department of Laboratory Medicine, Karolinska Institutet, SE-141 86 Stockholm, Hälsovägen, Stockholm, Sweden.
- Functional Area of Perioperative Medicine and Intensive Care, Karolinska University Hospital, Stockholm, Sweden.
| | - Anna Ekwall-Larson
- Division of Clinical Microbiology, Department of Laboratory Medicine, Karolinska Institutet, SE-141 86 Stockholm, Hälsovägen, Stockholm, Sweden
| | - Volkan Özenci
- Division of Clinical Microbiology, Department of Laboratory Medicine, Karolinska Institutet, SE-141 86 Stockholm, Hälsovägen, Stockholm, Sweden
- Department of Clinical Microbiology, Karolinska University Hospital, Stockholm, Sweden
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Berninghausen C, Schwab F, Gropmann A, Leidel BA, Somasundaram R, Hottenbacher L, Gastmeier P, Hansen S. Deficits in blood culture collection in the emergency department if sepsis is suspected: results of a retrospective cohort study. Infection 2024; 52:1385-1396. [PMID: 38441730 PMCID: PMC11289221 DOI: 10.1007/s15010-024-02197-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Accepted: 01/23/2024] [Indexed: 08/02/2024]
Abstract
PURPOSE Blood cultures (BCs) are key for pathogen detection in septic patients. We investigated the extent to which sampling was performed and what factors were associated with the absence of general or inadequate BC sampling. METHODS We conducted a retrospective cohort study of hospitalized patients with sepsis admitted to one of three EDs in 2018. Primary outcome was the extent of general BC collection of at least 1 set. Secondary outcome was the extent of adequate BC sampling, defined as ≥ 2 sets before antibiotic therapy (AT). Multivariable logistic regression analysis was performed to identify factors associated with deficits in both outcomes. RESULTS 1143 patients were analyzed. BCs were collected from 946 patients. Single BCs were taken from 520 patients, ≥ 2 sets from 426 patients. Overall, ≥ 2 BCs were taken from 349 patients before AT. BC sampling before AT occurred significantly more frequently when ≥ 2 BC sets were taken rather than a single one (81.9%, versus 68.4%, p < 0.001) and this also led to the highest pathogen detection rate in our cohort (65.6%). A body temperature of ≥ 38 °C was the a supporting factor for general and adequate BC collection in all three EDs. Retrospective analysis of 533 patients showed that the qSOFA score had no influence on general or adequate BC collection. CONCLUSION Data on everyday clinical practice in the pre-analytical phase of microbiological diagnostics shows considerable deficits and indicates the need for more implementation of best practice. The variations identified in BC sampling between EDs should be further investigated.
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Affiliation(s)
- Charlotte Berninghausen
- Department of Cardiology and Intensive Care, Vivantes Wenckebach Klinikum, Berlin, Germany
- Department of Emergency Medicine, Vivantes Auguste-Viktoria Klinikum and Vivantes Wenckebach Klinikum, Berlin, Germany
| | - Frank Schwab
- Institute of Hygiene and Environmental Medicine, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Alexander Gropmann
- Institute of Hygiene and Environmental Medicine, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Bernd A Leidel
- Department of Emergency Medicine, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Campus Benjamin Franklin, Berlin, Germany
| | - Rajan Somasundaram
- Department of Emergency Medicine, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Campus Benjamin Franklin, Berlin, Germany
| | - Lydia Hottenbacher
- Department of Emergency Medicine, Vivantes Auguste-Viktoria Klinikum and Vivantes Wenckebach Klinikum, Berlin, Germany
| | - Petra Gastmeier
- Institute of Hygiene and Environmental Medicine, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Sonja Hansen
- Institute of Hygiene and Environmental Medicine, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany.
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Kim TH, Kang J, Jang H, Joo H, Lee GY, Kim H, Cho U, Bang H, Jang J, Han S, Kim DY, Lee CM, Kang CK, Choe PG, Kim NJ, Oh MD, Kim TS, Kim I, Park WB, Kwon S. Blood culture-free ultra-rapid antimicrobial susceptibility testing. Nature 2024; 632:893-902. [PMID: 39048820 DOI: 10.1038/s41586-024-07725-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2023] [Accepted: 06/17/2024] [Indexed: 07/27/2024]
Abstract
Treatment assessment and patient outcome for sepsis depend predominantly on the timely administration of appropriate antibiotics1-3. However, the clinical protocols used to stratify and select patient-specific optimal therapy are extremely slow4. In particular, the major hurdle in performing rapid antimicrobial susceptibility testing (AST) remains in the lengthy blood culture procedure, which has long been considered unavoidable due to the limited number of pathogens present in the patient's blood. Here we describe an ultra-rapid AST method that bypasses the need for traditional blood culture, thereby demonstrating potential to reduce the turnaround time of reporting drug susceptibility profiles by more than 40-60 h compared with hospital AST workflows. Introducing a synthetic beta-2-glycoprotein I peptide, a broad range of microbial pathogens are selectively recovered from whole blood, subjected to species identification or instantly proliferated and phenotypically evaluated for various drug conditions using a low-inoculum AST chip. The platform was clinically evaluated by the enrolment of 190 hospitalized patients suspected of having infection, achieving 100% match in species identification. Among the eight positive cases, six clinical isolates were retrospectively tested for AST showing an overall categorical agreement of 94.90% with an average theoretical turnaround time of 13 ± 2.53 h starting from initial blood processing.
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Affiliation(s)
- Tae Hyun Kim
- Bio-MAX Institute, Seoul National University, Seoul, Korea
- Department of Electrical and Computer Engineering, Seoul National University, Seoul, Korea
| | - Junwon Kang
- Interdisciplinary Program in Bioengineering, Seoul National University, Seoul, Korea
- Integrated Major in Innovative Medical Science, Seoul National University, Seoul, Korea
| | - Haewook Jang
- Interdisciplinary Program in Bioengineering, Seoul National University, Seoul, Korea
| | - Hyelyn Joo
- Interdisciplinary Program in Bioengineering, Seoul National University, Seoul, Korea
| | - Gi Yoon Lee
- Department of Electrical and Computer Engineering, Seoul National University, Seoul, Korea
| | - Hamin Kim
- Interdisciplinary Program in Bioengineering, Seoul National University, Seoul, Korea
| | | | | | | | | | | | - Chan Mi Lee
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Chang Kyung Kang
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Pyoeng Gyun Choe
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Nam Joong Kim
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Myoung-Don Oh
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Taek Soo Kim
- Department of Laboratory Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Inho Kim
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea.
| | - Wan Beom Park
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea.
| | - Sunghoon Kwon
- Bio-MAX Institute, Seoul National University, Seoul, Korea.
- Department of Electrical and Computer Engineering, Seoul National University, Seoul, Korea.
- Interdisciplinary Program in Bioengineering, Seoul National University, Seoul, Korea.
- QuantaMatrix Inc., Seoul, Korea.
- Inter-University Semiconductor Research Center, Seoul National University, Seoul, Korea.
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Whelan SO, Mulrooney C, Moriarty F, Cormican M. Pediatric blood cultures-turning up the volume: a before and after intervention study. Eur J Pediatr 2024; 183:3063-3071. [PMID: 38656384 PMCID: PMC11192679 DOI: 10.1007/s00431-024-05544-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2024] [Revised: 03/23/2024] [Accepted: 03/26/2024] [Indexed: 04/26/2024]
Abstract
The major determinant of blood culture (BC) diagnostic performance is blood volume, and pediatric sample volumes are frequently low. We aimed to assess BC volumes in our institution, design an intervention to increase volumes, and assess its impact. All pediatric BCs submitted over a 7-month period to the microbiology laboratory in a university hospital (including emergency department, pediatric ward, and neonatal unit) were included. A pre-intervention period assessed current practice. A multi-faceted intervention (education, guideline introduction, active feedback strategies) was collaboratively designed by all stakeholders. Impact was assessed in a post-intervention period. The main outcome measures included the percentage of samples adequately filled using three measures of sample adequacy (1) manufacturer-recommended minimum validated volume-> 0.5 ml, (2) manufacturer-recommended optimal minimum volume-> 1.0 ml, (3) newly introduced age-specific recommendations. Three hundred ninety-eight pre-intervention and 388 post-intervention samples were included. Initial volumes were low but increased significantly post-intervention (median 0.77 ml vs. 1.52 ml), with multivariable regression analysis estimating volumes increased 89% post-intervention. There were significant increases in all measures of volume adequacy, including an increase in age-appropriate filling (20.4-53.1%), with less improvement in those aged > 3 years. Overall, 68.4% of pathogens were from adequately filled cultures, while 76% of contaminants were from inadequately filled cultures. A pathogen was detected in a higher proportion of adequately filled than inadequately filled cultures (9.4% vs. 2.2%, p < 0.001). Conclusion: Blood volume impacts BC sensitivity, with lower volumes yielding fewer pathogens and more contaminants. Focused intervention can significantly improve volumes to improve diagnostic performance. What is Known: • Blood volume is the major determinant of blood culture positivity, and yet pediatric blood culture volumes are frequently low, resulting in missed pathogens and increased contamination. What is New: • Adequately filled (for age) blood cultures have a pathogen detection rate three times higher than inadequately filled blood cultures. • This interventional study shows that collaboratively designed multi-modal interventions including focus on accurate volume measurement can lead to significant increases in blood volumes and improve blood culture diagnostic performance.
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Affiliation(s)
- Seán Olann Whelan
- National Virus Reference Laboratory, University College Dublin, Dublin, Ireland.
- Division of Medical Microbiology, Galway University Hospital, Galway, Ireland.
- Department of Microbiology, Children's Health Ireland at Temple Street, Dublin, Ireland.
| | - Conor Mulrooney
- Division of Medical Microbiology, Galway University Hospital, Galway, Ireland
| | - Frank Moriarty
- School of Pharmacy and Biomolecular Sciences, RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Martin Cormican
- Division of Medical Microbiology, Galway University Hospital, Galway, Ireland
- Discipline of Bacteriology, College of Medicine, Nursing & Health Sciences, University of Galway, Galway, Ireland
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Reisinger M, Kachel M, George I. Emerging and Re-Emerging Pathogens in Valvular Infective Endocarditis: A Review. Pathogens 2024; 13:543. [PMID: 39057770 PMCID: PMC11279809 DOI: 10.3390/pathogens13070543] [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: 06/01/2024] [Revised: 06/21/2024] [Accepted: 06/25/2024] [Indexed: 07/28/2024] Open
Abstract
Infective endocarditis (IE) is a microbial infection of the endocardial surface, most commonly affecting native and prosthetic valves of the heart. The epidemiology and etiology of the disease have evolved significantly over the last decades. With a growing elderly population, the incidence of degenerative valvopathies and the use of prosthetic heart valves have increased, becoming the most important predisposing risk factors. This change in the epidemiology has caused a shift in the underlying microbiology of the disease, with Staphylococci overtaking Streptococci as the main causative pathogens. Other rarer microbes, including Streptococcus agalactiae, Pseudomonas aeruginosa, Coxiella burnetti and Brucella, have also emerged or re-emerged. Valvular IE caused by these pathogens, especially Staphylococcus aureus, is often associated with a severe clinical course, leading to high rates of morbidity and mortality. Therefore, prompt diagnosis and management are crucial. Due to the high virulence of these pathogens and an increased incidence of antimicrobial resistances, surgical valve repair or replacement is often necessary. As the epidemiology and etiology of valvular IE continue to evolve, the diagnostic methods and therapies need to be progressively advanced to ensure satisfactory clinical outcomes.
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Affiliation(s)
- Maximilian Reisinger
- Division of Cardiac, Thoracic & Vascular Surgery, New York-Presbyterian Hospital, Columbia University Medical Center, New York, NY 10032, USA
| | - Mateusz Kachel
- Division of Cardiac, Thoracic & Vascular Surgery, New York-Presbyterian Hospital, Columbia University Medical Center, New York, NY 10032, USA
- Center for Cardiovascular Research and Development, American Heart of Poland, 40-028 Katowice, Poland
| | - Isaac George
- Division of Cardiac, Thoracic & Vascular Surgery, New York-Presbyterian Hospital, Columbia University Medical Center, New York, NY 10032, USA
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Morquin D, Lejeune J, Agostini C, Godreuil S, Reynes J, Le Moing V, Lamy B. Time Is of the Essence: Achieving Prompt and Effective Antimicrobial Therapy of Bloodstream Infection With Advanced Hospital Information Systems. Clin Infect Dis 2024; 78:1434-1442. [PMID: 38059510 DOI: 10.1093/cid/ciad744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Revised: 11/28/2023] [Accepted: 12/01/2023] [Indexed: 12/08/2023] Open
Abstract
The early administration of appropriate antibiotic therapy is crucial for the survival of patients with bacteremia. Current research focuses on improving analytical times through technology, whereas there have been very few efforts to improve postanalytical times even though they represent 40% of the time between blood taking and appropriate treatment administration. One of the clues is the efficiency and appropriateness of the result communication system. Here, we review all delays in the entire process with the aim of improving time to appropriate treatment administration. We discuss causes for long times to adjust treatment once microbiological results are released. We argue that the pervasive health information system in this organization serves as both a bottleneck and a rigid framework. Finally, we explore how next-generation hospital information systems should be designed to effectively assist the doctors in treating patients with bacteremia.
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Affiliation(s)
- David Morquin
- Département des Maladies Infectieuses et Tropicales, CHU Montpellier, Montpellier, France
- Espace de Recherche et d'Intégration des Outils numériques en Santé (ERIOS), CHU Montpellier, Montpellier, France
| | - Jordan Lejeune
- Département des Maladies Infectieuses et Tropicales, CHU Montpellier, Montpellier, France
| | - Céline Agostini
- Département des Maladies Infectieuses et Tropicales, CHU Montpellier, Montpellier, France
| | - Sylvain Godreuil
- Laboratoire de bactériologie, CHU Montpellier, Université Montpellier, Montpellier, France
| | - Jacques Reynes
- Département des Maladies Infectieuses et Tropicales CHU, CHU Montpellier, Université Montpellier, Montpellier, France
| | - Vincent Le Moing
- Département des Maladies Infectieuses et Tropicales CHU, CHU Montpellier, Université Montpellier, Montpellier, France
| | - Brigitte Lamy
- UFR Médecine, Université Côte d'Azur, CHU de Nice, INSERM, C3M, Nice, France
- UFR SMBH, Université Sorbonne Paris Nord, Bobigny, France
- Service de Microbiologie, Assistance publique - Hopitaux de Paris (APHP), Hôpitaux Universitaires Paris Seine Saint-Denis (HUPSSD), Bobigny, France
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11
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Cohen R, Tannous E, Natan OB, Vaknin A, Ganayem M, Reisfeld S, Lipman-Arens S, Mahamid L, Ishay L, Karisi E, Melnik N, Leibel M, Ashkar J, Freimann S. An emergency department intervention to improve earlier detection of community-onset bloodstream infection among hospitalized patients. Am J Infect Control 2024; 52:664-669. [PMID: 38232901 DOI: 10.1016/j.ajic.2024.01.003] [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: 10/18/2023] [Revised: 01/05/2024] [Accepted: 01/09/2024] [Indexed: 01/19/2024]
Abstract
BACKGROUND Blood cultures (BCs) are essential microbiologic tests, but blood culturing diagnostic stewardship is frequently poor. We aimed to study the process-related failures and to evaluate the effect of an emergency department (ED) intervention on BCs collection practices and yield. METHODS We implemented an ED-quality improvement intervention including educational sessions, phlebotomists addition, promoting single-site strategy for BC-collection and preanalytical data feedback. BC-bottles collected, positive BCs, blood volumes and documentation of collection times were measured, before (December 2021-August 2022) and after (September 2022-July 2023) intervention. Results were corrected to hospitalizations admissions or days. We used interrupted-time series analyses for comparisons. RESULTS A total of 64,295 BC bottles were evaluated, 26,261 before and 38,034 postintervention. The median ED-BCs collected per week increased from 88 to 105 BCs (P < .0001), resulting from increased early sampling (P = .0001). Solitary BCs decreased (95%-28%), documented times increased (2.8%-25%), and average blood volume increased (3 mL to 4.5 mL) postintervention. Community-onset Bloodstream infections (BSIs) increased (39.6-52 bottles/1,000 admissions, P = .0001), while Health care-associated BSIs decreased (39-27 bottles/10,000 days, P = .0042). Contamination rates did not change. CONCLUSIONS An ED-focused intervention based on the education sessions and single-site strategy improved culturing stewardship and facilitated the early identification of BSI without an increase in contamination.
