Positive Blood Culture Results Research Articles

Assessing the clinical utility of abdominal computed tomography in sepsis patients with unknown origin: A retrospective cohort study.

Early identification of the sources of infection in emergency department (ED) patients of sepsis remains challenging. Computed tomography (CT) has the potential to identify sources of infection. This retrospective study aimed to investigate the role of CT in identifying sources of infection in patients with sepsis without obvious infection foci in the ED. A retrospective chart review was conducted on patients with fever and sepsis visiting the ED of Linkou Chang Gung Memorial Hospital between July 1, 2020 and June 30, 2021. Data on patient demographics, vital signs, clinical symptoms, underlying medical conditions, laboratory results, administered interventions, length of hospital stay, and mortality outcomes were collected and analyzed. Of 218 patients included in the study, 139 (63.8%) had positive CT findings. The most common sources of infection detected by CT included liver abscesses, acute pyelonephritis, and cholangitis. Laboratory results showed that patients with positive CT findings had higher white blood cell and absolute neutrophil counts and lower hemoglobin levels. Positive blood culture results were more common in patients with positive CT findings. Additionally, the length of hospital stay was longer in the group with positive CT findings. Multivariate logistic regression analysis revealed that hemoglobin levels and positive blood culture results independently predicted positive CT findings in patients with fever or sepsis without an obvious source of infection. In patients with sepsis with an undetermined infection focus, those presenting with leukocytosis, anemia, and elevated absolute neutrophil counts tended to have positive findings on abdominal CT scans. These patients had high rates of bacteremia and longer lengths of stay. Abdominal CT remains a valuable diagnostic tool for identifying infection sources in carefully selected patients with sepsis of undetermined infection origins.

Kidney damage relates to agonal bacteremia: a single-center retrospective study.

Agonal bacteremia, diagnosed with postmortem positive blood culture results, is considered a possible contributing factor to death. We hypothesized that some premortem organ damage, such as kidney damage, can enhance agonal bacteremia. We performed a postmortem blood and alveolar fluid culture study in 30 cadavers and evaluated the relationship between blood culture results and clinical parameters, including organ damage (brain, heart, lung, kidney, liver and gastrointestinal tract). A total of 23 cases (76.7%) were positive for blood culture; the number of cultured species was one in 12 cases, two in 7 cases, and three in 4 cases. The ratio of agonal bacteremia was significantly higher in patients with heart damage (100%, n=13) and those with kidney damage (end-stage kidney damage, acute kidney injury, obstructive kidney failure, or metastatic kidney tumours) (100%, n=13). The mean number of cultured species was 0.67±0.98 in heart or kidney damage, 1.40±0.55 in heart damage only, 1.40±0.55 in kidney damage only, and 2.00±0.93 in heart and kidney damage. As the number of damaged organs increased (0 organs, no heart/kidney damage; 1 organ, heart or kidney damage; and 2 organs, heart and kidney damage), the mean number of cultured species increased significantly (p for trend=0.001964). Premortem kidney damage relates to agonal bacteremia.

Performance evaluation of 4-day versus 5-day blood cultures using the BD BACTEC FX system

Background: Blood culture (BC) systems have evolved to increase sensitivity and reduce turnaround times. This study compared the performance of a 4-day versus a 5-day BC incubation period using the BD BACTEC™ FX (Becton, Dickinson and Company, USA). Methods: A total of 37,379 consecutive sets of BC were evaluated over a 3-month period in a 2,700-bed tertiary care hospital. Positive BC results were reviewed to assess time-to-positivity (TTP) and species identification of the isolates. The BCs were performed in pairs of vials, utilizing either BD BACTEC Plus Aerobic/F or Peds Plus/F with BD BACTEC Lytic Anaerobic media. Results: A total of 14,899 episodes, averaging 2.51 sets per episode, were analyzed. Of these, 1,398 (9.38%) were positive, yielding 1,465 isolates. TTP (hours) were < 12 in 48.87%, 12-24 in 31.40%, 24-48 in 13.38%, 48-72 in 3.28%, 72-96 in 1.43%, and >96 in 1.64%. The two most prevalent organisms, Escherichia coli and Klebsiella spp. were detected within 12 hours in 88.75% and 78.90%, respectively. The respective median TTP (T50) values for E. coli, Klebsiella spp., Enterococcus faecalis/E. faecium, and Staphylococcus aureus were 9.24, 9.60, 13.75, and 14.20. T50 values for these species were significantly shorter in anaerobic bottles than in aerobic bottles. Of 24 BCs with TTP > 96, only 4 containing anaerobic bacteria or molds were first detected after 96 hours. Conclusion: A 4-day incubation has demonstrated excellent sensitivity. However, a 5-day incubation may be beneficial for hospitals caring for patients at high risk for infections with slow-growing fungi or fastidious bacteria.

