Cases Of Positive Blood Cultures Research Articles

Artificial placenta support of extremely preterm ovine fetuses at the border of viability for up to 336 hours with maintenance of systemic circulation but reduced somatic and organ growth.

Introduction: Artificial placenta therapy (APT) is an experimental life support system to improve outcomes for extremely preterm infants (EPI) less than 1,000g by obviating the need for pulmonary gas exchange. There are presently no long-term survival data for EPI supported with APT. To address this, we aimed to maintain 95d-GA (GA; term-150d) sheep fetuses for up to 2weeks using our APT system. Methods: Pregnant ewes (n = 6) carrying singleton fetuses underwent surgical delivery at 95d GA. Fetuses were adapted to APT and maintained for up to 2weeks with constant monitoring of key physiological parameters and extensive time-course blood and urine sampling, and ultrasound assessments. Six age-matched in-utero fetuses served as controls. Data were tested for group differences with ANOVA. Results: Six APT Group fetuses (100%) were adapted to APT successfully. The mean BW at the initiation of APT was 656 ± 42g. Mean survival was 250 ± 72h (Max 336h) with systemic circulation and key physiological parameters maintained mostly within normal ranges. APT fetuses had active movements and urine output constantly exceeded infusion volume over the experiment. At delivery, there were no differences in BW (with edema in three APT group animals), brain weight, or femur length between APT and in-utero Control animals. Organ weights and humerus lengths were significantly reduced in the APT group (p < 0.05). Albumin, IGF-1, and phosphorus were significantly decreased in the APT group (p < 0.05). No cases of positive blood culture were detected. Conclusion: We report the longest use of APT to maintain extremely preterm fetuses to date. Fetal systemic circulation was maintained without infection, but growth was abnormal. This achievement suggests a need to focus not only on cardiovascular stability and health but also on the optimization of fetal growth and organ development. This new challenge will need to be overcome prior to the clinical translation of this technology.

1853. Relevance of Actinomyces Bacteremia

Abstract Background Actinomyces species are Gram-positive anaerobic bacilli colonizing the human oropharynx, gastrointestinal tract, and urogenital tract asso­ciated with a wide range of infections. The isolation of Actinomyces spp. from sterile clinical samples is regarded as significant. We reviewed the risk factors, clinical features, and outcomes in patients with Actinomyces bacteremia. Methods We conducted a retrospective study of all inpatients with Actinomyces bacteremia from two tertiary care centers from 1/1/06 -9 /26/19 . Data were collected on demographic and clinical characteristics, co-morbidities, primary source of infection, treatment received and duration of therapy and outcomes. True bacteremia was defined as Actinomyces bacteremia with systemic manifestations of infection. Results A total of 82 cases of positive blood cultures were identified of which 33 were true bacteremia, based on clinical criteria among 19 females and 14 males ranging from 19-93 years (63.8 ±19.5). Majority of patients were blacks (70%). Clinical risk factors predominantly were diabetes mellitus (21%), chronic renal failure (18%) and active malignancy (12%). Majority of blood cultures were positive within 48 hrs. of admission 84.8%. Skin and soft tissue (27%) was the most common source followed by respiratory (15%), intrabdominal (15%), osteomyelitis (12%), odontogenic (6%), endovascular (6%) genitourinary (3%) and unknown source (16%). In 27 (81%) cases, bacteremia was isolated to species level: A.meyeri 8 (30%), A.odontolyticus 7 (26%), A.israelli 7 (26%), A.turicensis 4 (15%) and A.neuii 1 (4%). The infectious diseases service was consulted in 20 cases of true bacteremia. Duration of antibiotics ranged between 0-84 days (17.6 ±20.7). All-cause mortality during hospitalization was 24% (8). Conclusion Not all Actinomyces bacteremia may be relevant and can represent transient bacteremia. Better awareness and involvement of infectious disease service is recommended in understanding of the clinical significance, to ensure appropriate therapy for patients thereby implementing antibiotic stewardship to improve antibiotic use and, patient safety and improve outcomes. Further research will help to identify the true significance of these isolates. Disclosures All Authors: No reported disclosures.

Clinical Characteristics and Outcome of Candidemia: Experience from a Tertiary Referral Center in Saudi Arabia.