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Affiliation(s)
- Regev Cohen
- Infection Control and Infectious Diseases Units, Hillel Yaffe Medical Centre, Hadera, Israel; Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel.
| | - Elias Tannous
- Pharmacy Department, Hillel Yaffe Medical Centre, Hadera, Israel; Clinical Biochemistry and Pharmacology, Faculty of Health Sciences, Ben-Gurion University of the Negev, Be'er Sheva, Israel
| | - Orna Ben Natan
- Infection Control and Infectious Diseases Units, Hillel Yaffe Medical Centre, Hadera, Israel
| | - Aliza Vaknin
- Infection Control and Infectious Diseases Units, Hillel Yaffe Medical Centre, Hadera, Israel
| | - Mohammed Ganayem
- Infection Control and Infectious Diseases Units, Hillel Yaffe Medical Centre, Hadera, Israel
| | - Sharon Reisfeld
- Infection Control and Infectious Diseases Units, Hillel Yaffe Medical Centre, Hadera, Israel; Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Shelly Lipman-Arens
- Infection Control and Infectious Diseases Units, Hillel Yaffe Medical Centre, Hadera, Israel; Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Lamis Mahamid
- Infection Control and Infectious Diseases Units, Hillel Yaffe Medical Centre, Hadera, Israel; Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Linor Ishay
- Infection Control and Infectious Diseases Units, Hillel Yaffe Medical Centre, Hadera, Israel; Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Erez Karisi
- Information Technology Department, Hillel Yaffe Medical Centre, Hadera, Israel
| | - Noa Melnik
- Information Technology Department, Hillel Yaffe Medical Centre, Hadera, Israel
| | - Mira Leibel
- Emergency Department, Hillel Yaffe Medical Centre, Hadera, Israel
| | - Jalal Ashkar
- Emergency Department, Hillel Yaffe Medical Centre, Hadera, Israel
| | - Sarit Freimann
- Department of Laboratories, Clinical Microbiology Laboratory, Hillel Yaffe Medical Centre, Hadera, Israel
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12
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Aggarwal S, Sangle AL, Siddiqui MS, Haseeb M, Engade MB. An Observational Study on C-Reactive Protein to Platelet Ratio in Neonatal Sepsis. Cureus 2024; 16:e62230. [PMID: 39006693 PMCID: PMC11241635 DOI: 10.7759/cureus.62230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/12/2024] [Indexed: 07/16/2024] Open
Abstract
BACKGROUND Neonatal sepsis is a serious medical condition affecting many individuals in the developing world. C-reactive protein (CRP) level in serum and platelet counts have been reported to have role in diagnosis of neonatal sepsis. OBJECTIVE To evaluate the CRP to Platelet ratio (CPR) in relation to time and blood culture reports in neonatal sepsis patients from a tertiary care centre in the Marathwada region of Maharashtra. METHODS The present observational study was conducted at the level III Neonatal Intensive Care Unit of a tertiary care centre in Aurangabad city of Marathwada region in Maharashtra from September 2022 to July 2023. The study included 120 neonates (delivered after completion of 28-42 weeks of gestation) with clinical/culture-positive sepsis. The newborns of seropositive mothers, neonates delivered in other hospitals, babies with congenital dysmorphic features, and babies requiring surgical procedures were excluded from the study. Blood samples for complete blood count (CBC) and CRP were collected on days 1, 3 and 5. Blood cultures were sent on day 1 of illness. Repeated measures ANOVA was used to compare the parameters of CPR, CRP, and platelet count in blood culture-positive and blood culture-negative neonatal sepsis patients on days 1, 3 and 5. RESULTS Blood culture was positive in 37 (30.8%) cases. A repeated measures ANOVA showed a significant overall difference in the CPR across days 1, 3, and 5 (p = 0.006). The CPR was significantly higher in culture-positive neonates compared to culture-negative neonates (p = 0.042). CONCLUSION Higher CPR in blood culture-positive neonates compared to blood culture-negative neonates supports the role of CPR in the diagnosis and management of neonatal sepsis.
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Affiliation(s)
- Shreya Aggarwal
- Pediatrics, Mahatma Gandhi Mission Medical College and Hospital, Aurangabad, IND
| | - Avinash L Sangle
- Pediatrics, Mahatma Gandhi Mission Medical College and Hospital, Aurangabad, IND
| | - Mohd Saeed Siddiqui
- Pediatrics, Mahatma Gandhi Mission Medical College and Hospital, Aurangabad, IND
| | - Mohammad Haseeb
- Pediatrics, Mahatma Gandhi Mission Medical College and Hospital, Aurangabad, IND
| | - Madhuri B Engade
- Pediatrics, Mahatma Gandhi Mission Medical College and Hospital, Aurangabad, IND
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13
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Liu Y, Ma Y. Clinical applications of metagenomics next-generation sequencing in infectious diseases. J Zhejiang Univ Sci B 2024; 25:471-484. [PMID: 38910493 PMCID: PMC11199093 DOI: 10.1631/jzus.b2300029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Accepted: 06/06/2023] [Indexed: 05/23/2024]
Abstract
Infectious diseases are a great threat to human health. Rapid and accurate detection of pathogens is important in the diagnosis and treatment of infectious diseases. Metagenomics next-generation sequencing (mNGS) is an unbiased and comprehensive approach for detecting all RNA and DNA in a sample. With the development of sequencing and bioinformatics technologies, mNGS is moving from research to clinical application, which opens a new avenue for pathogen detection. Numerous studies have revealed good potential for the clinical application of mNGS in infectious diseases, especially in difficult-to-detect, rare, and novel pathogens. However, there are several hurdles in the clinical application of mNGS, such as: (1) lack of universal workflow validation and quality assurance; (2) insensitivity to high-host background and low-biomass samples; and (3) lack of standardized instructions for mass data analysis and report interpretation. Therefore, a complete understanding of this new technology will help promote the clinical application of mNGS to infectious diseases. This review briefly introduces the history of next-generation sequencing, mainstream sequencing platforms, and mNGS workflow, and discusses the clinical applications of mNGS to infectious diseases and its advantages and disadvantages.
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Affiliation(s)
- Ying Liu
- Department of Clinical Laboratory, Affiliated Jinhua Hospital, Zhejiang University School of Medicine, Jinhua 321000, China
| | - Yongjun Ma
- Department of Clinical Laboratory, Affiliated Jinhua Hospital, Zhejiang University School of Medicine, Jinhua 321000, China.
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14
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Pas ML, Boyen F, Castelain D, Chantillon L, Paepe D, Pille F, Pardon B, Bokma J. Bayesian evaluation of sensitivity and specificity of blood culture media and hypoglycemia in sepsis-suspected calves. J Vet Intern Med 2024; 38:1906-1916. [PMID: 38526076 PMCID: PMC11099746 DOI: 10.1111/jvim.17040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Accepted: 02/27/2024] [Indexed: 03/26/2024] Open
Abstract
BACKGROUND Sepsis is a life-threatening condition for which critically important antimicrobials are often indicated. The value of blood culture for sepsis is indisputable, but appropriate guidelines on sampling and interpretation are currently lacking in cattle. OBJECTIVE Compare the diagnostic accuracy of 2 blood culture media (pediatric plus [PP] and plus aerobic [PA]) and hypoglycemia for bacteremia detection. Estimate the contamination risk of blood cultures in critically ill calves. ANIMALS One hundred twenty-six critically ill calves, 0 to 114 days. METHODS Retrospective cross-sectional study in which the performance of PP, PA and hypoglycemia to diagnose sepsis was assessed using a Bayesian latent class model. A Cox proportional hazards model was used to compare time to positivity (TTP). Potential contamination was descriptively analyzed. Isolates were considered relevant when they were; member of the Enterobacterales, isolated from both blood cultures vials, or well-known, significant bovine pathogens. RESULTS The sensitivities for PP, PA, and hypoglycemia were higher when excluding assumed contaminants; 68.7% (95% credibility interval = 30.5%-93.7%), 87.5% (47.0%-99.5%), and 61.3% (49.7%-72.4%), respectively. Specificity was estimated at 95.1% (82.2%-99.7%), 94.2% (80.7%-99.7%), and 72.4% (64.6%-79.6%), respectively. Out of 121 interpretable samples, 14.9% grew a presumed contaminant in PA, PP, or both. There was no significant difference in the TTP between PA and PP. CONCLUSIONS AND CLINICAL IMPORTANCE PA and PP appear to outperform hypoglycemia as diagnostic tests for sepsis. PA seems most sensitive, but a larger sample size is required to verify this. Accuracy increased greatly after excluding assumed contaminants. The type of culture did not influence TTP or the contamination rate.
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Affiliation(s)
- Mathilde Laetitia Pas
- Department of Internal Medicine, Reproduction and Population MedicineFaculty of Veterinary Medicine, Ghent UniversityMerelbekeBelgium
| | - Filip Boyen
- Department of Pathobiology, Pharmacology and Zoological MedicineFaculty of Veterinary Medicine, Ghent UniversityMerelbekeBelgium
| | - Donatienne Castelain
- Department of Internal Medicine, Reproduction and Population MedicineFaculty of Veterinary Medicine, Ghent UniversityMerelbekeBelgium
| | - Laurens Chantillon
- Department of Internal Medicine, Reproduction and Population MedicineFaculty of Veterinary Medicine, Ghent UniversityMerelbekeBelgium
| | - Dominique Paepe
- Small Animal DepartmentFaculty of Veterinary Medicine, Ghent UniversityMerelbekeBelgium
| | - Frederik Pille
- Department of Large Animal Surgery, Anaesthesia and OrthopaedicsFaculty of Veterinary Medicine, Ghent UniversityMerelbekeBelgium
| | - Bart Pardon
- Department of Internal Medicine, Reproduction and Population MedicineFaculty of Veterinary Medicine, Ghent UniversityMerelbekeBelgium
| | - Jade Bokma
- Department of Internal Medicine, Reproduction and Population MedicineFaculty of Veterinary Medicine, Ghent UniversityMerelbekeBelgium
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15
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Liao Y, Liu Y, Feng Y, Zhen D, He F. Rapid Detection of Broad-Spectrum Pathogenic Bacteria Based on Highly Sensitive Proton Response of the Nucleic Acid Amplification SPQC Platform. Anal Chem 2024; 96:6756-6763. [PMID: 38625745 DOI: 10.1021/acs.analchem.4c00437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/17/2024]
Abstract
Pathogenic bacteria significantly contribute to elevated morbidity and mortality rates, highlighting the urgent need for early and precise detection. Currently, there is a paucity of effective broad-spectrum methods for detecting pathogenic bacteria. We have developed an innovative proton-responsive series piezoelectric quartz crystal (PR-SPQC) platform for the broad-spectrum identification of pathogenic bacteria. This was achieved by retrieving and aligning sequences from the NCBI GenBank database to identify and validate 16S rRNA oligonucleotide sequences that are signatures of pathogenic bacteria but absent in humans or fungi. The hyperbranched rolling circle amplification, activated exclusively by the screened target, exponentially generates protons that are detected by SPQC through a 2D polyaniline (PANI) film. The PR-SPQC platform demonstrates broad-spectrum capabilities in detecting pathogenic bacteria, with a detection limit of 2 CFU/mL within 90 min. Clinical testing of blood samples yielded satisfactory results. With its advantages in miniaturization, cost efficiency, and suitability for point-of-care testing, PR-SPQC has the potential to be extensively used for the rapid identification of diverse pathogenic bacteria within clinical practice and public health sectors.
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Affiliation(s)
- Yusheng Liao
- State Key Laboratory of Chemo/Biosensing and Chemometrics, College of Chemistry and Chemical Engineering, Hunan University, Changsha 410082, PR China
| | - Yu Liu
- State Key Laboratory of Chemo/Biosensing and Chemometrics, College of Chemistry and Chemical Engineering, Hunan University, Changsha 410082, PR China
| | - Ye Feng
- State Key Laboratory of Chemo/Biosensing and Chemometrics, College of Chemistry and Chemical Engineering, Hunan University, Changsha 410082, PR China
| | - Deshuai Zhen
- Hunan Key Laboratory of Typical Environment Pollution and Health Hazards, School of Public Health, University of South China, Hengyang 421001, PR China
| | - Fengjiao He
- State Key Laboratory of Chemo/Biosensing and Chemometrics, College of Chemistry and Chemical Engineering, Hunan University, Changsha 410082, PR China
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16
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Walter C, Weissert C, Gizewski E, Burckhardt I, Mannsperger H, Hänselmann S, Busch W, Zimmermann S, Nolte O. Performance evaluation of machine-assisted interpretation of Gram stains from positive blood cultures. J Clin Microbiol 2024; 62:e0087623. [PMID: 38506525 PMCID: PMC11005413 DOI: 10.1128/jcm.00876-23] [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: 08/08/2023] [Accepted: 02/24/2024] [Indexed: 03/21/2024] Open
Abstract
Manual microscopy of Gram stains from positive blood cultures (PBCs) is crucial for diagnosing bloodstream infections but remains labor intensive, time consuming, and subjective. This study aimed to evaluate a scan and analysis system that combines fully automated digital microscopy with deep convolutional neural networks (CNNs) to assist the interpretation of Gram stains from PBCs for routine laboratory use. The CNN was trained to classify images of Gram stains based on staining and morphology into seven different classes: background/false-positive, Gram-positive cocci in clusters (GPCCL), Gram-positive cocci in pairs (GPCP), Gram-positive cocci in chains (GPCC), rod-shaped bacilli (RSB), yeasts, and polymicrobial specimens. A total of 1,555 Gram-stained slides of PBCs were scanned, pre-classified, and reviewed by medical professionals. The results of assisted Gram stain interpretation were compared to those of manual microscopy and cultural species identification by matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF MS). The comparison of assisted Gram stain interpretation and manual microscopy yielded positive/negative percent agreement values of 95.8%/98.0% (GPCCL), 87.6%/99.3% (GPCP/GPCC), 97.4%/97.8% (RSB), 83.3%/99.3% (yeasts), and 87.0%/98.5% (negative/false positive). The assisted Gram stain interpretation, when compared to MALDI-TOF MS species identification, also yielded similar results. During the analytical performance study, assisted interpretation showed excellent reproducibility and repeatability. Any microorganism in PBCs should be detectable at the determined limit of detection of 105 CFU/mL. Although the CNN-based interpretation of Gram stains from PBCs is not yet ready for clinical implementation, it has potential for future integration and advancement.
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Affiliation(s)
- Christian Walter
- Department of Infectious Diseases, Medical Microbiology and Hygiene, Medical Faculty Heidelberg, Heidelberg University, Heidelberg, Germany
- University Hospital Heidelberg, Heidelberg, Germany
| | - Christoph Weissert
- Division of Human Microbiology, Centre for Laboratory Medicine, St. Gall, Switzerland
| | - Eve Gizewski
- MetaSystems Hard & Software GmbH, Altlussheim, Germany
| | - Irene Burckhardt
- Department of Infectious Diseases, Medical Microbiology and Hygiene, Medical Faculty Heidelberg, Heidelberg University, Heidelberg, Germany
- University Hospital Heidelberg, Heidelberg, Germany
| | | | | | | | - Stefan Zimmermann
- Department of Infectious Diseases, Medical Microbiology and Hygiene, Medical Faculty Heidelberg, Heidelberg University, Heidelberg, Germany
- University Hospital Heidelberg, Heidelberg, Germany
| | - Oliver Nolte
- Division of Human Microbiology, Centre for Laboratory Medicine, St. Gall, Switzerland
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17
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Zornitzki L, Anuk L, Frydman S, Morag-Koren N, Zahler D, Freund O, Biran R, Liron Y, Tau L, Tchebiner JZ, Katash H, Bornstein G. Rate and predictors of blood culture positivity after antibiotic administration: a prospective single-center study. Infection 2024; 52:483-490. [PMID: 37884696 DOI: 10.1007/s15010-023-02105-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Accepted: 09/27/2023] [Indexed: 10/28/2023]
Abstract
PURPOSE Blood culture obtainment prior to antibiotic administration, in patients with suspected infection, is considered the best practice in international guidelines. However, there is little data regarding the effect of a single dose of antibiotics on blood culture sterilization. METHODS We conducted a prospective study, enrolling consecutive patients with suspected infection, hospitalized in an internal medicine ward between December 2019 and January 2023. Included patients had a positive blood culture prior to antibiotic administration and a set of blood cultures taken within 24 h after a single dose of antibiotics. The rate of patients with pathogen isolation after antibiotic administration was assessed. Logistic regression was performed to examine factors associated with blood culture positivity. RESULTS A total of 155 patients were recruited for the study of which 131 (50.8% female 77.5 ± 13.4 years) met the inclusion criteria. The overall rate of patients with a positive blood culture after a single dose of antibiotics was 42.0% (55/131 patients). Increasing time between antibiotic administration and post-antibiotic culture was an independent predictor for blood culture sterilization (odds ratio 0.89 [95% confidence interval, 0.83-0.97; p = 0.006] for every 60 min). Blood culture volume was an independent predictor for blood culture positivity in a sensitivity analysis which included 82 patients (OR = 1.26 [95% CI 1.03-1.57] for every 1 ml increase; p = 0.024). CONCLUSION Blood culture positivity is reduced by antimicrobial therapy but remains high after a single dose of antibiotics. If cultures are not obtained prior to antibiotic administration, they should be obtained as soon as possible afterwards.