Metagenomic identification of pathogens and antimicrobial-resistant genes in bacterial positive blood cultures by nanopore sequencing.

Nanopore sequencing workflows have attracted increasing attention owing to their fast, real-time, and convenient portability. Positive blood culture samples were collected from patients with bacterial bloodstream infection and tested by nanopore sequencing. This study compared the sequencing results for pathogen taxonomic profiling and antimicrobial resistance genes to those of species identification and phenotypic drug susceptibility using traditional microbiology testing. A total of 37 bacterial positive blood culture results of strain genotyping by nanopore sequencing were consistent with those of mass spectrometry. Among them, one mixed infection of bacteria and fungi was identified using nanopore sequencing and confirmatory quantitative polymerase chain reaction. The amount of sequencing data was 21.89 ± 8.46 MB for species identification, and 1.0 MB microbial strain data enabled accurate determination. Data volumes greater than or equal to 94.6 MB nearly covered all the antimicrobial resistance genes of the bacteria in our study. In addition, the results of the antimicrobial resistance genes were compared with those of phenotypic drug susceptibility testing for Escherichia coli, Klebsiella pneumoniae, and Staphylococcus aureus. Therefore, the nanopore sequencing platform for rapid identification of causing pathogens and relevant antimicrobial resistance genes complementary to conventional blood culture outcomes may optimize antimicrobial stewardship management for patients with bacterial bloodstream infection.

Multi-institutional retrospective study investigating blood culture protocols and test positivity in 701 dogs.

(i) To determine the influence of specimen collection protocol (timing and specimen quantity), primary disease process, and pre-existing antimicrobial or immunosuppressive therapy on blood culture (BC) positivity and (ii) To determine agreement between urine culture and BC results. 701 client-owned dogs. Multi-institutional retrospective study (2019-2022). Mixed-effect logistic regression was used to determine whether primary disease process, the number of BCs, or the timing of specimen collection was associated with BC positivity. Prediction plots were generated. Associations between urine culture and BC results were performed using logistic regression. Dogs with a positive urine culture were more likely to have a positive BC (OR: 4.36, 95% CI: 2.12-8.97, p = 0.003). Dogs that had three BC specimens had the greatest odds of obtaining a positive BC result (adjusted predictive value: 0.44, 95% CI: 0.21-0.70), although this was not significant. Isolates from 38.5% of dogs with a positive BC had resistance to ≥3 antimicrobial classes. The timing between specimen collection had no significant association with BC positivity. Pre-existing antibiotic or immunosuppressive therapy had no significant association with BC positivity. Dogs with a positive urine culture were more likely to have a positive BC result.

Relationship between blood culture time to positivity, mortality rate, and severity of bacteremia

ObjectivesWe investigated the association between patient severity or mortality and time to positivity in bacteremia caused by various pathogens. Patients and methodsThis single-center retrospective study included patients with positive blood culture results. ResultsLonger time to positivity was associated with 30-day mortality for Staphylococcus aureus (221 cases, time to positivity: 17.4 h in the 30-day mortality group vs. 14.1 h in the survival group). Age, chronic kidney disease, cerebrovascular disease, hypertensive drug use, consciousness disorder, and minimal systolic blood pressure were significant predictors of 30-day mortality. For S. aureus, mortality within 30 days was significantly higher when time to positivity was > 24 h (p = 0.04). The time to positivity of Streptococcus pneumoniae, α, β-hemolytic Streptococcus, Enterococcus sp., Enterobacteriaceae, glucose-nonfermenting Gram-negative rods, Candida sp., and anaerobe was not significantly associated with 30-day mortality. ConclusionsAmong various pathogens, time to positivity > 24 h was associated with 30-day mortality for S. aureus.