Background:Candida bloodstream infections cause significant excess morbidity and mortality in the health-care setting. There is limited evidence regarding Candida species causing invasive infections in Saudi Arabia.Objective:To identify Candida species causing bloodstream infection and determine the clinical outcome and factors associated with mortality in a tertiary center in Saudi Arabia.Materials and Methods:This retrospective study included all cases of positive blood culture for Candida in patients admitted to King Abdulaziz Medical City, a tertiary care center in Riyadh, Saudi Arabia, between January 1, 2013 and June 30, 2019.Results:A total of 532 patients with candidemia were identified (male: 55.4%; mean age: 54 ± 26.2 years). The most common Candida species isolated was Candida albicans (26.7%), followed by Candida glabrata (22.7%), Candida parapsilosis (22.2%), and Candida tropicalis (18.4%). Non-albicans candidemia was more common in patients with diabetes (76.7%; P = 0.0560), neutropenia (89.8%; P = 0.0062), recent exposure to fluconazole (85.7%; P = 0.0394), and active chemotherapy (83.1%; P = 0.0128). In non-albicans, susceptibility to fluconazole varied from 95.9% with C. tropicalis to 41.5% with C. parapsilosis; nonetheless, all species were highly susceptible to echinocandins. The overall 30- and 90-day mortality rates were 39.9% and 56.4%, respectively. The mortality rate was nonsignificantly higher with non-albicans species at 30 days (41.2% vs. 35.9%; P = 0.2634) and 90 days (58.2% vs. 51.4%; P = 0.1620).Conclusion:This study found a changing pattern in the Candida species causing bloodstream infections and an epidemiological shift toward more non-albicans Candida species in Saudi Arabia.

An Update to Enterococcal Bacteremia: Epidemiology, Resistance, and Outcome.

An increase in resistant gram-positive cocci, especially enterococci, requires an epidemiologic re-assay and its results may affect empirical treatments for these infections. In this study, we investigated the microbial epidemiology and resistance pattern of enterococcal bacteremia. This study was a cross-sectional study that investigated all cases of positive blood cultures with Enterococcus spp. at a tertiary referral colligates hospital in Tehran in 2018. Enterococcus spp. was isolated from blood cultures of a total of 73 patients. Most of the patients were male i.e: 42 (57.7%). The mean age of the patients was 58.8 (±18.8) years. Hospital- acquired infection was the most prevalent type of infection involving enterococcal bacteremia (80.8%) compared with community-acquired (6.7%) and the health care-associated one (12.3%). Renal failure and cancer were the most underlying disease in E. faecalis and E. faecium, respectively. Mortality for Vancomycin-resistant enterococci (VRE) was approximately two times more than the sensitive ones. Between the dead/alive groups, the following items were significantly different (P.Value<0.05): Vancomycin resistance for enterococcus isolated, immunodeficiency as an underlying disease, Mechanical ventilation, hospitalization period, and the empiric regimen. Increased antibiotic-resistant strains, especially Vancomycin-resistant enterococci (VRE), pose a serious threat to the general public, especially hospitalized patients, causing an increase in mortality. Surveillance of microorganisms and antimicrobial resistance is a crucial part of an efficient health care system.

Clinical relevance of procalcitonin values in bacteremia

IntroductionThe aim of this study was to investigate procalcitonin levels according to the causative pathogens of bacteremia. The relationships between the clinical outcomes and procalcitonin levels were also studied. MethodsFrom among 452 patients, 507 cases of positive blood culture were included in the present study. Procalcitonin levels were studied according to the pathogen types. The prevalence of septic shock and the mortality rates were also studied in four groups stratified by the procalcitonin levels (groups 1, 2, 3, and 4 had procalcitonin levels of <0.5 ng/mL, 0.5 ≤ 2.0 ng/mL, 2.0 < 10 ng/mL, and ≥10 ng/mL, respectively). ResultsThe procalcitonin levels were significantly higher in bacteremia cases with Gram-negative rods (19.50 ng/mL), such as Escherichia coli (32.5 ng/mL), than those with Gram-positive rods (8.45 ng/mL) or Gram-positive cocci (9.21 ng/mL) (p < 0.01). The 28-day mortality rates in groups 1, 2, 3, and 4 were 6.0%, 12.0%, 14.9%, and 19.8%, respectively. The procalcitonin levels of samples taken before or on the same day of blood cultures were significantly lower than those taken one day after blood cultures. Multiple logistic regression analysis showed that C-reactive protein and procalcitonin ≥10 ng/mL were independently associated with a higher risk of mortality within 28 days. ConclusionsThe PCT levels were higher in cases of bacteremia caused by GNR than those caused by GPR or GPC. The 28-day mortality rate increased as the PCT levels increased. Clinical importance of early evaluations and appropriate interpretation of procalcitonin levels for bacteremia were indicated.