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Affiliation(s)
- Lior Zornitzki
- Department of Internal Medicine B, Tel Aviv Sourasky Medical Center, Affiliated with the School of Medicine, Tel Aviv University, 6 Weizmann Street, Tel Aviv, Israel.
| | - Lana Anuk
- School of Medicine, Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Shir Frydman
- Department of Internal Medicine B, Tel Aviv Sourasky Medical Center, Affiliated with the School of Medicine, Tel Aviv University, 6 Weizmann Street, Tel Aviv, Israel
| | - Nira Morag-Koren
- School of Medicine, Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - David Zahler
- Department of Cardiology, Tel Aviv Sourasky Medical Center, Affiliated with the School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ophir Freund
- Department of Internal Medicine B, Tel Aviv Sourasky Medical Center, Affiliated with the School of Medicine, Tel Aviv University, 6 Weizmann Street, Tel Aviv, Israel
| | - Roni Biran
- Department of Internal Medicine B, Tel Aviv Sourasky Medical Center, Affiliated with the School of Medicine, Tel Aviv University, 6 Weizmann Street, Tel Aviv, Israel
| | - Yael Liron
- Department of Internal Medicine B, Tel Aviv Sourasky Medical Center, Affiliated with the School of Medicine, Tel Aviv University, 6 Weizmann Street, Tel Aviv, Israel
| | - Luba Tau
- The Unit for Infectious Diseases, Tel Aviv Sourasky Medical Center, Affiliated with the School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Joseph Zvi Tchebiner
- Department of Internal Medicine B, Tel Aviv Sourasky Medical Center, Affiliated with the School of Medicine, Tel Aviv University, 6 Weizmann Street, Tel Aviv, Israel
| | - Haitam Katash
- Department of Internal Medicine B, Tel Aviv Sourasky Medical Center, Affiliated with the School of Medicine, Tel Aviv University, 6 Weizmann Street, Tel Aviv, Israel
| | - Gil Bornstein
- Department of Internal Medicine B, Tel Aviv Sourasky Medical Center, Affiliated with the School of Medicine, Tel Aviv University, 6 Weizmann Street, Tel Aviv, Israel
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18
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Menchinelli G, Oliveti A, Fiori B, D'Inzeo T, Spanu T, Murri R, Fantoni M, Sanguinetti M, Posteraro B, De Angelis G. Early assessment of blood culture negativity as a potential support tool for antimicrobial stewardship. Heliyon 2024; 10:e27849. [PMID: 38524553 PMCID: PMC10958360 DOI: 10.1016/j.heliyon.2024.e27849] [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: 12/11/2023] [Revised: 02/09/2024] [Accepted: 03/07/2024] [Indexed: 03/26/2024] Open
Abstract
Objective To assess whether 48-h negative blood culture (BC) bottles are still negative at the classic 120-h incubation endpoint and whether 48 h might be the time to make antimicrobial therapy decisions. Methods Data from the first collected bottles from bloodstream infection (BSI) episodes of single patients were retrospectively analyzed. Probabilities of bottles being negative at the classic endpoint were calculated from 0 to 120 h of incubation. Results Among BC-negative episodes (4018/4901 [82.0%]), most (2097/4018 (52.2%) occurred in medicine patients. At 48 h, probability was 100.0% (95% CI, 99.9-100.0) for all 4018 patients. Of these, 1244 (31.0%) patients remained on antibiotics until 120 h. Excluding 401 (32.2%) patients who received antibiotics for another (non-bloodstream) infection, 843 (67.8%) of 1244 patients could have merited early (48-h) discontinuation of antibiotics. Stopping treatment in these patients would have led to saving 5201 days of access (943 [18.1%] days), watch (3624 [69.7%] days), or reserve (634 [12.2%]) AWaRe groups' antibiotics, which correspond to 65.6% (5201/7928) of days of administered antibiotics in all 1244 patients. Conclusion As an early indicator of BC negativity, the 48-h endpoint could reliably support antimicrobial stewardship, but the clinical judgment remains imperative especially when BSI is highly suspected.
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Affiliation(s)
- Giulia Menchinelli
- Dipartimento di Scienze di Laboratorio e Infettivologiche, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168, Rome, Italy
| | - Alice Oliveti
- Dipartimento di Scienze Biotecnologiche di Base, Cliniche Intensivologiche e Perioperatorie, Università Cattolica del Sacro Cuore, 00168, Rome, Italy
| | - Barbara Fiori
- Dipartimento di Scienze di Laboratorio e Infettivologiche, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168, Rome, Italy
| | - Tiziana D'Inzeo
- Dipartimento di Scienze di Laboratorio e Infettivologiche, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168, Rome, Italy
- Dipartimento di Scienze Biotecnologiche di Base, Cliniche Intensivologiche e Perioperatorie, Università Cattolica del Sacro Cuore, 00168, Rome, Italy
| | - Teresa Spanu
- Dipartimento di Scienze di Laboratorio e Infettivologiche, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168, Rome, Italy
- Dipartimento di Scienze Biotecnologiche di Base, Cliniche Intensivologiche e Perioperatorie, Università Cattolica del Sacro Cuore, 00168, Rome, Italy
| | - Rita Murri
- Dipartimento di Scienze di Laboratorio e Infettivologiche, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168, Rome, Italy
- Dipartimento di Sicurezza e Bioetica, Università Cattolica del Sacro Cuore, 00168, Rome, Italy
| | - Massimo Fantoni
- Dipartimento di Scienze di Laboratorio e Infettivologiche, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168, Rome, Italy
- Dipartimento di Sicurezza e Bioetica, Università Cattolica del Sacro Cuore, 00168, Rome, Italy
| | - Maurizio Sanguinetti
- Dipartimento di Scienze di Laboratorio e Infettivologiche, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168, Rome, Italy
- Dipartimento di Scienze Biotecnologiche di Base, Cliniche Intensivologiche e Perioperatorie, Università Cattolica del Sacro Cuore, 00168, Rome, Italy
| | - Brunella Posteraro
- Dipartimento di Scienze Biotecnologiche di Base, Cliniche Intensivologiche e Perioperatorie, Università Cattolica del Sacro Cuore, 00168, Rome, Italy
- Dipartimento di Scienze Mediche e Chirurgiche Addominali ed Endocrino Metaboliche, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168, Rome, Italy
| | - Giulia De Angelis
- Dipartimento di Scienze di Laboratorio e Infettivologiche, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168, Rome, Italy
- Dipartimento di Scienze Biotecnologiche di Base, Cliniche Intensivologiche e Perioperatorie, Università Cattolica del Sacro Cuore, 00168, Rome, Italy
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Zhao Z, Wang Y, Kang Y, Wu G, He J, Wang Z, Yang J, Wang Y, Yang X, Jia W. A retrospective study of the detection of sepsis pathogens comparing blood culture and culture-independent digital PCR. Heliyon 2024; 10:e27523. [PMID: 38510040 PMCID: PMC10951527 DOI: 10.1016/j.heliyon.2024.e27523] [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: 04/10/2023] [Revised: 02/22/2024] [Accepted: 03/01/2024] [Indexed: 03/22/2024] Open
Abstract
Fast and precise identification of microorganisms in the early diagnosis of sepsis is crucial for enhancing patient outcomes. Digital PCR (dPCR) is a highly sensitive approach for absolute quantification that can be utilized as a culture-independent molecular technique for diagnosing sepsis pathogens. We performed a retrospective investigation on 69 ICU patients suspected of sepsis. Our findings showed that a multiplex dPCR diagnostic kit outperformed blood culture in detecting the 15 most frequent bacteria that cause sepsis. Ninety-two bacterial strains were identified using dPCR at concentrations varying from 34 copies/mL to 105,800 copies/mL. The detection rate of dPCR was much greater than that of BC, with 27.53% (19/69) versus 73.91% (51/69). The sensitivity of dPCR was 63.2%. Our research indicated that dPCR outperforms blood culture in the early detection of sepsis-causing microorganisms. The diagnostic kit can detect a greater variety of pathogens with quantitative data, including polymicrobial infections, and has a quicker processing time. DPCR is a valuable technique that could aid in the proper management of sepsis.
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Affiliation(s)
- Zhijun Zhao
- Medical Laboratory Center, General Hospital of Ningxia Medical University, Yinchuan, China
- Ningxia Key Laboratory of Clinical Pathogenic Microorganisms, Yinchuan, China
| | - Yixuan Wang
- School of Clinical Medicine, Ningxia Medical University, Yinchuan, China
- Ningxia Key Laboratory of Clinical Pathogenic Microorganisms, Yinchuan, China
| | - Yuting Kang
- Ningxia Key Laboratory of Clinical Pathogenic Microorganisms, Yinchuan, China
| | - Geng Wu
- School of Clinical Medicine, Ningxia Medical University, Yinchuan, China
| | - Jing He
- Department of Research and Development, Rainsure Scientific Co. Ltd., Suzhou, China
| | - Zhanying Wang
- Department of Research and Development, Rainsure Scientific Co. Ltd., Suzhou, China
| | - Ju Yang
- Department of Research and Development, Rainsure Scientific Co. Ltd., Suzhou, China
| | - Yaqi Wang
- Department of Research and Development, Rainsure Scientific Co. Ltd., Suzhou, China
| | - Xiaojun Yang
- Department of Critical Care Medicine, General Hospital of Ningxia Medical University, Yinchuan, China
| | - Wei Jia
- Medical Laboratory Center, General Hospital of Ningxia Medical University, Yinchuan, China
- Ningxia Key Laboratory of Clinical Pathogenic Microorganisms, Yinchuan, China
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Kumar A, Raj N, Singh S, Das A, Singh V, Sen M, Agarwal J. A Retrospective Observational Study of the Microbial Etiology and Antimicrobial Susceptibility Patterns of Blood Cultures From ICU Patients at a Healthcare Facility in North India. Cureus 2024; 16:e57356. [PMID: 38694412 PMCID: PMC11061268 DOI: 10.7759/cureus.57356] [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] [Accepted: 03/31/2024] [Indexed: 05/04/2024] Open
Abstract
Introduction Bloodstream infections (BSI) are a leading source of fatalities and morbidity in hospitals. However, the clinical spectrum and antimicrobial resistance differ globally. Identifying the pathogenic spectrum and variations in antibiotic resistance is crucial for controlling BSI and preventing inappropriate antibiotic use. Material and methods This retrospective observational study was conducted at the Dr. Ram Manohar Lohia Institute of Medical Sciences, Lucknow, UP, India, for one year between June 2022 and June 2023. A total of 669 adult patients' blood cultures were obtained from ICUs. Blood culture was done using a BacT/Alert 3D (BioMérieux SA, Marcy-l'Étoile, France) automated system. Identification of the bacterial as well as fungal isolates was done using matrix-assisted laser desorption ionization-time-of-flight mass spectrometry (MALDI-TOF MS), and the antimicrobial susceptibility profile was analyzed using the VITEK 2 Compact system (BioMérieux SA). Results Of the 669 blood culture samples, 213 (31.8%) showed bacterial or fungal growth. Of these 213 isolates, the most common isolate was coagulase-negative Staphylococci (21.6%), followed by Klebsiella pneumoniae (19.3%) and Acinetobacter spp. (17.8%). The majority of gram-negative bacteria were resistant to most drugs, and vancomycin and linezolid were both effective against the majority of gram-positive bacteria. Conclusion The current study found that septicemia was more frequently caused by gram-negative bacteria than by gram-positive bacteria. Blood cultures are always necessary in cases of suspected septicemia, and once the antimicrobial susceptibility profile of the pathogen causing septicemia has been determined, suitable antimicrobials should be prescribed and used to lower the antimicrobial resistance burden.
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Affiliation(s)
- Amit Kumar
- Microbiology, Dr. Ram Manohar Lohia Institute of Medical Sciences, Lucknow, IND
| | - Nikhil Raj
- Microbiology, Dr. Ram Manohar Lohia Institute of Medical Sciences, Lucknow, IND
| | - Sangeeta Singh
- Microbiology, Dr. Ram Manohar Lohia Institute of Medical Sciences, Lucknow, IND
| | - Anupam Das
- Microbiology, Dr. Ram Manohar Lohia Institute of Medical Sciences, Lucknow, IND
| | - Vikramjeet Singh
- Microbiology, Dr. Ram Manohar Lohia Institute of Medical Sciences, Lucknow, IND
| | - Manodeep Sen
- Microbiology, Dr. Ram Manohar Lohia Institute of Medical Sciences, Lucknow, IND
| | - Jyotsna Agarwal
- Microbiology, Dr. Ram Manohar Lohia Institute of Medical Sciences, Lucknow, IND
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Kijineh B, Alemeyhu T, Mengistu M, Ali MM. Prevalence of phenotypic multi-drug resistant Klebsiella species recovered from different human specimens in Ethiopia: A systematic review and meta-analysis. PLoS One 2024; 19:e0297407. [PMID: 38335186 PMCID: PMC10857728 DOI: 10.1371/journal.pone.0297407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2023] [Accepted: 01/04/2024] [Indexed: 02/12/2024] Open
Abstract
BACKGROUND Multidrug-resistant (MDR) Klebsiella species are among public health important bacteria that cause infections difficult to treat with available antimicrobial agents. Infections with Klebsiella lead to high morbidity and mortality in developing countries particularly in patients admitted to the intensive care unit. This systematic review and meta-analysis aimed to determine the pooled prevalence of MDR Klebsiella species from different human specimens using studies conducted in Ethiopia from 2018-2022. METHODS We have systematically searched online databases such as PubMed/Medline, Google Scholar, Hinari, African journals online, Web of Science, Cochrane, and grey literature (Addis Ababa University and Hawassa University) to identify studies reporting the proportion of MDR Klebsiella species in Ethiopia. Published articles were selected based on the Preferred Reporting Item of Systematic Review and Meta-analysis (PRISMA). R-Studio version 4.2.3 was used to conduct pooled prevalence, heterogeneity test, and publication bias. A binary random effect model was used to determine the pooled prevalence. Heterogeneity was checked with the inconsistency index (I2). Publication bias was checked with a funnel plot and Egger test. Sensitivity analysis was conducted with leave-one-out analysis. Joanna Briggs Institute's critical appraisal tool for prevalence studies was used to check the quality of each article. RESULTS In this systematic review and meta-analysis, 40 articles were included in which 12,239 human specimens were examined. Out of the total specimens examined, 721 Klebsiella species were isolated and 545 isolates were reported to be MDR Klebsiella species. The prevalence of MDR Klebsiella species ranged from 7.3%-100% whereas the pooled prevalence of MDR Klebsiella species was 72% (95% CI: 63 - 82%, I2 = 95%). Sub-group analysis based on region revealed the highest prevalence of MDR from Addis Ababa (97%) and the least from the Somali region (33%); whereas sub-group analysis based on the specimen type indicated the highest prevalence was from blood culture specimens 96% and the least was from other specimens (ear and vaginal discharge, and stool) (51%). CONCLUSION Our finding indicated a high prevalence of MDR Klebsiella species found in different human specimens. The prevalence of MDR Klebsiella varies across regions in Ethiopia, age, the type of specimens, source and site of infection. Therefore, integrated action should be taken to reduce the prevalence of MDR Klebsiella species in regional states and focus on clinical features. Effective infection and prevention control should be applied to reduce the transmission within and outside health care settings.
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Affiliation(s)
- Biniyam Kijineh
- Department of Medical Laboratory Science, Wachemo University College of Medicine and Health Sciences, Hossana, Ethiopia
| | - Tsegaye Alemeyhu
- School of Medical Laboratory Science, Hawassa University College of Medicine and Health Sciences, Hawassa, Ethiopia
| | - Mulugeta Mengistu
- School of Medical Laboratory Science, Hawassa University College of Medicine and Health Sciences, Hawassa, Ethiopia
| | - Musa Mohammed Ali
- School of Medical Laboratory Science, Hawassa University College of Medicine and Health Sciences, Hawassa, Ethiopia
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22
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Williams J, Hills A, Ray M, Greenslade J. Changing culture: An intervention to improve blood culture quality in the emergency department. Emerg Med Australas 2024; 36:133-139. [PMID: 37899725 DOI: 10.1111/1742-6723.14329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Revised: 08/25/2023] [Accepted: 09/21/2023] [Indexed: 10/31/2023]
Abstract
OBJECTIVE Blood cultures (BCs) remain a key investigation in ED patients at risk of bacteraemia. The aim of this study was to assess the effect of a multi-modal, nursing-led intervention to improve the quality of BCs in the ED, in terms of single culture, underfilling and contamination rates. METHOD The present study was conducted in the ED of a large urban tertiary referral hospital. The study included four phases: pre-intervention, intervention, post-intervention and sustainability periods. A multi-modal intervention to improve BC quality consisting small group education, posters, brief educational videos, social media presence, quality feedback, small group/individual mentoring and availability of BC collection kits was designed and delivered by two senior ED nurses over 7 weeks. Study data comprised rates of single, underfilled and contaminated cultures in each of three 18-week periods: pre-intervention (baseline), post-intervention and sustainability. RESULTS Over the study period 4908 BC sets were collected during 2347 episodes of care in the ED. Single culture sets reduced from 56.2% in the pre-intervention period to 22.8% post-intervention (P < 0.01) and 18.8% in the sustainability period (P < 0.01). Underfilled bottle rates were also significantly reduced (aerobic 52.8% pre-intervention to 19.2% post-intervention, 18.8% sustainability, anaerobic 46.8% pre-intervention to 23.3% post-intervention, 23.8% sustainability). Skin contaminants were grown from 3.7% of BC sets in the pre-intervention period, improving to 1.5% in the post-intervention period (P < 0.001) and 2.1% in the sustainability period (P = 0.03). Total volume of blood cultured was significantly associated with diagnosis of bacteraemia. CONCLUSION Significant improvements in BC quality are possible with nursing-based interventions in the ED.