State-of-the-Art Review: Persistent Enterococcal Bacteremia.

Persistent enterococcal bacteremia is a commonly encountered and morbid syndrome without a strong evidence base for optimal management practices. Here we highlight reports on the epidemiology of enterococcal bacteremia to better describe and define persistent enterococcal bacteremia, discuss factors specific to Enterococcus species that may contribute to persistent infections, and describe a measured approach to diagnostic and therapeutic strategies for patients with these frequently complicated infections. The diagnosis of persistent enterococcal bacteremia is typically clinically evident in the setting of repeatedly positive blood culture results; instead, the challenge is to determine in an accurate, cost-effective, and minimally invasive manner whether any underlying nidus of infection (eg, endocarditis or undrained abscess) is present and contributing to the persistent bacteremia. Clinical outcomes for patients with persistent enterococcal bacteremia remain suboptimal. Beyond addressing host immune status if relevant and pursuing source control for all patients, management decisions primarily involve the selection of the proper antimicrobial agent(s). Options for antimicrobial therapy are often limited in the setting of intrinsic and acquired antimicrobial resistance among enterococcal clinical isolates. The synergistic benefit of combination antimicrobial therapy has been demonstrated for enterococcal endocarditis, but it is not clear at present whether a similar approach will provide any clinical benefit to some or all patients with persistent enterococcal bacteremia.

Bacterial profile and antimicrobial sensitivity pattern of blood specimen isolates in patients with bacteremia in the intensive care unit at Dr. Soetomo Hospital

Link of Video Abstract: https://youtu.be/2wcFE-82J2s Background: Critically ill patients in intensive care have a higher predisposition to acquire bacterial infections in the bloodstream. Research on bacterial profiles and blood culture sensitivity patterns in bacteremia patients can provide information for the basis of diagnosis, approaches, and treatment strategies in patients. To better understand the microbial profile and pattern of antimicrobial sensitivity of blood specimen isolate among non-COVID patients in the intensive care unit, we evaluated data from medical records that included blood cultures for all participants in the intensive care unit from January 2019 to April 2022. Method: A retrospective observational study with a cross-sectional approach was conducted in the Clinical Microbiology Department and Medical Record Unit at Dr. Soetomo Hospital. Data on surgical and non-surgical noncovid patients with bacteremia in intensive care unit patients was collected from January 2019 to April 2022. The Sample was taken with a consecutive sampling technique. Results: There were 140 isolates with positive blood culture results. The most common bacteria are coagulase-negative Staphylococcus 22 (15.7%), Acinetobacter baumanii 25 (17.9%), and Pseudomonas aeruginosa 13 (4.9%) in surgical and non-surgical patients. Sensitivity to Gram-positive bacteria in surgical and non-surgical patients before the pandemic linezolid 75% and vancomycin 58,3%. During pandemic linezolid at 76.9% and vancomycin at 69.2%. Sensitivity of Gram-negative bacteria in surgical patients before the pandemic was imipenem 57.1%, meropenem 57.1%, and amikacin 47.6%. During the pandemic, amikacin 73.5%, meropenem 55.1%, and imipenem 53.1%. Non-surgical patients before the pandemic gram negative sensitivity to meropenem was 100%, ceftazidime 66.7%. During the pandemic, amikacin 59.1%, and cotrimoxazole 45.5%. Conclusion: There was no difference in the surgical and non-surgical bacterial profiles before the pandemic and during the pandemic.