Diagnosis of infective endocarditis using echocardiography.

The aim of this study was to evaluate the application of transthoracic echocardiography for the diagnosis of infective endocarditis (IE) to provide a basis for the better treatment of IE. From October 2016 to October 2018, 87 consecutive patients with IE at our hospital were selected for this study. All the patients were subjected to transthoracic echocardiography. The morphology, structure, activity, and closure of the patients’ heart valves were observed for vegetation identification, and the size, number, location, morphology, and echo intensity of vegetation, as well as degree of valve involvement, were determined.The 87 patients investigated in this study included 38 cases of congenital heart disease, 27 cases of nonrheumatic valvular heart disease, 12 patients who underwent valve surgery, 5 cases of rheumatic valvular heart disease, and 5 patients with no obvious signs of heart disease. The most common clinical manifestations were heart murmur in 80 cases and fever in 60 cases. The most common complications were heart failure in 35 cases, followed by organ embolism in 12 cases. There were 36 cases of positive blood cultures, including 26 cases of Gram-positive cocci and 10 cases of Gram-negative bacilli. Echocardiography showed aortic valve involvement in 37 cases, mitral valve involvement in 34 cases, tricuspid valve involvement in 10 cases, pulmonary valve involvement in 2 cases, and the involvement of an artificial valve in 5 cases. Twenty-six of these cases showed multiple valve involvement, and 20 patients exhibited serious complications. No significant differences were found between echocardiography and actual surgical observations with respect to their accuracy in detecting the size, number, and location of vegetation in the 69 patients who underwent surgery (P > .05). Echocardiography could detect the occurrence of severe complications, namely, the rupture of chordae tendineae, valve prolapse, valve perforation, and paravalvular abscess, and no significant difference in diagnostic accuracy was found between echocardiography and surgical observations (P > .05).Transthoracic echocardiography can rapidly and accurately detect IE vegetation and its complications and has important clinical value for guiding clinical treatment and determining prognosis.

Application of the biocopolymer preparation system, rapid BACpro® II kit, for mass-spectrometry-based bacterial identification from positive blood culture bottles by the MALDI Biotyper system

Matrix-assisted laser desorption ionization time-of-flight mass spectrometry (MALDI-TOF MS) is increasingly used for identification of microorganisms from positive blood cultures. Pretreatments to effectively remove non-bacterial components and selectively collect microorganisms are a prerequisite for successful identification, and a variety of home-brew and commercial protocols have been reported. Although commercially available kits, mainly the Sepsityper Kit, are increasingly used, the identification rates reported often are not satisfactory, particularly for Gram-positive isolates. We recently developed a method to collect bacteria from positive blood culture bottles using a polyallylamine-polystyrene copolymer that has been used in wastewater processing. This pretreatment protocol is now commercially available as the rapid BACpro® II kit (Nittobo Medical Co., Tokyo, Japan). The operation time required for processing using this novel kit is approximately 10 min, and the entire procedure can be completed within a biosafety cabinet.Since the performance of the rapid BACpro® II kit has not been tested using the MALDI Biotyper system, we prospectively evaluated the performance of the rapid BACpro® II kit as compared with the Sepsityper® kit.Performance of the rapid BACpro® II kit was evaluated using a total of 193 monomicrobial cases of positive blood culture. Medium from blood culture bottles was pretreated by the rapid BACpro® II kit or the Sepsityper® Kit, and isolated cells were subjected to direct identification by MS fingerprinting in parallel with conventional subculturing for reference identification. The overall MALDI-TOF MS-based identification rates with >1.7 score and >2.0 score obtained using the rapid BACpro® II kit were 99.5% and 80.8%, respectively, whereas those obtained using the Sepsityper® Kit were 89.1% and 68.4%, respectively (P < 0.05 for >1.7 and P < 0.05 for >2.0 by Pearsons's chi-square). In Gram-positive cases, the rapid BACpro® II kit gave identification rate of 100% with >1.7 score and 69.4% with >2.0 score, whereas there were 84.7% and 56.8%, respectively by the Sepsityper® Kit (P < 0.05 for >1.7).These results are preliminary, but considering that this new kit is easy to perform and the identification rates are promising, the rapid BACpro® II kit deserves assessment in a larger-scale study with a variety of platforms for MS-based bacterial identification.