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Affiliation(s)
- Julian Williams
- Emergency and Trauma Centre, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
- Faculty of Medicine and Biomedical Sciences, The University of Queensland, Brisbane, Queensland, Australia
| | - Angela Hills
- Emergency and Trauma Centre, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
| | - Mercedes Ray
- Emergency and Trauma Centre, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
| | - Jaimi Greenslade
- Emergency and Trauma Centre, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
- School of Public Health and Social Work, Queensland University of Technology, Brisbane, Queensland, Australia
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23
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Burban A, Słupik D, Reda A, Szczerba E, Grabowski M, Kołodzińska A. Novel Diagnostic Methods for Infective Endocarditis. Int J Mol Sci 2024; 25:1245. [PMID: 38279244 PMCID: PMC10816594 DOI: 10.3390/ijms25021245] [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: 12/15/2023] [Revised: 01/14/2024] [Accepted: 01/15/2024] [Indexed: 01/28/2024] Open
Abstract
Infective endocarditis (IE) remains a dangerous disease and continues to have a high mortality rate. Unfortunately, despite continuous improvements in diagnostic methods, in many cases, blood cultures remain negative, and the pathogen causing endocarditis is unknown. This makes targeted therapy and the selection of appropriate antibiotics impossible. Therefore, we present what methods can be used to identify the pathogen in infective endocarditis. These are mainly molecular methods, including PCR and MGS, as well as imaging methods using radiotracers, which offer more possibilities for diagnosing IE. However, they are still not widely used in the diagnosis of IE. The article summarizes in which cases we should choose them and what we are most hopeful about in further research into the diagnosis of IE. In addition, registered clinical trials that are currently underway for the diagnosis of IE are also presented.
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Affiliation(s)
- Anna Burban
- 1st Chair and Department of Cardiology, Medical University of Warsaw, 02-097 Warsaw, Poland
- Doctoral School, Medical University of Warsaw, 02-091 Warsaw, Poland
| | - Dorota Słupik
- 1st Chair and Department of Cardiology, Medical University of Warsaw, 02-097 Warsaw, Poland
| | - Aleksandra Reda
- 1st Chair and Department of Cardiology, Medical University of Warsaw, 02-097 Warsaw, Poland
| | - Ewa Szczerba
- 1st Chair and Department of Cardiology, Medical University of Warsaw, 02-097 Warsaw, Poland
| | - Marcin Grabowski
- 1st Chair and Department of Cardiology, Medical University of Warsaw, 02-097 Warsaw, Poland
| | - Agnieszka Kołodzińska
- 1st Chair and Department of Cardiology, Medical University of Warsaw, 02-097 Warsaw, Poland
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24
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Song J, Lin S, Zhu L, Lin Y, An W, Zhang J, Wang H, Yang Z, Liao Y, Xu Y, Li Q. Direct identification of pathogens via microbial cellular DNA in whole blood by MeltArray. Microb Biotechnol 2024; 17:e14380. [PMID: 38084800 PMCID: PMC10832520 DOI: 10.1111/1751-7915.14380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Revised: 10/27/2023] [Accepted: 11/16/2023] [Indexed: 02/03/2024] Open
Abstract
Rapid identification of pathogens is critical for early and appropriate treatment of bloodstream infections. The various culture-independent assays that have been developed often have long turnaround times, low sensitivity and narrow pathogen coverage. Here, we propose a new multiplex PCR assay, MeltArray, which uses intact microbial cells as the source of genomic DNA (gDNA). The successive steps of the MeltArray assay, including selective lysis of human cells, microbial cell sedimentation, microbial cellular DNA extraction, target-specific pre-amplification and multiplex PCR detection, allowed the detection of 35 major bloodstream infectious pathogens in whole blood within 5.5 h. The limits of detection varied depending on the pathogen and ranged from 1 to 5 CFU/mL. Of 443 blood culture samples, including 373 positive blood culture samples and 70 negative blood culture samples, the MeltArray assay showed a sensitivity of 93.8% (350/373, 95% confidence interval [CI] = 90.7%-96.0%), specificity of 98.6% (69/70, 95% CI = 91.2%-99.9%), positive predictive value of 99.7% (95% CI = 98.1%-99.9%), and negative predictive value of 75.0% (95% CI = 64.7%-83.2%). The MeltArray detection results of 16 samples differed from MALDI-TOF and were confirmed by Sanger sequencing. Further testing of 110 whole blood samples from patients with suspected bloodstream infections using blood culture results revealed that the MeltArray assay had a clinical sensitivity of 100% (9/9, 95% CI = 62.8%-100.0%), clinical specificity of 74.5% (70/94, 95% CI = 64.2%-82.7%), positive predictive value of 27.3% (95% CI = 13.9%-45.8%), and negative predictive value of 100.0% (95% CI = 93.5%-100.0%). Compared with metagenomic next-generation sequencing, the MeltArray assay displayed a positive agreement of 85.7% (6/7, 95% CI = 42.0%-99.2%) and negative agreement of 100.0% (4/4, 95% CI = 39.6%-100.0%). We conclude that the MeltArray assay can be used as a rapid and reliable tool for direct identification of pathogens in bloodstream infections.
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Affiliation(s)
- Jiabao Song
- Engineering Research Centre of Molecular Diagnostics of the Ministry of Education, State Key Laboratory of Cellular Stress Biology, State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, School of Life SciencesXiamen UniversityXiamenChina
| | - Su Lin
- Engineering Research Centre of Molecular Diagnostics of the Ministry of Education, State Key Laboratory of Cellular Stress Biology, State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, School of Life SciencesXiamen UniversityXiamenChina
| | - Lin Zhu
- Engineering Research Centre of Molecular Diagnostics of the Ministry of Education, State Key Laboratory of Cellular Stress Biology, State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, School of Life SciencesXiamen UniversityXiamenChina
| | - Yong Lin
- Zhongshan HospitalXiamen UniversityXiamenChina
| | - Wenbin An
- Xiang'an HospitalXiamen UniversityXiamenChina
| | - Jinding Zhang
- Engineering Research Centre of Molecular Diagnostics of the Ministry of Education, State Key Laboratory of Cellular Stress Biology, State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, School of Life SciencesXiamen UniversityXiamenChina
| | - Haohao Wang
- Engineering Research Centre of Molecular Diagnostics of the Ministry of Education, State Key Laboratory of Cellular Stress Biology, State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, School of Life SciencesXiamen UniversityXiamenChina
| | - Zhuan Yang
- Engineering Research Centre of Molecular Diagnostics of the Ministry of Education, State Key Laboratory of Cellular Stress Biology, State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, School of Life SciencesXiamen UniversityXiamenChina
| | - Yiqun Liao
- Engineering Research Centre of Molecular Diagnostics of the Ministry of Education, State Key Laboratory of Cellular Stress Biology, State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, School of Life SciencesXiamen UniversityXiamenChina
| | - Ye Xu
- Engineering Research Centre of Molecular Diagnostics of the Ministry of Education, State Key Laboratory of Cellular Stress Biology, State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, School of Life SciencesXiamen UniversityXiamenChina
| | - Qingge Li
- Engineering Research Centre of Molecular Diagnostics of the Ministry of Education, State Key Laboratory of Cellular Stress Biology, State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, School of Life SciencesXiamen UniversityXiamenChina
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25
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Ahmad S, Rahman H, Mumtaz S, Qasim M, Rahman ZU, Alsuwat MA, Halawani IF, Alzahrani FM, Ali S. mecA and fdh: markers of pathogenicity and commensalism in Staphylococcus epidermidis of pediatric origin from Pakistan. Diagn Microbiol Infect Dis 2024; 108:116109. [PMID: 37918188 DOI: 10.1016/j.diagmicrobio.2023.116109] [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: 08/16/2023] [Revised: 10/11/2023] [Accepted: 10/12/2023] [Indexed: 11/04/2023]
Abstract
Staphylococcus epidermidis is an opportunistic bacterial pathogen. The study screened isolates of S. epidermidis of pediatric origin for genetic markers of discriminatory potential. 103 isolates (n = 75 clinical; n = 28 community) were screened for methicillin resistance (mecA), formate dehydrogenase (fdh) and an array of virulence factors through multiplex PCR and Congo red assay. The isolates were typed in four distinct categories, based on the presence of selected virulent factors. The type A clinical isolates carrying icaADBC operon (n = 22; 29.3%, P = 0.117) were not significantly differentiating the origin of isolates. The type B clinical isolates representing methicillin resistant S. epidermidis (MRSE) (n = 73; 97.3%, P < 0.00001) and the type C clinical isolates lacking formate dehydrogenase fdh (n = 62; 82.6%, P < 0.00001) were having significant discriminatory potential of clinical isolates, respectively. All type D community isolates were carrying fdh (n = 28; 100%, P < 0.00001). MecA and fdh are significant differential markers of pathogenicity and commensalism in S. epidermidis of pediatric origin.
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Affiliation(s)
- Saghir Ahmad
- Department of Microbiology, Abdul Wali Khan University Mardan, Mardan, Pakistan
| | - Hazir Rahman
- Department of Microbiology, Abdul Wali Khan University Mardan, Mardan, Pakistan.
| | - Sumbal Mumtaz
- Department of Microbiology, Abdul Wali Khan University Mardan, Mardan, Pakistan
| | - Muhammad Qasim
- Department of Microbiology, Kohat University of Science and Technology, Kohat, Pakistan
| | - Zia Ur Rahman
- Department of Microbiology, Abdul Wali Khan University Mardan, Mardan, Pakistan
| | - Meshari A Alsuwat
- Department of Clinical Laboratories Sciences, College of Applied Medical Sciences, Taif University, P.O. Box 11099, Taif 21944, Saudi Arabia
| | - Ibrahim F Halawani
- Department of Clinical Laboratories Sciences, College of Applied Medical Sciences, Taif University, P.O. Box 11099, Taif 21944, Saudi Arabia
| | - Fuad M Alzahrani
- Department of Clinical Laboratories Sciences, College of Applied Medical Sciences, Taif University, P.O. Box 11099, Taif 21944, Saudi Arabia
| | - Sajid Ali
- Department of Biotechnology, Abdul Wali Khan University Mardan, Mardan, Pakistan
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Pehlivan J, Douillet D, Jérémie R, Perraud C, Niset A, Eveillard M, Chenouard R, Mahieu R. A clinical decision rule to rule out bloodstream infection in the emergency department: retrospective multicentric observational cohort study. Emerg Med J 2023; 41:20-26. [PMID: 37940371 DOI: 10.1136/emermed-2022-212987] [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: 11/19/2022] [Accepted: 10/27/2023] [Indexed: 11/10/2023]
Abstract
BACKGROUND We aimed to identify patients at low risk of bloodstream infection (BSI) in the ED. METHODS We derived and validated a prediction model to rule out BSI in the ED without the need for laboratory testing by determining variables associated with a positive blood culture (BC) and assigned points according to regression coefficients. This retrospective study included adult patients suspected of having BSI (defined by at least one BC collection) from two European ED between 1 January 2017 and 31 December 2019. The primary end point was the BSI rate in the validation cohort for patients with a negative Bacteremia Rule Out Criteria (BAROC) score. The effect of adding laboratory variables to the model was evaluated as a second step in a two-step diagnostic strategy. RESULTS We analysed 2580 patients with a mean age of 64 years±21, of whom 46.1% were women. The derived BAROC score comprises 12 categorical clinical variables. In the validation cohort, it safely ruled out BSI without BCs in 9% (58/648) of patients with a sensitivity of 100% (95% CI 95% to 100%), a specificity of 10% (95% CI 8% to 13%) and a negative predictive value of 100% (95% CI 94% to 100%). Adding laboratory variables (creatinine ≥177 µmol/L (2.0 mg/dL), platelet count ≤150 000/mm3 and neutrophil count ≥12 000/mm3) to the model, ruled out BSI in 10.2% (58/570) of remaining patients who had been positive on the BAROC score. The BAROC score with laboratory results had a sensitivity of 100% (95% CI 94% to 100%), specificity of 11% (95% CI 9% to 14%) and negative predictive value of 100% (95% CI 94 to 100%). In the validation cohort, there was no evidence of a difference in discrimination between the area under the receiver operating characteristic for BAROC score with versus without laboratory testing (p=0.6). CONCLUSION The BAROC score safely identified patients at low risk of BSI and may reduce BC collection in the ED without the need for laboratory testing.
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Affiliation(s)
- Jonathan Pehlivan
- Service de maladies infectieuses et tropicales, Centre hospitalier universitaire d'Angers, Centre Hospitalier Universitaire d'Angers, Angers, France
| | - Delphine Douillet
- Emergency Department, Angers University Hospital, CHU Angers, Angers, France
- UMR MitoVasc CNRS 6015-INSERM 1083, University of Angers, Angers, France
| | - Riou Jérémie
- Micro et Nano médecines translationnelles, MINT, UMR INSERM 1066, UMR CNRS 6021, University of Angers, Angers, France
- Methodology and Biostatistics Department, Delegation to Clinical Research and Innovation, Angers University Hospital, CHU Angers, Angers, France
| | - Clément Perraud
- Emergency Department, Angers University Hospital, CHU Angers, Angers, France
| | - Alexandre Niset
- Emergency Department, Cliniques Universitaires Saint-Luc, Université catholique de Louvain, Hopital à Bruxelles-Cliniques universitaires Saint-Luc, Bruxelles, Belgium
| | - Matthieu Eveillard
- Laboratoire de Bactériologie, Institut de Biologie en Santé-PBH, CHU Angers, Angers, France
| | - Rachel Chenouard
- Laboratoire de Bactériologie, Institut de Biologie en Santé-PBH, CHU Angers, Angers, France
| | - Rafael Mahieu
- Service de maladies infectieuses et tropicales, Centre hospitalier universitaire d'Angers, CHU Angers Maladies infectieuses et tropicales, Angers, France
- Faculty of Medicine, Université de Nantes, Inserm, CRCINA, SFR ICAT, University of Angers, Angers, France
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Mukhula VT, Harawa PP, Phiri C, Khoswe S, Mbale E, Tigoi C, Walson JL, Berkley JA, Bandsma R, Iroh Tam PY, Voskuijl W. Evaluating blood culture collection practice in children hospitalized with acute illness at a tertiary hospital in Malawi. J Trop Pediatr 2023; 70:fmad043. [PMID: 38055837 PMCID: PMC10699738 DOI: 10.1093/tropej/fmad043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/08/2023]
Abstract
BACKGROUND Blood culture collection practice in low-resource settings where routine blood culture collection is available has not been previously described. METHODOLOGY We conducted a secondary descriptive analysis of children aged 2-23 months enrolled in the Malawi Childhood Acute Illness and Nutrition (CHAIN) study, stratified by whether an admission blood culture had been undertaken and by nutritional status. Chi-square test was used to compare the differences between groups. RESULTS A total of 347 children were included, of whom 161 (46%) had a blood culture collected. Children who had a blood culture collected, compared to those who did not, were more likely to present with sepsis (43% vs. 20%, p < 0.001), gastroenteritis (43% vs. 26%, p < 0.001), fever (86% vs. 73%, p = 0.004), and with poor feeding/weight loss (30% vs. 18%, p = 0.008). In addition, hospital stay in those who had a blood culture was, on average, 2 days longer (p = 0.019). No difference in mortality was observed between those who did and did not have a blood culture obtained. CONCLUSION Blood culture collection was more frequent in children with sepsis and gastroenteritis, but was not associated with mortality. In low-resource settings, developing criteria for blood culture based on risk factors rather than clinician judgement may better utilize the existing resources.