Machine learning-derived blood culture classification with both predictive and prognostic values in the intensive care unit: A retrospective cohort study

ObjectivesDiagnosis and management of intensive care unit (ICU)-acquired bloodstream infections are often based on positive blood culture results. This retrospective cohort study aimed to develop a classification model using data-driven characterisation to optimise the management of intensive care patients with blood cultures. Setting, methodology/designAn unsupervised clustering model was developed based on the clinical characteristics of patients with blood cultures in the Medical Information Mart for Intensive Care (MIMIC)-IV database (n = 2451). It was tested using the data from the MIMIC-III database (n = 2047). Main outcome measuresThe prognosis, blood culture outcomes, antimicrobial interventions, and trajectories of infection indicators were compared between clusters. ResultsFour clusters were identified using machine learning-based k-means clustering based on data obtained 48 h before the first blood culture sampling. Cluster γ was associated with the highest 28-day mortality rate, followed by clusters α, δ, and β. Cluster γ had a higher fungal isolation rate than cluster β (P < 0.05). Cluster δ was associated with a higher isolation rate of Gram-negative organisms and fungi (P < 0.05). Patients in clusters γ and δ underwent more femoral site vein catheter placements than those in cluster β (P < 0.001, all). Patients with a duration of antibiotics treatment of 4, 6, and 7 days in clusters α, δ, and γ, respectively, had the lowest 28-day mortality rate. ConclusionsMachine learning identified four clusters of intensive care patients with blood cultures, which yielded different prognoses, blood culture outcomes, and optimal duration of antibiotic treatment. Such data-driven blood culture classifications suggest further investigation should be undertaken to optimise treatment and improve care. Implications for clinical practiceIntensive care unit-acquired bloodstream infections are heterogeneous. Meaningful classifications associated with outcomes should be described. Using machine learning and cluster analysis could help in understanding heterogeneity. Data-driven blood culture classification could identify distinct physiological states and prognoses before deciding on blood culture sampling, optimise treatment, and improve care.

Association of Positive Bacterial Cultures Obtained from the Throat, Anus, Ear, Bronchi and Blood in Very-Low-Birth-Weight Premature Infants with Severe Retinopathy of Prematurity-Own Observations.

The causative factors responsible for the development of Retinopathy of Prematurity (ROP) are still unexplored. Therefore, one of the most important factors can be perinatal inflammation. This retrospective study included 114 premature infants (228 eyes) meeting a birth criteria of ≤ 32 weeks gestational age (GA) and a birth weight (BW) ≤ 1710. Examined Group (EG) n = 51 of BW 852.7 ± 255.7; GA 26.3 ± 2.0 with severe ROP treated by diode laser or anti-VEGF intravitreal injection. Control Group (CG) n = 63 of BW 1313.9 ± 284.5; GA 28.8 ± 1.6 without ROP. Microbiological bacterial and fungal cultures of the ear, anus, bronchial throat and blood were taken. Medical data and laboratory tests in correlation to 3 ROP and A-ROP were analysed. Positive bacterial tests dominated in EG, 47% vs. CG, 23%. Significant correlations between positive cultures obtained from natural cavities: anus (p < 0.001), throat (p = 0.002), as well as from blood (p = 0.001) and severe ROP which requires diode laser and anti-VEGF treatment were noted. Significant inflammation markers which correlate with the development of severe ROP are Klebsiella pneumoniae (KP) (p = 0.002) and Coagulase-negative Staphylococci (CoNS) (p < 0.001). CoNS, p < 0.001; KP, p = 0.002; the remaining Maltophilia stenotrophomonas (MS); Staphylococcus aureus (SA), p = 0.005; and Enterobacter cloacae (EC), p = 0.02 were the most frequent bacteria in severe ROP. High levels of white blood cells (WBC), C-reactive protein (CRP), lymphocytes (LYM) and low thrombocytes (PLT) correlated sequentially with (Odds Ratio, OR) CoNS (2.3); MS (5.9); KP (3.1); and all positive cultures (APC) (9.5). An important correlation between the BPD-EC (4.3); intrauterine inflammation-KP (3.4); PDA-EC (3.9); and asphyxia-CoNS (3.0) was identified. It cannot be ruled out that positive microbiological results of blood, anal and pharyngeal cultures may become prognostic markers for the early development of ROP, which would enable early initiation of ophthalmological treatment in premature infants from the VLBW group.