An improved in-house lysis-filtration protocol for bacterial identification from positive blood culture bottles with high identification rates by MALDI-TOF MS

Matrix-assisted laser desorption ionization–time of flight mass spectrometry (MALDI-TOF MS) is now a well-established method for identification of microorganisms from positive blood cultures. Pretreatments to effectively remove non-bacterial proteins are a prerequisite for successful identification, and a variety of protocols have been reported. Although commercially available kits, mainly the Sepsityper Kit, are increasingly used, the identification rates reported often are not satisfactory, particularly for Gram-positive isolates. We developed a new, in-house lysis-filtration protocol and prospectively evaluated its performance compared to the Sepsityper kit. The in-house protocol consists of three simple steps: lysis by ammonium chloride, aspiration with a syringe fitted with a 0.45-μm membrane, and centrifugation to collect microbes. The novel protocol requires only 20 min.Performance of the in-house protocol was evaluated using a total of 117 monomicrobial cases of positive blood culture. Medium from blood culture bottles was pretreated by the in-house protocol or the commercial kit, and isolated cells were subjected to direct identification by mass spectrometry fingerprinting in parallel with conventional subculturing for reference identification. The overall MALDI-TOF MS-based identification rates with score > 1.7 and > 2.0 obtained using the in-house protocol were 99.2% and 85.5%, respectively, whereas those obtained using the Sepsityper Kit were 85.4% and 61.5%, respectively. For Gram-positive cases, the in-house protocol yielded scores >1.7 and > 2.0 at 98.5% and 76.1%, respectively, whereas the commercial kit yielded these scores at 76.1% and 43.3%, respectively. Although these are preliminary results, these values suggest that this easy lysis-filtration protocol deserves assessment in a larger-scale test.

Pneumococcal biliary tract infections - How rare are they?

Pneumococcal biliary tract infections (PBTIs) were reported as rare due to the bacterium's bile solubility. The purpose of this study was to determine the occurrence and clinical characteristics of PBTIs. A retrospective case series review was conducted from January 2006 to August 2014 at a tertiary referral university hospital in Japan. Patients with a blood or bile culture positive for Streptococcus pneumoniae diagnosed with definite cholangitis or cholecystitis according to Tokyo Guideline 2013 were enrolled in this study. Data on clinical information, treatments, and outcomes were collected. During 104 months, 48 cases of positive blood cultures and 13 cases of positive bile cultures were recorded, and after excluding 43 and 5 of these, respectively, a total of 10 patients were diagnosed with PBTI. Most patients (9/10) had biliary tract problems and biliary devices in place. PBTIs were not rare; conversely, they were a relatively common cause of pneumococcal bacteremia in this center treating a high volume of biliary tract illnesses.