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Affiliation(s)
- Victoria Temwanani Mukhula
- Paediatrics and Child Health Research Group, , Malawi-Liverpool Wellcome Research Programme P.O. Box 30096, Chichiri, Blantyre, Malawi
| | - Philliness Prisca Harawa
- Paediatrics and Child Health Research Group, , Malawi-Liverpool Wellcome Research Programme P.O. Box 30096, Chichiri, Blantyre, Malawi
- Department of Paediatrics and Child Health, Kamuzu University of Health Sciences, Blantyre, Malawi
| | - Chisomo Phiri
- The Childhood Acute Illness & Nutrition (CHAIN) Network, Nairobi, Kenya
| | - Stanley Khoswe
- The Childhood Acute Illness & Nutrition (CHAIN) Network, Nairobi, Kenya
| | - Emmie Mbale
- Department of Paediatrics and Child Health, Kamuzu University of Health Sciences, Blantyre, Malawi
- The Childhood Acute Illness & Nutrition (CHAIN) Network, Nairobi, Kenya
| | - Caroline Tigoi
- The Childhood Acute Illness & Nutrition (CHAIN) Network, Nairobi, Kenya
| | - Judd L Walson
- The Childhood Acute Illness & Nutrition (CHAIN) Network, Nairobi, Kenya
- Departments of Global Health, Medicine, Pediatrics and Epidemiology, University of Washington, Seattle, WA, USA
| | - James A Berkley
- The Childhood Acute Illness & Nutrition (CHAIN) Network, Nairobi, Kenya
- Department of Medicine, , University of Oxford, Oxford, UK
| | - Robert Bandsma
- The Childhood Acute Illness & Nutrition (CHAIN) Network, Nairobi, Kenya
- Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Pui-Ying Iroh Tam
- Paediatrics and Child Health Research Group, , Malawi-Liverpool Wellcome Research Programme P.O. Box 30096, Chichiri, Blantyre, Malawi
- Department of Paediatrics and Child Health, Kamuzu University of Health Sciences, Blantyre, Malawi
- Department of Clinical Sciences, , Liverpool School of Tropical Medicine, Liverpool, UK
| | - Wieger Voskuijl
- The Childhood Acute Illness & Nutrition (CHAIN) Network, Nairobi, Kenya
- Amsterdam Center for Global Health, University of Amsterdam & Emma Children's Hospital, Amsterdam University Medical Centers, Amsterdam, The Netherlands
- Amsterdam Institute for Global Health and Development, University of Amsterdam, Amsterdam University Medical Centers, Amsterdam, The Netherlands
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Pilkington E, Goncalves R, Henze L, Grapes N, Volk H, De Decker S. Determining the prevalence and risk factors for positive bacterial culture in canine discospondylitis: 120 cases. Vet Rec 2023; 193:e3053. [PMID: 37211971 DOI: 10.1002/vetr.3053] [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: 08/01/2022] [Revised: 04/05/2023] [Accepted: 04/27/2023] [Indexed: 05/23/2023]
Abstract
BACKGROUND Identification of the aetiologic agent in canine discospondylitis is infrequent; and risk factors for a positive bacterial culture have not previously been reported. METHODS Medical records at three institutions were searched to identify clinical features of dogs with discospondylitis diagnosed via radiography or cross-sectional imaging. Inclusion in this retrospective case-control study required culture of one or more samples. Multivariable binary logistic regression identified features associated with a positive culture. RESULTS Fifty (42%) of 120 dogs had one or more positive culture results obtained from either urine (28/115), blood (25/78), intervertebral disc aspiration (10/34) or cerebrospinal fluid (1/18). A positive culture was associated with higher bodyweight (p = 0.002, odds ratio [OR] = 1.054, 95% confidence interval [CI]: 1.019-1.089), more sample types cultured (p = 0.037, OR = 1.806, 95% CI: 1.037-3.147) and institution (p = 0.021). The presence of possibly associated preceding events (e.g., surgery), pyrexia, number of disc sites affected and serum C-reactive protein result, among other features, were not statistically significant. LIMITATIONS All isolates cultured were included since differentiation of true aetiologic agents from contaminants was not possible without histological confirmation and culture from surgical or postmortem biopsies. CONCLUSIONS Clinical features typically associated with infection were not identified as risk factors for positive culture in canine discospondylitis. The statistical significance of the institution suggests that standardisation of sampling protocols is necessary.
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Affiliation(s)
- Ed Pilkington
- Small Animal Teaching Hospital, Institute of Veterinary Science, University of Liverpool, Liverpool, UK
| | - Rita Goncalves
- Small Animal Teaching Hospital, Institute of Veterinary Science, University of Liverpool, Liverpool, UK
| | - Lea Henze
- Department of Small Animal Medicine and Surgery, University of Veterinary Medicine Hanover, Hanover, Germany
| | - Nick Grapes
- Department of Clinical Science and Services, Royal Veterinary College, Hatfield, UK
| | - Holger Volk
- Department of Small Animal Medicine and Surgery, University of Veterinary Medicine Hanover, Hanover, Germany
| | - Steven De Decker
- Department of Clinical Science and Services, Royal Veterinary College, Hatfield, UK
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Ku TSN, Al Mohajer M, Newton JA, Wilson MH, Monsees E, Hayden MK, Messacar K, Kisgen JJ, Diekema DJ, Morgan DJ, Sifri CD, Vaughn VM. Improving antimicrobial use through better diagnosis: The relationship between diagnostic stewardship and antimicrobial stewardship. Infect Control Hosp Epidemiol 2023; 44:1901-1908. [PMID: 37665212 DOI: 10.1017/ice.2023.156] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/05/2023]
Abstract
Antimicrobial stewardship programs (ASPs) exist to optimize antibiotic use, reduce selection for antimicrobial-resistant microorganisms, and improve patient outcomes. Rapid and accurate diagnosis is essential to optimal antibiotic use. Because diagnostic testing plays a significant role in diagnosing patients, it has one of the strongest influences on clinician antibiotic prescribing behaviors. Diagnostic stewardship, consequently, has emerged to improve clinician diagnostic testing and test result interpretation. Antimicrobial stewardship and diagnostic stewardship share common goals and are synergistic when used together. Although ASP requires a relationship with clinicians and focuses on person-to-person communication, diagnostic stewardship centers on a relationship with the laboratory and hardwiring testing changes into laboratory processes and the electronic health record. Here, we discuss how diagnostic stewardship can optimize the "Four Moments of Antibiotic Decision Making" created by the Agency for Healthcare Research and Quality and work synergistically with ASPs.
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Affiliation(s)
- Tsun Sheng N Ku
- Billings Clinic, Billings, Montana
- Rocky Vista University Montana College of Osteopathic Medicine, Billings, Montana
| | - Mayar Al Mohajer
- Section of Infectious Diseases, Department of Medicine, Baylor College of Medicine, Houston, Texas
- Infectious Diseases Section, Baylor St. Luke's Medical Center, Houston, Texas
- Infection Prevention, Diagnostic Stewardship and Antibiotic Stewardship, CommonSpirit Health Texas Division, Houston, Texas
| | - James A Newton
- Department of Antibiotic Stewardship, Washington Regional Medical Center, Fayetteville, Arkansas
| | - Marie H Wilson
- Infection Prevention & Control, Fred Hutchinson Cancer Center, Seattle, Washington
| | - Elizabeth Monsees
- Performance Excellence, Children's Mercy Hospital, Kansas City, Missouri
- University of Missouri School of Medicine, Kansas City, Missouri
| | - Mary K Hayden
- Division of Infectious Diseases, Department of Internal Medicine, Rush University Medical Center, Chicago, Illinois
| | - Kevin Messacar
- Department of Pediatrics, Section of Infectious Diseases, University of Colorado/Children's Hospital Colorado, Aurora, Colorado
| | | | - Daniel J Diekema
- Division of Infectious Diseases, Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, Iowa
- Maine Medical Center, Portland, Maine
| | - Daniel J Morgan
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, Maryland
- VA Maryland Healthcare System, Baltimore, Maryland
| | - Costi D Sifri
- University of Virginia School of Medicine, Charlottesville, Virginia
| | - Valerie M Vaughn
- Division of General Internal Medicine, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, Utah
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Merien A, Bacle A, Tattevin P, Bellasfar D, Piau C, Cattoir V, Soulat L, Malledant Y, Garlantezec R. Effectiveness of a multimodal intervention to improve blood culture collection in an adult emergency department. Eur J Clin Microbiol Infect Dis 2023; 42:1519-1522. [PMID: 37853227 DOI: 10.1007/s10096-023-04680-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Accepted: 10/09/2023] [Indexed: 10/20/2023]
Abstract
We investigated the impact of a multimodal intervention to improve the compliance of BC collections as a composite outcome, taking into account both blood volume collected and absence of solitary BC. We performed a quasi-experimental study using a before-after design (5 months for pre- and post-intervention evaluation) in an adult emergency department at a tertiary care hospital that showed that a multimodal intervention was associated with a dramatic increase in the proportion of blood cultures that were collected as recommended per national guidelines, from 17.3% (328/1896) to 68.9% (744/1080), P < 0.0001. The implementation of such intervention in other settings could improve the diagnosis of bloodstream infections and reduce irrelevant costs.
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Affiliation(s)
- Alexis Merien
- Adult Emergency Department, CHU de Rennes, F-35000, Rennes, France
| | - Astrid Bacle
- CHU de Rennes, Univ Rennes, Inserm, EHESP, Irset (Institut de Recherche en Santé, Environnement Et Travail) - UMR_S 1085, F-35000, Rennes, France
| | - Pierre Tattevin
- CHU de Rennes, Univ Rennes, INSERM U1230, IFR140, F-35033, Rennes, France
| | - Dorsaf Bellasfar
- Adult Emergency Department, CHU de Rennes, F-35000, Rennes, France
| | - Caroline Piau
- CHU de Rennes, Univ Rennes, INSERM U1230, IFR140, F-35033, Rennes, France
| | - Vincent Cattoir
- CHU de Rennes, Univ Rennes, INSERM U1230, IFR140, F-35033, Rennes, France
| | - Louis Soulat
- Adult Emergency Department, CHU de Rennes, F-35000, Rennes, France
| | - Yannick Malledant
- CHU de Rennes, Univ Rennes, Inra, Inserm, Institut NUMECAN - UMR_A 1341, UMR_S 1241, 35000, Rennes, France
| | - Ronan Garlantezec
- CHU de Rennes, Univ Rennes, Inserm, EHESP, Irset (Institut de Recherche en Santé, Environnement Et Travail) - UMR_S 1085, F-35000, Rennes, France.
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Vaculík O, Bernatová S, Rebrošová K, Samek O, Šilhan L, Růžička F, Šerý M, Šiler M, Ježek J, Zemánek P. Rapid identification of pathogens in blood serum via Raman tweezers in combination with advanced processing methods. BIOMEDICAL OPTICS EXPRESS 2023; 14:6410-6421. [PMID: 38420303 PMCID: PMC10898560 DOI: 10.1364/boe.503628] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Revised: 10/06/2023] [Accepted: 10/21/2023] [Indexed: 03/02/2024]
Abstract
Pathogenic microbes contribute to several major global diseases that kill millions of people every year. Bloodstream infections caused by these microbes are associated with high morbidity and mortality rates, which are among the most common causes of hospitalizations. The search for the "Holy Grail" in clinical diagnostic microbiology, a reliable, accurate, low cost, real-time, and easy-to-use diagnostic method, is one of the essential issues in clinical practice. These very critical conditions can be met by Raman tweezers in combination with advanced analysis methods. Here, we present a proof-of-concept study based on Raman tweezers combined with spectral mixture analysis that allows for the identification of microbial strains directly from human blood serum without user intervention, thus eliminating the influence of a data analyst.
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Affiliation(s)
- Ondřej Vaculík
- Institute of Scientific Instruments of the Czech Academy of Sciences, v.v.i., Královopolská 147, Brno, 61264, Czech Republic
| | - Silvie Bernatová
- Institute of Scientific Instruments of the Czech Academy of Sciences, v.v.i., Královopolská 147, Brno, 61264, Czech Republic
| | - Katarína Rebrošová
- Department of Microbiology, Faculty of Medicine of Masaryk University and St. Anne's, University Hospital, Pekařská 53, Brno, 65691, Czech Republic
| | - Ota Samek
- Institute of Scientific Instruments of the Czech Academy of Sciences, v.v.i., Královopolská 147, Brno, 61264, Czech Republic
| | - Lukáš Šilhan
- Institute of Scientific Instruments of the Czech Academy of Sciences, v.v.i., Královopolská 147, Brno, 61264, Czech Republic
| | - Filip Růžička
- Department of Microbiology, Faculty of Medicine of Masaryk University and St. Anne's, University Hospital, Pekařská 53, Brno, 65691, Czech Republic
| | - Mojmír Šerý
- Institute of Scientific Instruments of the Czech Academy of Sciences, v.v.i., Královopolská 147, Brno, 61264, Czech Republic
| | - Martin Šiler
- Institute of Scientific Instruments of the Czech Academy of Sciences, v.v.i., Královopolská 147, Brno, 61264, Czech Republic
| | - Jan Ježek
- Institute of Scientific Instruments of the Czech Academy of Sciences, v.v.i., Královopolská 147, Brno, 61264, Czech Republic
| | - Pavel Zemánek
- Institute of Scientific Instruments of the Czech Academy of Sciences, v.v.i., Královopolská 147, Brno, 61264, Czech Republic
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Klein A, Shapira M, Lipman-Arens S, Bamberger E, Srugo I, Chistyakov I, Stein M. Diagnostic Accuracy of a Real-Time Host-Protein Test for Infection. Pediatrics 2023; 152:e2022060441. [PMID: 37916266 DOI: 10.1542/peds.2022-060441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/11/2023] [Indexed: 11/03/2023] Open
Abstract
OBJECTIVE Determining infection etiology can be difficult because viral and bacterial diseases often manifest similarly. A host protein test that computationally integrates the circulating levels of TNF-related apoptosis-induced ligand, interferon γ-induced protein-10, and C-reactive protein to differentiate between bacterial and viral infection (called MMBV) demonstrated high performance in multiple prospective clinical validation studies. Here, MMBV's diagnostic accuracy is evaluated in febrile children for whom physicians were uncertain about etiology when applied at the physician's discretion. METHODS Patients aged 3 months to 18 years were retrospectively recruited (NCT03075111; SPIRIT study; 2014-2017). Emergency department physician's etiological suspicion and certainty level were recorded in a questionnaire at blood-draw. MMBV results are based on predefined score thresholds: viral/non-bacterial etiology (0 ≤ score <35), equivocal (35 ≤ score ≤65), and bacterial or coinfection (65 < score ≤100). Reference standard etiology (bacterial/viral/indeterminate) was adjudicated by 3 independent experts based on all available patient data. Experts were blinded to MMBV. MMBV and physician's etiological suspicion were assessed against the reference standard. RESULTS Of 3003 potentially eligible patients, the physicians were uncertain about infection etiology for 736 of the cases assigned a reference standard (128 bacterial, 608 viral). MMBV performed with sensitivity 89.7% (96/107; 95% confidence interval 82.4-94.3) and specificity 92.6% (498/538; 95% confidence interval 90.0-94.5), significantly outperforming physician's etiological suspicion (sensitivity 49/74 = 66.2%, specificity 265/368 = 72.0%; P < .0001). MMBV equivocal rate was 12.4% (91/736). CONCLUSIONS MMBV was more accurate in determining etiology compared with physician's suspicion and had high sensitivity and specificity according to the reference standard.