Early Onset Sepsis in Neonates

Background Neonatal sepsis is one of the most important causes of neonatal morbidity and mortality. The most common risk factors associated with early onset sepsis (EOS) are preterm delivery, low birth weight, premature rupture of membranes, maternal urinary tract infection, Clinical manifestations of neonatal sepsis are nonspecific. These include temperature instability, respiratory distress, apnea, poor feeding, lethargy, irritability, convulsions, hypotonia, poor perfusion and abdominal distension Aim and objectives To describe epidemiology, demographic and incidence of early onset sepsis in neonate with risk factors at NICUS of Ain Shams University Hospitals. Subjects and methods This study is prospective cohort study, was carried out on 80 neonates with one or more maternal risk factors associated with EOS. Neonates will be completely evaluated and subsequently discriminated over the period of 1st 72hours of life in Neonates with risk factors for early-onset sepsis. diagnosis of EOS will be established based on the presence of any clinical evidence suggestive of sepsis, quantitatie C-reactive protein (CRP) levels ≥6 mg/dL, Rodwell’s hematological scores ≥3 and/or Tollner’s scores ≥ 10 with or without positive blood culture results, within the 1st 72 hours postnatal age. Result Among the studied maternal risk factors of neonatal sepsis in our study, 73.8% had PROM being the most common maternal risk factor for early neonatal sepsis followed by ceserian mode (C.S) of delivery 66.3%, and 26.2% had Chorioamintis. The gestational age was distributed as 36.76±3.01 with minimum 30 and maximum 42 weeks, of Ballard score 37.05±2.88 and weight was 2.87±0.82. 58.8% were females and 41.3% were males. Also, 42.5% of the studied group was preterm. 42.5% of studied group was diagnosed with sepsis. Conclusion Early diagnosis is important for early intervention and treatment. This diagnosis in neonates is usually based on clinical and laboratory findings.

Lymphocyte to C-Reactive Protein Ratio as an Early Biomarker to Distinguish Sepsis from Pneumonia in Neonates.

Neonatal sepsis is an acute and severe disease that seriously threatens the life and health of newborns. Neonates with pneumonia may also have unrecognized neonatal sepsis. Early diagnosis of neonatal sepsis is beneficial for early treatment. This study aimed to evaluate the clinical significance of the lymphocyte-to-C-reactive protein ratio (LCR) as an early biomarker to distinguish sepsis from pneumonia. This retrospective study enrolled 1635 neonates with pneumonia from February 2016 to March 2022. Among them, 182 cases were diagnosed with sepsis based on the positive blood culture results. Clinical and laboratory data were extracted from the electronic medical records. LCR was calculated as the ratio of the total lymphocyte count (×109 cells/L) to the C-reactive protein level (mg/L). Binary logistic regression analysis was conducted to evaluate the clinical significance of LCR as an early biomarker in distinguishing sepsis from pneumonia. Receiver operating characteristic (ROC) analysis was performed to assess the diagnostic value of LPCR in sepsis cases. All statistical analyses were conducted using Statistical Product and Service Solutions, version 24.0. The neonates with pneumonia combined with sepsis had a lower LCR than that of the neonates with pneumonia. Further analysis showed that the prevalence of neonatal pneumonia combined with sepsis was significantly higher in the low-LCR group than in the high-LCR group (20.7% vs 5.5%, P < 001). Binary logistic regression revealed that LCR was an independent risk factor for identifying pneumonia combined with sepsis. The ROC curve analysis revealed that LCR had better power than the lymphocyte count and CRP level individually in diagnosing neonatal pneumonia combined with sepsis (0.72 vs 0.65 vs 0.66, P < 0.001), with 62% sensitivity and 72% specificity. LCR can be a potential early biomarker in distinguishing neonates with sepsis from those with pneumonia.