A Comparative Evaluation of Microbial Pattern and Antibiotic Susceptibility in a Level III NICU Between Two Decades

Background: Sepsis is one of the most common causes of neonatal mortality and morbidity in NICUs. Prescription of broad-spectrum antibiotics is increasing; hence, increase in antibiotic resistance is a concern. Information about changing microbial patterns and antimicrobial sensitivity over time helps us to choose the most appropriate antibiotics. Objectives: The aim of this research was to assess the changing microbial patterns and antibiotic susceptibility during a 23-year interval from 1992 to 2015 in the NICU of the Mofid Children’s hospital in Tehran, Iran. Methods: We conducted a retrospective comparative descriptive study between 1992 and 2015. Neonates with positive blood cultures were enrolled, and the microbial characteristics and antibiograms of the blood cultures were compared. Results: One-hundred cases of positive blood cultures in 1992 and 103 cases in 2015 were analyzed and compared. Overall, 57% of neonates were male and 43% were female; 56% of the sepsis was late onset and 44% was early onset; 63% of neonates had term gestation and 37% were preterm. We found that the most common causes of positive blood culture isolated in 1992 were Staphylococcus aureus (59%) and Staphylococcus epidermidis (40.9%). In 2015, the most common causes were (coagulase negative staphylococci) CONS (33.98%) and Pseudomonas aeruginosa (20.3%). In the evaluation of antibiograms, the rate of resistance to cephalosporins, aminoglycosides (except tobramycin), and oxacillins increased from 1992 to 2015. In 2015, the sensitivity rate to imipenem, meropenem, ciprofloxacillin, vancomycin, and linezolid was greater than the resistance, whereas to piperacillin, colistin, and cefepim, and cefotaxim, the rate of resistance was higher. In the evaluation of antibiotic sensitivity based on microorganisms in 2015, piperacillin had the highest effectiveness against pseudomonas and Klebsiella, with no effectiveness against Acinetobacter. Ciprofloxacin had the highest effectiveness against E. coli and Klebsiella. One-hundred percent of Streptococci, 83.3% of Staphylococcus aureus, and 71.4% of coagulase negative Staphylococci were sensitive to vancomycin. Conclusions: In this research, we found that the pattern of microbial and antibiotic sensitivity has changed, and overall antibiotic resistance is increasing. This is an indication that healthcare providers should use broad-spectrum antibiotics with caution.

The role of CRP, PCT, IL-6 and presepsin in early diagnosis of bacterial infectious complications in paediatric haemato-oncological patients.

Bacterial infection is the most common complication in paediatric oncological patients during cancer treatment. A suitable tool for early prediction of unfavourable course of infection is still needed. We performed a prospective longitudinal observational study to evaluate of the role of serum biomarkers (C-reactive protein, procalcitonin, interleukin-6, presepsin) in the early diagnosis of bacteraemia (gram-negative versus gram-positive) in patients with haematological malignancies. We observed 69 febrile episodes in 33 patients (17 male, 16 female; 1.5-18.9 years, mean 7.31 years, median 5 years). Within this sample, there were 22 cases of positive blood cultures, 16 cases of sepsis, 38 cases of fever with no signs or symptoms of sepsis, and two deaths from infectious complications. All markers tested had good negative predictive value (73% - 93%). CRP was characterized by good specificity for registration bacteraemia (96%, 95% CI: 85% - 99%), but other results were inconclusive. We identified comparably balanced sensitivity (64% - 81%) and specificity (61% - 88%) for interleukin-6 and procalcitonin, and we proved their quality to predict positive blood culture and clinical signs of sepsis as well. Patients with gram-negative bacteraemia had significantly elevated levels of PCT and IL-6 in comparison with a group of patients with gram-positive bacteraemia (p = 0.04 for PCT and p = 0.005 for IL-6). Presepsin was characterized by poor specificity (27%, 95% CI: 15% - 43%) and positive predictive value (24%, 95% CI: 12 - 39%) for predicting bacteraemia, and by better sensitivity (84%, 95% CI: 55% - 98%) and specificity (58%, 95% CI: 42% - 73%) for predicting clinical signs of sepsis.

Clinical manifestation and laboratory findings in positive blood culture in neonatal septicemia