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Affiliation(s)
- Adi Klein
- Pediatrics Department
- Rappaport Faculty of Medicine, Technion - Israel Institute of Technology, Haifa, Israel
| | - Ma'anit Shapira
- Laboratory Division
- Rappaport Faculty of Medicine, Technion - Israel Institute of Technology, Haifa, Israel
| | - Shelly Lipman-Arens
- Infectious Diseases, Hillel Yaffe Medical Center, Hadera, Israel
- Rappaport Faculty of Medicine, Technion - Israel Institute of Technology, Haifa, Israel
| | - Ellen Bamberger
- Rappaport Faculty of Medicine, Technion - Israel Institute of Technology, Haifa, Israel
- Pediatrics Department
| | | | | | - Michal Stein
- Pediatric Infectious Diseases Unit, Sheba Medical Center, Edmond and Lily Safra Children's Hospital, Tel-Hashomer, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Aiken AM, Rehman AM, de Kraker MEA, Madrid L, Kebede M, Labi AK, Obeng-Nkrumah N, Nyamwaya B, Kagucia E, Cocker D, Kawaza K, Lester R, Iregbu KC, Medugu N, Nwajiobi-Princewill PI, Dramowski A, Sonda T, Hemed A, Fwoloshi S, Ojok D, Scott JAG, Whitelaw A. Mortality associated with third-generation cephalosporin resistance in Enterobacterales bloodstream infections at eight sub-Saharan African hospitals (MBIRA): a prospective cohort study. THE LANCET. INFECTIOUS DISEASES 2023; 23:1280-1290. [PMID: 37454672 DOI: 10.1016/s1473-3099(23)00233-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Revised: 03/10/2023] [Accepted: 03/30/2023] [Indexed: 07/18/2023]
Abstract
BACKGROUND Bacteria of the order Enterobacterales are common pathogens causing bloodstream infections in sub-Saharan Africa and are frequently resistant to third-generation cephalosporin antibiotics. Although third-generation cephalosporin resistance is believed to lead to adverse outcomes, this relationship is difficult to quantify and has rarely been studied in this region. We aimed to measure the effects associated with resistance to third-generation cephalosporins in hospitalised patients with Enterobacterales bloodstream infection in Africa. METHODS We conducted a prospective, matched, parallel cohort study at eight hospitals across sub-Saharan Africa. We recruited consecutive patients of all age groups with laboratory-confirmed Enterobacterales bloodstream infection and matched them to at least one patient without bloodstream infection on the basis of age group, hospital ward, and admission date. Date of infection onset (and enrolment) was defined as the day of blood sample collection for culturing. Patients infected with bacteria with a cefotaxime minimum inhibitory concentration of 1 mg/L or lower were included in the third-generation cephalosporin-susceptible (3GC-S) cohort, and the remainder were included in the third-generation cephalosporin-resistant (3GC-R) cohort. The primary outcomes were in-hospital death and death within 30 days of enrolment. We used adjusted multivariable regression models to first compare patients with bloodstream infection against matched patients within the 3GC-S and 3GC-R cohorts, then compared estimates between cohorts. FINDINGS Between Nov 1, 2020, and Jan 31, 2022, we recruited 878 patients with Enterobacterales bloodstream infection (221 [25·2%] to the 3GC-S cohort and 657 [74·8%] to the 3GC-R cohort) and 1634 matched patients (420 [25·7%] and 1214 [74·3%], respectively). 502 (57·2%) bloodstream infections occurred in neonates and infants (age 0-364 days). Klebsiella pneumoniae (393 [44·8%] infections) and Escherichia coli (224 [25·5%] infections) were the most common Enterobacterales species identified. The proportion of patients who died in hospital was higher in patients with bloodstream infection than in matched controls in the 3GC-S cohort (62 [28·1%] of 221 vs 22 [5·2%] of 420; cause-specific hazard ratio 6·79 [95% CI 4·06-11·37] from Cox model) and the 3GC-R cohort (244 [37·1%] of 657 vs 115 [9·5%] of 1214; 5·01 [3·96-6·32]). The ratio of these cause-specific hazard ratios showed no significant difference in risk of in-hospital death in the 3GC-R cohort versus the 3GC-S cohort (0·74 [0·42-1·30]). The ratio of relative risk of death within 30 days (0·82 [95% CI 0·53-1·27]) also indicated no difference between the cohorts. INTERPRETATION Patients with bloodstream infections with Enterobacterales bacteria either resistant or susceptible to third-generation cephalosporins had increased mortality compared with uninfected matched patients, with no differential effect related to third-generation cephalosporin-resistance status. However, this finding does not account for time to appropriate antibiotic treatment, which remains clinically important to optimise. Measures to prevent transmission of Enterobacterales could reduce bloodstream infection-associated mortality from both drug-resistant and drug-susceptible bacterial strains in Africa. FUNDING Bill & Melinda Gates Foundation.
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Affiliation(s)
- Alexander M Aiken
- Infectious Disease Epidemiology Department, London School of Hygiene & Tropical Medicine, London, UK.
| | - Andrea M Rehman
- Infectious Disease Epidemiology Department, London School of Hygiene & Tropical Medicine, London, UK
| | - Marlieke E A de Kraker
- Infection Control Program and WHO Collaborating Center on Patient Safety and Antimicrobial Resistance, University of Geneva Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - Lola Madrid
- Infectious Disease Epidemiology Department, London School of Hygiene & Tropical Medicine, London, UK; College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Meron Kebede
- College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Appiah-Korang Labi
- Department of Medical Microbiology, University of Ghana Medical School, University of Ghana, Accra, Ghana
| | - Noah Obeng-Nkrumah
- Department of Medical Laboratory Sciences, School of Biomedical and Allied Health Sciences, University of Ghana, Accra, Ghana
| | - Brian Nyamwaya
- KEMRI Centre for Geographic Medical Research, Kilifi, Kenya
| | - Eunice Kagucia
- KEMRI Centre for Geographic Medical Research, Kilifi, Kenya
| | - Derek Cocker
- Department of Medicine, Malawi-Liverpool Wellcome Programme, Kamuzu University of Health Sciences, Blantyre, Malawi; David Price Evans Infectious Diseases & Global Health Group, University of Liverpool, Liverpool, UK; Liverpool School of Tropical Medicine, Liverpool, UK
| | - Kondwani Kawaza
- Department of Paediatrics and Child Health, Malawi-Liverpool Wellcome Programme, Kamuzu University of Health Sciences, Blantyre, Malawi
| | - Rebecca Lester
- Department of Medicine, Malawi-Liverpool Wellcome Programme, Kamuzu University of Health Sciences, Blantyre, Malawi; Liverpool School of Tropical Medicine, Liverpool, UK
| | - Kenneth C Iregbu
- Department of Medical Microbiology, National Hospital Abuja, Abuja, Nigeria
| | - Nubwa Medugu
- Department of Medical Microbiology, National Hospital Abuja, Abuja, Nigeria; Nile University of Nigeria, Abuja, Nigeria
| | | | - Angela Dramowski
- Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Tolbert Sonda
- Kilimanjaro Clinical Research Institute, Kilimanjaro Christian Medical Centre, Moshi, Tanzania
| | - Asia Hemed
- Kilimanjaro Clinical Research Institute, Kilimanjaro Christian Medical Centre, Moshi, Tanzania
| | - Sombo Fwoloshi
- Department of Medicine, University Teaching Hospital, Ministry of Health, Lusaka, Zambia
| | - David Ojok
- Centre for Infectious Disease Research in Zambia, Lusaka, Zambia
| | - J Anthony G Scott
- Infectious Disease Epidemiology Department, London School of Hygiene & Tropical Medicine, London, UK
| | - Andrew Whitelaw
- Department of Medical Microbiology, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa; National Health Laboratory Service, Tygerberg Hospital, Cape Town, South Africa
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Smith L, Ali-Napo R, Ben-Zeev D, Olawuyi J. Optimizing Blood Culture Collection Volumes. Am J Nurs 2023; 123:53-56. [PMID: 37882404 PMCID: PMC10653679 DOI: 10.1097/01.naj.0000995368.45516.ec] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2023]
Abstract
ABSTRACT Infection in an immunocompromised person can be a life-threatening emergency. Collection of blood culture specimens is an important method for detecting organisms when infection is suspected. One aspect of proper blood culture collection is obtaining an accurate blood volume in the sample in accordance with the blood culture bottle manufacturer's recommendation. Underfilling the culture bottle can lead to false-negative results, while overfilling it can lead to false-positive results. At our institution, the Department of Laboratory Medicine (DLM) routinely monitors blood culture bottle volumes and notifies the nursing department of underfill/overfill events, which the department then reviews. Over several years, the DLM and the nursing department noted an increase in these events. A clinical nurse specialist and three staff nurses in the oncology/critical care services area partnered with the DLM to determine why. Upon investigation, two key issues-imprecise weighing of bottles and staff misunderstanding of the proper blood culture collection technique-were discovered. In response, the nursing standard of practice and guidance on the DLM webpage were updated and nursing education was performed. As a result, underfill/overfill events decreased by 71% in a little over a year.
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Affiliation(s)
- Leslie Smith
- Leslie Smith is an oncology/cellular therapy clinical nurse specialist at the National Institutes of Health Clinical Center in Bethesda, MD, where Ruth Ali-Napo and Justina Olawuyi are clinical research nurses and Deborah Ben-Zeev is a clinical manager. Contact author: Leslie Smith, . The authors have disclosed no potential conflicts of interest, financial or otherwise
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Dong G, Ma T, Xu Z, Zhang M, Hu Y, Yang J, Li T. Fibrinogen-to-Albumin Ratio in Neonatal Sepsis. Int J Gen Med 2023; 16:4965-4972. [PMID: 37928956 PMCID: PMC10625383 DOI: 10.2147/ijgm.s432903] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2023] [Accepted: 10/23/2023] [Indexed: 11/07/2023] Open
Abstract
Background Previous studies have established an association between fibrinogen-to-albumin ratio (FAR) and cancer, cardiovascular disease, and coronavirus disease 2019. However, no studies have investigated the relationship between FAR and neonatal sepsis. This study aims to evaluate the association of fibrinogen-to-albumin ratio with the presence and severity of sepsis in neonates. Methods A total of 1292 neonates with suspected sepsis were enrolled in this study. Clinical and laboratory data were collected from electronic medical records. Neonates with final diagnosis with sepsis were divided into the sepsis group, The remaining neonates were divided into the control group. Neonates with sepsis were further categorized into mild (n = 312) and severe (n = 425) groups based on the severity of their condition. FAR was determined by dividing the plasma fibrinogen concentration (g/L) by the serum albumin concentration (g/L). The statistical analyses were conducted using the SPSS 26.0 statistical software package, as deemed appropriate. Results FAR levels were significantly higher in neonates with sepsis compared to the control group. Additionally, a significant gradual increase in FAR was observed in the control, mild sepsis, and severe sepsis groups (P < 0.001). Correlation analysis showed that FAR had a positive correlation with PCT, CRP, and the length of hospital stay. Multiple logistic regression analysis showed that FAR was independently associated with the presence and severity of neonatal sepsis. Specifically, FAR was identified as an independent risk factor for both the presence of sepsis (OR = 8.641, 95% CI 5.708-13.080, P < 0.001) and severe sepsis (OR = 2.817, 95% CI 1.701-4.666, P < 0.001). Conclusion FAR is significantly increased in neonates with sepsis and had a correlation with the severity of sepsis. Increased FAR was an independent predictor for the presence and severity of neonatal sepsis.
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Affiliation(s)
- Geng Dong
- Zhengzhou Key Laboratory of Children’s Infection and Immunity, Children’s Hospital Affiliated to Zhengzhou University, Henan Children’s Hospital, Zhengzhou Children’s Hospital, Zhengzhou, People’s Republic of China
| | - Tingting Ma
- Department of Neurology, Children’s Hospital Affiliated to Zhengzhou University, Henan Children’s Hospital, Zhengzhou Children’s Hospital, Zhengzhou, People’s Republic of China
| | - Zhe Xu
- Zhengzhou Key Laboratory of Children’s Infection and Immunity, Children’s Hospital Affiliated to Zhengzhou University, Henan Children’s Hospital, Zhengzhou Children’s Hospital, Zhengzhou, People’s Republic of China
| | - Min Zhang
- Zhengzhou Key Laboratory of Children’s Infection and Immunity, Children’s Hospital Affiliated to Zhengzhou University, Henan Children’s Hospital, Zhengzhou Children’s Hospital, Zhengzhou, People’s Republic of China
| | - Yidi Hu
- Zhengzhou Key Laboratory of Children’s Infection and Immunity, Children’s Hospital Affiliated to Zhengzhou University, Henan Children’s Hospital, Zhengzhou Children’s Hospital, Zhengzhou, People’s Republic of China
| | - Junmei Yang
- Zhengzhou Key Laboratory of Children’s Infection and Immunity, Children’s Hospital Affiliated to Zhengzhou University, Henan Children’s Hospital, Zhengzhou Children’s Hospital, Zhengzhou, People’s Republic of China
| | - Tiewei Li
- Zhengzhou Key Laboratory of Children’s Infection and Immunity, Children’s Hospital Affiliated to Zhengzhou University, Henan Children’s Hospital, Zhengzhou Children’s Hospital, Zhengzhou, People’s Republic of China
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Delgado V, Ajmone Marsan N, de Waha S, Bonaros N, Brida M, Burri H, Caselli S, Doenst T, Ederhy S, Erba PA, Foldager D, Fosbøl EL, Kovac J, Mestres CA, Miller OI, Miro JM, Pazdernik M, Pizzi MN, Quintana E, Rasmussen TB, Ristić AD, Rodés-Cabau J, Sionis A, Zühlke LJ, Borger MA. 2023 ESC Guidelines for the management of endocarditis. Eur Heart J 2023; 44:3948-4042. [PMID: 37622656 DOI: 10.1093/eurheartj/ehad193] [Citation(s) in RCA: 226] [Impact Index Per Article: 226.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/26/2023] Open
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Sun C, Tan D, Yu J, Liu J, Shen D, Li S, Zhao S, Zhang L, Li H, Cai K, Xu S, Huang L. Predictive models for sepsis in children with Staphylococcus aureus bloodstream infections: a retrospective cohort study. BMC Pediatr 2023; 23:496. [PMID: 37784062 PMCID: PMC10544563 DOI: 10.1186/s12887-023-04317-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Accepted: 09/16/2023] [Indexed: 10/04/2023] Open
Abstract
BACKGROUND The presence of Staphylococcus aureus in the bloodstream can lead to the development of sepsis; however, the severity and risk factors of the systemic inflammatory response to Staphylococcus aureus bloodstream infections were unclear. This study is aimed to build a model to predict the risk of sepsis in children with Staphylococcus aureus bloodstream infections. METHODS A retrospective analysis of hospitalized pediatric patients diagnosed with Staphylococcus aureus bloodstream infections was performed between January 2013 and December 2019. Each patient was assessed using the pediatric version of the Sequential Organ Failure Assessment score (pSOFA) within 24 h of blood culture collection. A nomogram based on logistic regression models was constructed to predict the risk factors for sepsis in children with Staphylococcus aureus bloodstream infections. It was validated using the area under the receiver-operating characteristic curve (AUC). RESULTS Of the 94 patients included in the study, 35 cases (37.2%) developed sepsis. The pSOFA scores ranged from 0 to 8, with 35 patients having a pSOFA score of ≥ 2. Six children (6.4%) died within 30 days, who were all from the sepsis group and had different pSOFA scores. The most common organs involved in sepsis in children with staphylococcal bloodstream infections were the neurologic system (68.6%), respiratory system (48.6%), and coagulation system (45.7%). Hospital-acquired infections (adjusted odds ratio [aOR], 3.0; 95% confidence interval [CI], 1.3-7.2), implanted catheters (aOR, 10.4; 95% CI, 3.8-28.4), procalcitonin level ≥ 1.7 ng/mL (aOR, 15.4; 95% CI, 2.7-87.1), and underlying diseases, especially gastrointestinal malformations (aOR, 14.0; 95% CI, 2.9-66.7) were associated with Staphylococcus aureus sepsis. However, methicillin-resistant Staphylococcus aureus infection was not a risk factor for sepsis. The nomogram had high predictive accuracy for the estimation of sepsis risk, with an AUC of 0.85. CONCLUSIONS We developed a predictive model for sepsis in children with Staphylococcus aureus infection.
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Affiliation(s)
- Chen Sun
- Department of Infectious Disease, Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, Zhejiang, 310052, China
- Department of Infectious Disease, Xinhua Children's Hospital, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, 1665 Kongjiang Road, Shanghai, 200092, China
| | - Dongdong Tan
- Department of Pediatrics, Liuzhou Maternity and Child Healthcare Hospital, Liuzhou, Guangxi, China
| | - Jiajia Yu
- Department of Clinical Laboratory, Xinhua Children's Hospital, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jingxian Liu
- Department of Clinical Laboratory, Xinhua Children's Hospital, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Dihua Shen
- Department of Pediatric Surgery, Xinhua Children's Hospital, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Shuang Li
- Department of Infectious Disease, Xinhua Children's Hospital, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, 1665 Kongjiang Road, Shanghai, 200092, China
| | - Shiyong Zhao
- Department of Infectious Diseases, Hangzhou Children's Hospital, Hangzhou, China
| | - Liya Zhang
- Department of Infectious Disease, Xinhua Children's Hospital, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, 1665 Kongjiang Road, Shanghai, 200092, China
| | - Huajun Li
- Department of Infectious Disease, Xinhua Children's Hospital, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, 1665 Kongjiang Road, Shanghai, 200092, China
| | - Kang Cai
- Department of Infectious Disease, Xinhua Children's Hospital, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, 1665 Kongjiang Road, Shanghai, 200092, China
| | - Shanshan Xu
- Department of Infectious Disease, Xinhua Children's Hospital, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, 1665 Kongjiang Road, Shanghai, 200092, China.
| | - Lisu Huang
- Department of Infectious Disease, Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, Zhejiang, 310052, China.
- Department of Infectious Disease, Xinhua Children's Hospital, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, 1665 Kongjiang Road, Shanghai, 200092, China.
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Elvy J, Haremza E, Morris AJ, Whiley M, Gay S. Blood culture quality assurance: findings from a RCPAQAP Key Incident Monitoring and Management Systems (KIMMS) audit of blood culture performance. Pathology 2023; 55:850-854. [PMID: 37400348 DOI: 10.1016/j.pathol.2023.03.012] [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: 09/07/2022] [Revised: 01/10/2023] [Accepted: 03/28/2023] [Indexed: 07/05/2023]
Abstract
Blood cultures (BC) are the gold standard investigation for bloodstream infection. Standards exist for BC quality assurance, but key quality indicators are seldom measured. The Royal College of Pathologists of Australasia Quality Assurance Programs (RCPAQAP) Key Incident Monitoring and Management Systems (KIMMS) invited laboratories for the first time to participate in an audit to determine adult BC positivity rates, contamination rates, sample fill volumes and the proportion received as a single set. The overall aim of the KIMMS audit was to provide laboratories with a mechanism for peer review and benchmarking. Results from 45 laboratories were analysed. The majority of laboratories (n=28, 62%) reported a positivity rate outside the recommended range of 8-15%. Contamination rates ranged from zero (n=5) to 12.5%, with seven laboratories (15%) reporting a contamination rate greater than the recommended 3%. Fifteen laboratories (33%) reported an average fill volume of less than the recommended 8-10 mL per bottle, with 11 laboratories (24%) reporting fill volumes of 5 mL or less whilst 13 (28%) laboratories were not able to provide any fill volume data. Thirteen laboratories (29%) reported that 50% or more of BC were received as single set, and eight (17%) were not able to report this data. This audit highlights there are deficiencies in BC quality measures across laboratories. To support BC quality improvement efforts, RCPAQAP KIMMS will offer a yearly BC quality assurance audit to encourage laboratories to monitor their BC quality performance.
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Affiliation(s)
- Juliet Elvy
- The Royal College of Pathologists of Australasia Quality Assurance Programs (RCPAQAP), Sydney, NSW, Australia; Department of Microbiology, Southern Community Laboratories, Dunedin Hospital, Dunedin, New Zealand.
| | - Elizabeth Haremza
- The Royal College of Pathologists of Australasia Quality Assurance Programs (RCPAQAP), Sydney, NSW, Australia
| | - Arthur J Morris
- The Royal College of Pathologists of Australasia Quality Assurance Programs (RCPAQAP), Sydney, NSW, Australia; Clinical Microbiology Laboratory, LabPLUS, Auckland City Hospital, Auckland, New Zealand
| | - Michael Whiley
- The Royal College of Pathologists of Australasia Quality Assurance Programs (RCPAQAP), Sydney, NSW, Australia; NSW Health Pathology, Sydney, NSW, Australia
| | - Stephanie Gay
- The Royal College of Pathologists of Australasia Quality Assurance Programs (RCPAQAP), Sydney, NSW, Australia
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Lefrak L, Schaffer KE, Bohnert J, Mendel P, Payton KSE, Lee HC, Bolaris MA, Zangwill KM. Blood culture procedures and practices in the neonatal intensive care unit: A survey of a large multicenter collaborative in California. Infect Control Hosp Epidemiol 2023; 44:1576-1581. [PMID: 36924050 DOI: 10.1017/ice.2023.33] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/18/2023]
Abstract
OBJECTIVE To describe variation in blood culture practices in the neonatal intensive care unit (NICU). DESIGN Survey of neonatal practitioners involved with blood culturing and NICU-level policy development. PARTICIPANTS We included 28 NICUs in a large antimicrobial stewardship quality improvement program through the California Perinatal Quality Care Collaborative. METHODS Web-based survey of bedside blood culture practices and NICU- and laboratory-level practices. We evaluated adherence to recommended practices. RESULTS Most NICUs did not have a procedural competency (54%), did not document the sample volume (75%), did not receive a culture contamination report (57%), and/or did not require reporting to the provider if <1 mL blood was obtained (64%). The skin asepsis procedure varied across NICUs. Only 71% had a written procedure, but ≥86% changed the needle and disinfected the bottle top prior to inoculation. More than one-fifth of NICUs draw a culture from an intravascular device only (if present). Of 13 modifiable practices related to culture and contamination, NICUs with nurse practitioners more frequently adopted >50% of practices, compared to units without (92% vs 50% of units; P < .02). CONCLUSIONS In the NICU setting, recommended practices for blood culturing were not routinely performed.
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Affiliation(s)
- Linda Lefrak
- Nurse Consultant, State of California Department of Public Health, Center for Health Care Quality, Healthcare-Associated Infections Program, Sacramento, California
| | - Kristen E Schaffer
- California Perinatal Quality Care Collaborative, Palo Alto, California
- Division of Neonatology, Stanford University, Palo Alto, California
| | - Janine Bohnert
- California Perinatal Quality Care Collaborative, Palo Alto, California
- Division of Neonatology, Stanford University, Palo Alto, California
| | | | - Kurlen S E Payton
- California Perinatal Quality Care Collaborative, Palo Alto, California
- Division of Neonatology, Department of Pediatrics, Cedars-Sinai Medical Center, Los Angeles, California
| | - Henry C Lee
- California Perinatal Quality Care Collaborative, Palo Alto, California
- Division of Neonatology, Stanford University, Palo Alto, California
| | - Michael A Bolaris
- Department of Pediatrics, Rancho Los Amigos Rehabilitation Center, Downey, California
| | - Kenneth M Zangwill
- Division of Pediatric Infectious Diseases, Department of Infection Prevention and Control, Harbor-UCLA Medical Center and The Lundquist Institute at Harbor-UCLA Medical Center, Torrance, California
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Słabisz N, Dudek-Wicher R, Leśnik P, Majda J, Kujawa K, Nawrot U. Impact of the COVID-19 Pandemic on the Epidemiology of Bloodstream Infections in Hospitalized Patients-Experience from a 4th Military Clinical Hospital in Poland. J Clin Med 2023; 12:5942. [PMID: 37762882 PMCID: PMC10531964 DOI: 10.3390/jcm12185942] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Revised: 09/05/2023] [Accepted: 09/11/2023] [Indexed: 09/29/2023] Open
Abstract
Bloodstream infections (BSIs) are associated with high mortality and inappropriate or delayed antimicrobial therapy. The purpose of this study was to investigate the impact of the COVID-19 pandemic on the epidemiology of BSIs in hospitalized patients. The research aimed to compare the incidence of BSIs and blood culture results in patients hospitalized before and during the COVID-19 pandemic. METHODS Retrospective and prospective data were collected from blood cultures obtained from 4289 patients hospitalized between June 2018 and July 2022. Two groups of patients were distinguished: those with BSIs admitted during the pre-COVID-19 period and those admitted during the COVID-19 surge. Demographic and clinical data, blood cytology, and biochemistry results were analyzed, and the usefulness of PCT was assessed in patients with COVID-19. RESULTS The study showed a significant increase in the incidence of BSIs during the pandemic compared to the pre-COVID-19 period. Positive blood cultures were obtained in 20% of patients hospitalized during the pandemic (vs. 16% in the pre-COVID-19 period). The incidence of BSIs increased from 1.13 to 2.05 cases per 1000 patient days during COVID-19, and blood culture contamination was more frequently observed. The mortality rate was higher for patients hospitalized during the COVID-19 pandemic. An increased frequency of MDRO isolation was observed in the COVID-19 period. CONCLUSIONS The incidence of BSIs increased and the mortality rate was higher in the COVID-19 period compared to the pre-COVID-19 period. The study showed limited usefulness of procalcitonin in patients with COVID-19, likely due to the administered immunosuppressive therapy.
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Affiliation(s)
- Natalia Słabisz
- Department of Laboratory Diagnostic, 4th Military Clinical Hospital in Wroclaw, 53-114 Wroclaw, Poland; (N.S.); (J.M.)
| | - Ruth Dudek-Wicher
- Department of Pharmaceutical Microbiology and Parasitology, Faculty of Pharmacy, Wroclaw Medical University, 50-367 Wroclaw, Poland;
| | - Patrycja Leśnik
- Clinical Department of Anesthesiology and Intensive Care, 4th Military Clinical Hospital in Wroclaw, 53-114 Wroclaw, Poland;
| | - Jacek Majda
- Department of Laboratory Diagnostic, 4th Military Clinical Hospital in Wroclaw, 53-114 Wroclaw, Poland; (N.S.); (J.M.)
| | - Krzysztof Kujawa
- Statistical Analysis Centre, Wroclaw Medical University, 50-368 Wroclaw, Poland;
| | - Urszula Nawrot
- Department of Pharmaceutical Microbiology and Parasitology, Faculty of Pharmacy, Wroclaw Medical University, 50-367 Wroclaw, Poland;
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Vrettou CS, Douka E, Perivolioti EP, Vassiliou AG, Sarri A, Giannopoulou V, Trigkidis KK, Jahaj E, Dimopoulou I, Kotanidou A. Accuracy of T2 magnetic resonance assays as point-of-care methods in the intensive care unit. J Hosp Infect 2023; 139:240-248. [PMID: 37392869 DOI: 10.1016/j.jhin.2023.06.021] [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: 03/13/2023] [Revised: 05/29/2023] [Accepted: 06/07/2023] [Indexed: 07/03/2023]
Abstract
BACKGROUND Novel molecular diagnostic methods are being evaluated in order to expedite pathogen identification in patients with bacteraemia. AIMS To evaluate the feasibility and diagnostic accuracy of the T2 magnetic resonance (T2MR) assays - T2 Bacteria (T2B) and T2 Resistance (T2R) - as point-of-care tests in the intensive care unit compared with blood-culture-based tests. METHODS Prospective cross-sectional study of consecutive patients with suspected bacteraemia. Diagnostic accuracy was evaluated using blood culture as the reference method. FINDINGS In total, 208 cases were included in the study. The mean time from sampling to report was lower for the T2MR assays compared with blood-culture-based methods (P<0.001). The rate of invalid reports was 6.73% for the T2B assay and 9.9% for the T2R assay. For the T2B assay, overall positive percentage agreement (PPA) was 84.6% [95% confidence interval (CI) 71.9-93.1%], negative percentage agreement (NPA) was 64.3% (95% CI 55.4-72.6%), positive predictive value (PPV) was 48.9% (95% CI 42.5-55.3%) and negative predictive value (NPV) was 91.2% (95% CI 84.4-95.2%). Cohen's kappa coefficient was 0.402. For the T2R assay, overall PPA was 80% (95% CI 51.9-95.7%), NPA was 69.2% (95% CI 54.9-81.3%), PPV was 42.9% (95% CI 31.7-54.8%) and NPV was 92.3% (95% CI 81.1-97.1%). Cohen's kappa coefficient was 0.376. CONCLUSION T2MR assays have high NPV for rapid exclusion of bacteraemia, and could potentially assist with antimicrobial stewardship when applied as point-of-care diagnostic tests in the intensive care unit.
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Affiliation(s)
- C S Vrettou
- First Department of Critical Care Medicine and Pulmonary Services, Evangelismos Hospital, National and Kapodistrian University of Athens Medical School, Athens, Greece.
| | - E Douka
- First Department of Critical Care Medicine and Pulmonary Services, Evangelismos Hospital, National and Kapodistrian University of Athens Medical School, Athens, Greece
| | - E P Perivolioti
- Department of Clinical Microbiology, Evangelismos Hospital, Athens, Greece
| | - A G Vassiliou
- First Department of Critical Care Medicine and Pulmonary Services, Evangelismos Hospital, National and Kapodistrian University of Athens Medical School, Athens, Greece
| | - A Sarri
- First Department of Critical Care Medicine and Pulmonary Services, Evangelismos Hospital, National and Kapodistrian University of Athens Medical School, Athens, Greece
| | - V Giannopoulou
- First Department of Critical Care Medicine and Pulmonary Services, Evangelismos Hospital, National and Kapodistrian University of Athens Medical School, Athens, Greece
| | - K K Trigkidis
- First Department of Critical Care Medicine and Pulmonary Services, Evangelismos Hospital, National and Kapodistrian University of Athens Medical School, Athens, Greece
| | - E Jahaj
- First Department of Critical Care Medicine and Pulmonary Services, Evangelismos Hospital, National and Kapodistrian University of Athens Medical School, Athens, Greece
| | - I Dimopoulou
- First Department of Critical Care Medicine and Pulmonary Services, Evangelismos Hospital, National and Kapodistrian University of Athens Medical School, Athens, Greece
| | - A Kotanidou
- First Department of Critical Care Medicine and Pulmonary Services, Evangelismos Hospital, National and Kapodistrian University of Athens Medical School, Athens, Greece
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Yang M, Tao C. Diagnostic efficiency of the FilmArray blood culture identification (BCID) panel: a systematic review and meta-analysis. J Med Microbiol 2023; 72. [PMID: 37712641 DOI: 10.1099/jmm.0.001608] [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] [Indexed: 09/16/2023] Open
Abstract
Introduction. The FilmArray blood culture identification panel (BCID) panel is a multiplex PCR assay with high sensitivity and specificity to identify the most common pathogens in bloodstream infections (BSIs).Hypothesis. We hypothesize that the BCID panel has good diagnostic performance for BSIs and can be popularized in clinical application.Aim: To provide summarized evidence for the diagnostic accuracy of the BCID panel for the identification of positive blood cultures.Methodology. We searched the MEDLINE, EMBASE and Cochrane databases through March 2021 and assessed the efficacy of the diagnostic test of the BCID panel. We performed a meta-analysis and calculated the summary sensitivity and specificity of the BCID panel. Systematic review protocols were registered in the International Prospective Register of Systematic Reviews (PROSPERO) (registration number CRD42021239176).Results. A total of 16 full-text articles were eligible for analysis. The overall sensitivities of the BCID panel on Gram-positive bacteria, Gram-negative bacteria and fungi were 97 % (95 % CI, 0.96-0.98), 100 % (95 % CI, 0.98-01.00) and 99 % (95 % CI, 0.87-1.00), respectively. The pooled diagnostic specificities were 99 % (95 % CI, 0.97-1.00), 100 % (95 % CI, 1.00-1.00) and 100 % (95 % CI, 1.00-1.00) for Gram-positive bacteria, Gram-negative bacteria and fungi, respectively.Conclusions. The BCID panel has high rule-in value for the early detection of BSI patients. The BCID panel can still provide valuable information for ruling out bacteremia or fungemia in populations with low pretest probability.
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Affiliation(s)
- Mei Yang
- Department of Laboratory Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, PR China
| | - Chuanmin Tao
- Department of Laboratory Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, PR China
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Kühn A, Gründling M. [Preclinical early detection and diagnosis of sepsis - step by step]. Dtsch Med Wochenschr 2023; 148:1201-1205. [PMID: 37657458 DOI: 10.1055/a-2127-6035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/03/2023]
Abstract
Because of very unspecific sepsis symptoms, early recognition of the emergency sepsis is difficult. If the disease is recognized in time it is possible to initiate diagnosis and treatment quickly. Rapid treatment of sepsis leads to lower mortality and less severe long-term consequences. Early detection is therefore of central importance in the diagnostic and therapeutic process, also in the outpatient setting.
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Boakye-Yiadom E, Najjemba R, Thekkur P, Labi AK, Gil-Cuesta J, Asafo-Adjei K, Mensah P, van Boetzelaer E, Jessani NS, Orish VN. Use and Quality of Blood Cultures for the Diagnosis of Bloodstream Infections: A Cross-Sectional Study in the Ho Teaching Hospital, Ghana, 2019-2021. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:6631. [PMID: 37681771 PMCID: PMC10487590 DOI: 10.3390/ijerph20176631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/10/2023] [Revised: 07/22/2023] [Accepted: 08/17/2023] [Indexed: 09/09/2023]
Abstract
Blood Culture and Drug Susceptibility Testing (CDST) remains vital for the diagnosis and management of bloodstream infections (BSIs). While the Ghana National Standard Treatment Guidelines require CDST to be performed in each case of suspected or clinically diagnosed BSI, these are poorly adhered to in the Ho Teaching Hospital (HTH). This study used secondary medical and laboratory records to describe blood CDST requests by clinicians and the quality of CDST processes for the diagnosis of BSI among patients admitted to HTH from 2019 to 2021. Of 4278 patients, 33% were infants. Pneumonia and neonatal sepsis cases were 40% and 22%, respectively. Only 8% (351/4278) had blood CDST requested. Of 94% (329/351) blood CDST processed and reported, only 7% (22/329) were culture-positive, with likely contaminants being recovered from 16% (52/329) of the specimens. The duration from admission to request was 2 days (IQR: 0-5), and Further qualitative studies must be conducted to understand the reasons for low blood CDST utilisation among clinicians and the patient outcomes. Targeted interventions are required to enhance the utilisation of blood CDST by clinicians and the quality of laboratory processes.