Background/objective: Neonatal septicemia is one of the major causes of mortality in newborns. The aim of this study is to evaluate the clinical manifestations and laboratory findings in positive blood culture in neonatal septicemia. Methods: In this retrospective study, we allocated 100 records positive blood culture of neonates suffering from septicemia. A questionnaire was completed for each patient consisting the age at admission, gender, weight at birth, admission time, type of delivery, pre- or post-term delivery and the clinical symptoms. Types of organism causing sepsis, and their resistance to antibiotics were evaluated and method for empirical treatment was recommended. Results: Respiratory distress, cyanosis and lethargy were more common in the patients. The antibiogram showed Ampicillin resistance in 86% and Gentamycin resistance in 66% of studied records. Also, 36% cases of positive blood culture with gram-negative and 64% with gram-positive bacteria were observed. The most common bacteria in blood cultures were negative-coagulase Staphylococcus (%35), Staphylococcus Aureus (%24), Klebsiella (%18), respectively. Other bacteria were Enterobacter, Escherichia coli and Enterococcus (%5), Acinetobacter (%3), Pseudomonas aeruginosa and Negative-Gram Bacilli (%2) and Ceratia (%1). The most common effective antibiotics against bacterial growth in Antibiograms were Vancomycin, Cephalosporin, Amikacin, Co-trimoxazole and Gentamycin. Conclusion: Since the most common bacteria in neonatal septicemia cases were negative-coagulase Staphylococcus, Staphylococcus Aureus, Klebsiella, the pediatricians must select the regiments that cover gram-negative bacteria for empirical antibiotic treatments.

Clinical consequences of using PNA-FISH in Staphylococcal bacteraemia

To optimize patient treatment and rational use of antimicrobials, it is important to provide fast information on findings in blood-cultures (BCs). The purpose of this study was to evaluate the impact of using peptide nucleic acid fluorescence in situ hybridization (PNA-FISH) on positive BCs containing Gram-positive cocci in clusters to differentiate between Staphylococcus aureus (SA) and coagulase negative staphylococci (CoNS) on the prescribed antimicrobial therapy and on the number of contacts between microbiologist and clinician. All cases of positive BCs in our laboratory with SA or CoNS in the year 2011 were identified and the charts were reviewed retrospectively. The group of patients with BCs tested with PNA-FISH was compared to the group of patients with untested BCs. A total of 200 patients with SA and 725 patients with CoNS were included. The mean number of contacts was 0.82 when PNA-FISH showed CoNS and 1.39 when PNA-FISH was not done (p < 0.0001). More patients were recommended appropriate antimicrobial therapy for SA bacteraemia in the PNA-FISH group (98.0%) than in the non-PNA-FISH group (89.4 %) (p = 0.025). The percentage treated with dicloxacillin was 29.6 in the PNA-FISH group, and 8.2 in the non-PNA-FISH group (p = 0.0003). The use of PNA-FISH on BCs in this study was associated with more appropriate and narrow spectrum antimicrobial therapy for patients with SA in an area with low prevalence of methicillin-resistant SA, and a lower number of contacts between clinical microbiologist and clinician about BCs with CoNS as contaminants.

Outcome of central venous catheter-related bacteraemia according to compliance with guidelines: experience with 91 episodes

Infection is a major complication associated with the use of central venous catheters. Guidelines for medical management of catheter-related bacteraemia have been published, but no study has assessed the appropriateness of physician practices. To assess medical practices in cases of central venous catheter-related bacteraemia (CRB) in a university hospital. Cases were recorded over a period of 12 months and their management was evaluated. All cases of positive blood cultures based on central venous catheter sampling were analysed, and episodes of CRB were determined in this group of patients. Medical management and patient outcome were analysed independently by two physicians. In all, 187 cases of positive blood culture were recorded and 91 cases of CRB were analysed. Systemic antimicrobial therapy was optimal in 56% of the episodes. In 51 episodes, catheter salvage was attempted, for 29 with an indication in agreement with the guidelines but without antibiotic-lock therapy in 20 episodes. The overall medical management was appropriate in 41.8% of the episodes. The overall cure rate was 72.5%. CRB-related death occurred in 5.5% of the episodes. Cure was associated with guideline compliance (P=0.03) and with adaptation of systemic antimicrobial therapy (P<0.01). Conservative treatment success was associated with compliance with the guidelines for the indication (P=0.01). Medical management of CRB did not closely adhere to international guidelines. CRB outcome was associated with the appropriateness of this management, particularly when conservative treatment was attempted.