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Affiliation(s)
- Emily Boakye-Yiadom
- Department of Microbiology and Immunology, University of Health and Allied Sciences, Ho PMB 31, Volta Region, Ghana;
- Laboratory Department, Ho Teaching Hospital, Ho P.O. Box MA 374, Volta Region, Ghana; (K.A.-A.); (P.M.)
| | | | - Pruthu Thekkur
- International Union Against Tuberculosis and Lung Disease, 68 Boulevard Saint Michel, 75006 Paris, France;
| | - Appiah-Korang Labi
- Ghana Country Office, World Health Organization, 7 Ameda Street, Roman Ridge, Accra P.O. Box MB 142, Ghana;
| | - Julita Gil-Cuesta
- Luxembourg Operational Research Unit, Operational Centre Brussels, Médecins Sans Frontières, Rue Arbre Benit 46, 1050 Brussels, Belgium;
| | - Karikari Asafo-Adjei
- Laboratory Department, Ho Teaching Hospital, Ho P.O. Box MA 374, Volta Region, Ghana; (K.A.-A.); (P.M.)
| | - Prosper Mensah
- Laboratory Department, Ho Teaching Hospital, Ho P.O. Box MA 374, Volta Region, Ghana; (K.A.-A.); (P.M.)
| | - Elburg van Boetzelaer
- Luxembourg Operational Research Unit, Médecins Sans Frontières, 68 Rue de Gasperich, L-1617 Luxembourg, Luxembourg;
| | - Nasreen S. Jessani
- Centre for Evidence-Based Health Care, Division of Epidemiology and Biostatistics, Department of Global Health, Stellenbosch University, Tygerburg 7505, South Africa;
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 North Wolfe Street, Baltimore, MD 21205, USA
| | - Verner Ndudri Orish
- Department of Microbiology and Immunology, University of Health and Allied Sciences, Ho PMB 31, Volta Region, Ghana;
- Sickle Cell Disease Unit, Department of Internal Medicine, Ho Teaching Hospital, Ho P.O. Box MA 374, Volta Region, Ghana
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Kim K, Park S. Validation of the Accuracy of Automatic Measurement of Blood Volume in Culture Bottles for Blood Culture. Diagnostics (Basel) 2023; 13:2685. [PMID: 37627944 PMCID: PMC10453367 DOI: 10.3390/diagnostics13162685] [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: 06/07/2023] [Revised: 08/07/2023] [Accepted: 08/12/2023] [Indexed: 08/27/2023] Open
Abstract
Several manufacturers have developed systems that automatically measure the amount of blood in culture bottles. We compared the volumes measured automatically by the Virtuo instrument (bioMérieux, France) (height-based volumes) and those calculated by weighing the bottles. In all, 150 pairs of aerobic and anaerobic blood culture bottles (BacT/ALERT FA/FN Plus, bioMérieux) were randomly selected over two periods to compare the height- and weight-based volumes and analyze the effect of foam. We also estimated the limit of detection (LOD) and the cut-off value for 5 mL equine blood. The mean height-based volume was approximately 0.67 mL greater than the weight-based volume, particularly in anaerobic culture bottles. Foam did not have a significant effect. The LOD for the automatic height-based volume of equine blood was 0.2-0.4 mL. The 5 mL cut-off was 4-4.2 mL. Therefore, when reporting or monitoring blood volume within culture bottles in the laboratory, these performance characteristics should be adequately considered.
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Affiliation(s)
| | - Sunggyun Park
- Departments of Laboratory Medicine, Keimyung University School of Medicine, Daegu 42601, Republic of Korea;
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Aiesh BM, Daraghmeh D, Abu-Shamleh N, Joudallah A, Sabateen A, Al Ramahi R. Blood culture contamination in a tertiary care hospital: a retrospective three-year study. BMC Infect Dis 2023; 23:448. [PMID: 37403044 DOI: 10.1186/s12879-023-08428-0] [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: 01/15/2023] [Accepted: 06/26/2023] [Indexed: 07/06/2023] Open
Abstract
BACKGROUND Bloodstream infections (BSI) are a leading cause of morbidity and mortality in hospitalized patients worldwide. A blood culture is the primary tool for determining whether a patient has BSI and requires antimicrobial therapy, but it can result in an inappropriate outcome if the isolated microorganisms are deemed contaminants from the skin. Despite the development of medical equipment and technology, there is still a percentage of blood culture contamination. The aims of this study were to detect the blood culture contamination (BCC) rate in a tertiary care hospital in Palestine and to identify the departments with the highest rates along with the microorganisms isolated from the contaminated blood samples. METHOD Blood cultures that were taken at An-Najah National University Hospital between January 2019 and December 2021 were evaluated retrospectively. Positive blood cultures were classified as either true positives or false positives based on laboratory results and clinical pictures. Statistical analysis was performed using the Statistical Package for Social Sciences (SPSS) version 21. A p-value of less than 0.05 was considered statistically significant for all analyses. RESULTS Out of 10,930 blood cultures performed in the microbiology laboratory from 2019 to 2021, 1479 (13.6%) were identified as positive blood cultures that showed microbial growth. Of these, 453 were blood culture contaminations, representing 4.17% of total blood cultures and 30.63% of the positive blood culture samples. The highest rate of contamination was in the hemodialysis unit (26.49%), followed by the emergency department (15.89%). Staphylococcus epidermidis was the most prevalent (49.2%), followed by Staphylococcus hominis (20.8%) and Staphylococcus haemolyticus (13.2%). The highest annual contamination rate was observed in 2019 (4.78%) followed by 2020 (3.95%) and the lowest was in 2021 (3.79%). The rate of BCC was decreasing, although it did not reach statistically significant levels (P value = 0.085). CONCLUSION The rate of BCC is higher than recommended. The rates of BCC are different in different wards and over time. Continuous monitoring and performance improvement projects are needed to minimize blood culture contamination and unnecessary antibiotic use.
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Affiliation(s)
- Banan M Aiesh
- Infection Control Department, An-Najah National University Hospital, Nablus, Palestine
| | - Duha Daraghmeh
- Department of Pharmacy, Faculty of Medicine and Health Sciences, An-Najah National University, Nablus, Palestine
| | - Nasreen Abu-Shamleh
- Department of Pharmacy, Faculty of Medicine and Health Sciences, An-Najah National University, Nablus, Palestine
| | - Abdalmenem Joudallah
- Department of Pharmacy, Faculty of Medicine and Health Sciences, An-Najah National University, Nablus, Palestine
| | - Ali Sabateen
- Infection Control Department, An-Najah National University Hospital, Nablus, Palestine
| | - Rowa' Al Ramahi
- Department of Pharmacy, Faculty of Medicine and Health Sciences, An-Najah National University, Nablus, Palestine.
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Chen Y, Dai Y, Zhou Y, Huang Y, Jin Y, Geng Y, Ji B, Xu R, Zhu W, Hu S, Li Z, Liang J, Xiao Y. Improving Blood Culture Quality with a Medical Staff Educational Program: A Prospective Cohort Study. Infect Drug Resist 2023; 16:3607-3617. [PMID: 37309379 PMCID: PMC10257920 DOI: 10.2147/idr.s412348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Accepted: 05/24/2023] [Indexed: 06/14/2023] Open
Abstract
Purpose Blood cultures (BCs) are essential laboratory tests for diagnosing blood stream infections. BC diagnostic improvement depends on several factors during the preanalytical phase outside of innovative technologies. In order to evaluate the impact of an educational program on BC quality improvement, a total of 11 hospitals across China were included from June 1st 2020 to January 31st 2021. Methods Each hospital recruited 3 to 4 wards to participate. The project was divided into three different periods, pre-implementation (baseline), implementation (educational activities administered to the medical staff) and post-implementation (experimental group). The educational program was led by hospital microbiologists and included professional presentations, morning meetings, academic salons, seminars, posters and procedural feedback. Results The total number of valid BC case report forms was 6299, including 2739 sets during the pre-implementation period and 3560 sets during the post-implementation period. Compared with the pre-implementation period, some indicators, such as the proportion of patients who had 2 sets or more, volume of blood cultured, and BC sets per 1000 patient days, were improved in the post-implementation period (61.2% vs 49.8%, 18.56 vs 16.09 sets, and 8.0 vs 9.0mL). While BC positivity and contamination rates did not change following the educational intervention (10.44% vs 11.97%, 1.86% vs 1.94%, respectively), the proportion of coagulase negative staphylococci-positive samples decreased in BSI patients (6.87% vs 4.28%). Conclusion Therefore, medical staff education can improve BC quality, especially increasing volume of blood cultured as the most important variable to determine BC positivity, which may lead to improved BSI diagnosis.
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Affiliation(s)
- Yunbo Chen
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, People’s Republic of China
- Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Hangzhou, People’s Republic of China
| | - Yuanyuan Dai
- Clinical Laboratory, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, People’s Republic of China
| | - Yizheng Zhou
- Clinical Laboratory, Jingzhou Central Hospital, Jingzhou, People’s Republic of China
| | - Ying Huang
- Clinical Laboratory, First Affiliated Hospital of Anhui Medical University, Hefei, People’s Republic of China
| | - Yan Jin
- Clinical Laboratory, Shandong Provincial Hospital, Jinan, People’s Republic of China
| | - Yan Geng
- Clinical Laboratory, The Second Affiliated Hospital of Xi’an Jiaotong University, Xi’an, People’s Republic of China
| | - Bing Ji
- Clinical Laboratory, Affiliated Hospital of Binzhou Medical College, Binzhou, People’s Republic of China
| | - Rong Xu
- Clinical Laboratory, People’s Hospital of Yichun City, Yichun, People’s Republic of China
| | - Wencheng Zhu
- Clinical Laboratory, Lu’an Civil Hospital, Lu’an, People’s Republic of China
| | - Shuyan Hu
- Clinical Laboratory, People’s Hospital of Qingyang, Qingyang, People’s Republic of China
| | - Zhuo Li
- Clinical Laboratory, The First Affiliated Hospital of Xi’an Medical University, Xi’an, People’s Republic of China
| | - Jinhua Liang
- Clinical Laboratory, The Affiliated Hongqi Hospital of Mudanjiang Medicine College, Mudanjiang, People’s Republic of China
| | - Yonghong Xiao
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, People’s Republic of China
- Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Hangzhou, People’s Republic of China
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Akaishi T, Tokuda K, Katsumi M, Fujimaki SI, Aoyagi T, Harigae H, Ishii T. Blood Culture Result Profile in Patients With Central Line-Associated Bloodstream Infection (CLABSI): A Single-Center Experience. Cureus 2023; 15:e40202. [PMID: 37435240 PMCID: PMC10331171 DOI: 10.7759/cureus.40202] [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] [Accepted: 06/09/2023] [Indexed: 07/13/2023] Open
Abstract
Background Central line-associated bloodstream infection (CLABSI) is among the most common bloodstream infections in the university hospital and intensive care unit settings. This study evaluated the routine blood test findings and microbe profiles of bloodstream infection (BSI) by the presence and types of central vein (CV) access devices (CVADs). Methods A total of 878 inpatients at a university hospital who were clinically suspected for BSI and underwent blood culture (BC) testing between April 2020 and September 2020 were enrolled. Data regarding age at BC testing, sex, WBC count, serum C-reactive protein (CRP) level, BC test results, yielded microbes, and usage and types of CVADs were evaluated. Results The BC yields were detected in 173 patients (20%), suspected contaminating pathogens in 57 (6.5%), and 648 (74%) with a negative yield. The WBC count (p=0.0882) and CRP level (p=0.2753) did not significantly differ between the 173 patients with BSI and the 648 patients with negative BC yields. Among the 173 patients with BSI, 74 used CVADs and met the diagnosis of CLABSI; 48 had a CV catheter, 16 had CV access ports, and 10 had a peripherally inserted central catheter (PICC). Patients with CLABSI showed lower WBC counts (p=0.0082) and serum CRP levels (p=0.0024) compared to those with BSI who did not use CVADs. The most commonly yielded microbes in those with CV catheters, CV-ports, and PICC were Staphylococcus epidermidis (n=9; 19%), Staphylococcus aureus (n=6; 38%), and S. epidermidis (n=8; 80%), respectively. Among those with BSI who did not use CVADs, Escherichia coli (n=31; 31%) was the most common pathogen, followed by S. aureus (n=13; 13%). Conclusion Patients with CLABSI showed lower WBC counts and CRP levels than those with BSI who did not use CVADs. Staphylococcus epidermidis was among the most common microbes in CLABSI and accounted for the majority of yielded microbes in patients who used PICC.
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Affiliation(s)
| | | | - Makoto Katsumi
- Laboratory Medicine, Tohoku University Hospital, Sendai, JPN
| | | | - Tetsuji Aoyagi
- Microbiology and Infectious Diseases, Toho University, Tokyo, JPN
| | | | - Tadashi Ishii
- Kampo and Integrative Medicine, Tohoku University Hospital, Sendai, JPN
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Hajjar N, Ting JY, Shah PS, Lee KS, Dunn MS, Srigley JA, Khurshid F. Blood culture collection practices in NICU; A national survey. Paediatr Child Health 2023; 28:166-171. [PMID: 37205138 PMCID: PMC10186103 DOI: 10.1093/pch/pxac112] [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: 06/08/2022] [Accepted: 10/23/2022] [Indexed: 03/17/2024] Open
Abstract
Background Sepsis is the leading cause of mortality and morbidity in neonates. Blood cultures are the gold standard in diagnosing neonatal sepsis; however, there are currently no consensus guidelines for blood culture collection in neonates and significant practice variation exists in Neonatal Intensive Care Units (NICUs) globally. Objective To examine current practices in obtaining blood cultures in the evaluation of neonatal sepsis in NICUs across Canada. Methods A nine-item electronic survey was sent to each of the 29 level-3 NICUs in Canada, which are equipped to provide highly specialized care for newborns. Results Responses were received from 90% (26/29) of sites. Sixty-five percent (17/26) of sites have blood culture collection guidelines for the investigation of neonatal sepsis. Forty-eight percent (12/25) of sites routinely target 1.0 mL per culture bottle. In late-onset sepsis (LOS), 58% (15/26) of sites process one aerobic culture bottle, whereas four sites routinely add anaerobic culture bottles. In early-onset sepsis (EOS) in very low birth weight infants (BW <1.5 kg), 73% (19/26) of sites use umbilical cord blood, and 72% (18/25) use peripheral venipuncture. Two sites routinely collect cord blood for culture in EOS. Only one site applies the concept of differential time-to-positivity to diagnose central-line-associated bloodstream infection. Conclusions There is significant practice variation in methods used to obtain blood cultures in level-3 NICUs across Canada. Standardization of blood culture collection practices can provide reliable estimates of the true incidence of neonatal sepsis and help to develop appropriate antimicrobial stewardship strategies.
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Affiliation(s)
- Nicole Hajjar
- Department of Pediatrics, Queen’s University, Kingston, Ontario, Canada
| | - Joseph Y Ting
- Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
| | - Prakesh S Shah
- Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
| | - Kyong-Soon Lee
- Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
| | - Michael S Dunn
- Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
| | - Jocelyn A Srigley
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Faiza Khurshid
- Department of Pediatrics, Queen’s University, Kingston, Ontario, Canada
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Kalmovich B, Rahamim-Cohen D, Shapiro Ben David S. Impact on Patient Management of a Novel Host Response Test for Distinguishing Bacterial and Viral Infections: Real World Evidence from the Urgent Care Setting. Biomedicines 2023; 11:biomedicines11051498. [PMID: 37239167 DOI: 10.3390/biomedicines11051498] [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: 04/21/2023] [Revised: 05/13/2023] [Accepted: 05/18/2023] [Indexed: 05/28/2023] Open
Abstract
Antibiotic overuse and underuse are prevalent in urgent care settings, driven in part by diagnostic uncertainty. A host-based test for distinguishing bacterial and viral infections (MeMed BV) has been clinically validated previously. Here we examined how BV impacts antibiotic prescription in a real-world setting. The intention to treat with antibiotics before the receipt of a BV result was compared with practice after the receipt of a BV result at three urgent care centers. The analysis included 152 patients, 57.9% children and 50.7% female. In total, 131 (86.2%) had a bacterial or viral BV result. Physicians were uncertain about prescription for 38 (29.0%) patients and for 30 (78.9%) of these cases, subsequently acted in accordance with the BV result. Physicians intended to prescribe antibiotics to 39 (29.8%) patients, of whom 17 (43.6%) had bacterial BV results. Among the remaining 22 patients with viral BV results, antibiotic prescriptions were reduced by 40.9%. Overall, the physician prescribed in accordance with BV results in 81.7% of all cases (p < 0.05). In total, the physicians reported that BV supported or altered their decision making in 87.0% of cases (p < 0.05). BV impacts patient management in real-world settings, supporting appropriate antibiotic use.
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Affiliation(s)
- Boaz Kalmovich
- Health Division, Maccabi Healthcare Services, Tel Aviv 6812509, Israel
| | | | - Shirley Shapiro Ben David
- Health Division, Maccabi Healthcare Services, Tel Aviv 6812509, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
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