Impact of infectious diseases service consultation on diagnosis of infective endocarditis

The infectious diseases (ID) consultation service is a new clinical entity in Japan. We examined the impact of ID consultation on the diagnosis of infective endocarditis (IE) at a large teaching hospital in Japan. Routine consultation with an ID service for cases of positive blood culture was implemented at Kameda Medical Center in November 2004. In addition, ID service doctors started to give lectures on ID to doctors and also provided local guidelines on ID. We compared the incidence of IE during a 3-y and 10-month period before intervention with that during a 5-y and 2-month period after intervention. The modified Duke criteria were used to confirm the diagnosis of definite IE. Patients who fulfilled the criteria for definite IE were included in the analysis. Twenty-seven cases of IE were diagnosed before the implementation of routine consultation, and 76 cases after. The respective incidences of IE were 48.7 and 84.8 per 100,000 patients discharged from the hospital (p = 0.01). The relapse rate of IE within 6 months was significantly lower in patients who underwent routine consultation (22.2% vs 2.2%; p = 0.02). Routine consultation with an ID service for cases of positive blood culture, together with consecutive lecturing and local guidelines by ID specialists, resulted in improved detection of IE and a reduced relapse rate within 6 months. Timely consultation with an ID specialist in bacteraemia cases may be beneficial for improving the outcomes of patients in this setting.

Analysis of 246 cases of positive blood culture

目的 研究血液感染的微生物种类和病因.方法血液标本在BacT/Alert 3D240全自动培养仪中培养,采用BioMerieux API系统鉴定.结果 246例血培养阳性患者共分离出细菌247株,其中革兰阴性菌163株,占66.0%,革兰阳性菌75株,占30.4%,真菌9株,占3.6%,感染率最高的细菌是大肠埃希菌、甲型副伤寒菌、伤寒沙门菌及非金葡葡萄球菌.血液感染中内科疾病占82.5%、外科疾病占4.1%、其他占13.4%,41.5%的患者以发热为主要症状.77.6%的沙门菌分离自呼吸科和急诊科患者,大肠埃希菌主要见于肾内科、血液科及外科患者.非金葡葡萄球菌主要见于呼吸科和儿科患者.血培养涂片诊断的准确率为99.6%.标本在孵育12、24、36、48、72、96h的阳性率依次为24.4%、74.0%、87.4%、93.1%、97.2%和99.2%.结论快速血培养技术是血液感染病原学诊断必要手段。

Antimicrobial Therapy of Septicemic Patients in Intensive Care Units before and after Blood Culture Reporting

68 cases of positive blood cultures from 54 intensive care unit (ICU) patients were analyzed retrospectively. The empiric antimicrobial therapy was correct in 65% of the cases as judged by the species and sensitivity of the blood culture isolate. After initial Gram-staining results were known, coverage increased to 77%. After the final blood culture results the coverage was still only 81%. The bacteremia-related mortality was 13%. Although there was no significant difference between the occurrence of bacteremia-related and non-bacteremia-related deaths either in patients with correct or non-optimal empiric treatment, this study emphasizes the need for better utilization of culture reporting. A considerable part of the final blood culture results went unnoticed by the ICU physicians which stresses the importance of good communication between the laboratory and wards.

Fungemia with Saccharomycetaceae: Report of four Cases and Review of the Literature

Invasive fungal disease with Saccharomycetaceae is very rarely reported and these fungi are usually considered nonpathogenic. We report here 4 cases of positive blood cultures with fungal species belonging to this family. Severe neutropenia, permanent central venous catheter, ongoing antibacterial chemotherapy, and major abdominal surgery were identified as risk factors for fungemia in patients. In the immunocompromised host isolation of such species from sterile fluids cannot be ignored but should be considered an opportunistic infection and treated as such.

Nosocomial bacteremia caused by Bacillus species.

During a six year period, 11 cases of bacteremia caused by Bacillus spp. were observed corresponding to 1% of all bacteremic episodes in our hospital. Most patients had cancer as underlying disease. All cases of positive blood cultures were associated with a clinical syndrome compatible with sepsis including high fever. None of the subsequent deaths could be related to the bacteremia caused by Bacillus spp. Four of eight cases of Bacillus subtilis bacteremia were associated with the absorption of an oral preparation containing Bacillus subtilis spores, which was administered empirically in some units of the hospital to reduce what was considered to be tube-feeding related diarrhea.