Clinical Characteristics and Outcomes of Patients With Cutibacterium acnes Endocarditis

It is suggested that patients with Cutibacterium acnes endocarditis often present without fever or abnormal inflammatory markers. However, no study has yet confirmed this statement. To assess the clinical characteristics and outcomes of patients with C acnes endocarditis. A case series of 105 patients presenting to 7 hospitals in the Netherlands and France (4 university hospitals and 3 teaching hospitals) with definite endocarditis according to the modified Duke criteria between January 1, 2010, and December 31, 2020, was performed. Clinical characteristics and outcomes were retrieved from medical records. Cases were identified by blood or valve and prosthesis cultures positive for C acnes, retrieved from the medical microbiology databases. Infected pacemaker or internal cardioverter defibrillator lead cases were excluded. Statistical analysis was performed in November 2022. Main outcomes included symptoms at presentation, presence of prosthetic valve endocarditis, laboratory test results at presentation, time to positive results of blood cultures, 30-day and 1-year mortality rates, type of treatment (conservative or surgical), and endocarditis relapse rates. A total of 105 patients (mean [SD] age, 61.1 [13.9] years; 96 men [91.4%]; 93 patients [88.6%] with prosthetic valve endocarditis) were identified and included. Seventy patients (66.7%) did not experience fever prior to hospital admission, nor was it present at hospitalization. The median C-reactive protein level was 3.6 mg/dL (IQR, 1.2-7.5 mg/dL), and the median leukocyte count was 10.0 × 103/µL (IQR, 8.2-12.2 × 103/µL). The median time to positive blood culture results was 7 days (IQR, 6-9 days). Surgery or reoperation was indicated for 88 patients and performed for 80 patients. Not performing the indicated surgical procedure was associated with high mortality rates. Seventeen patients were treated conservatively, in accordance with the European Society of Cardiology guideline; these patients showed relatively high rates of endocarditis recurrence (5 of 17 [29.4%]). This case series suggests that C acnes endocarditis was seen predominantly among male patients with prosthetic heart valves. Diagnosing C acnes endocarditis is difficult due to its atypical presentation, with frequent absence of fever and inflammatory markers. The prolonged time to positivity of blood culture results further delays the diagnostic process. Not performing a surgical procedure when indicated seems to be associated with higher mortality rates. For prosthetic valve endocarditis with small vegetations, there should be a low threshold for surgery because this group seems prone to endocarditis recurrence.

Platelet-to-lymphocyte ratio in early onset neonatal

Objectives Neonatal sepsis is a major contributor to morbidity and mortality worldwide. Although blood culture is the gold standard of sepsis diagnosis, it often lacks sensitivity and diagnostic speed. Platelet-to-lymphocyte ratio (PLR) is a widely available, effective, simple, and affordable marker that can predict early onset neonatal sepsis (EONS).&#x0D; Objective To assess the correlation between PLR and EONS as well as the diagnostic value of PLR for predicting EONS.&#x0D; Methods This study included all inpatient neonates with suspected early-onset neonatal sepsis at Dr. R. D. Kandou Hospital, Manado, North Sulawesi, Indonesia. Neonates were categorized into sepsis (confirmed by positive blood culture results) and non-sepsis (negative blood culture results) groups. Bivariate analysis, including the chi-square test for categorical data and independent t-test for numerical data, was performed to identify any significant associations between the platelet-to-lymphocyte ratio (PLR) and EONS. The sensitivity, specificity, and area under the receiver operating characteristic (ROC) curve were calculated to determine the optimal PLR cut-off point to predict EONS.&#x0D; Results In this study, we investigated the relationship between PLR and early-onset neonatal sepsis (EONS) in 176 neonates with suspected EONS. Blood cultures confirmed sepsis in 84 neonates (47.7%), with Klebsiella pneumoniae being the most common causative organism. We found a significant positive correlation between PLR and EONS (p&lt;0.001), and a PLR cut-off point of 61.806 was identified to predict EONS with high sensitivity (90.2%) and specificity (85.7%)&#x0D; Conclusion Our study demonstrates a strong positive correlation between PLR and EONS, and a PLR cut-off point of 61.806 can be used as a valuable marker for predicting EONS in neonates with suspected sepsis. These findings could aid in the early identification and treatment of neonates with sepsis, ultimately improving patient outcomes.

Clinical characteristics and laboratory test in full-term neonates with sepsis in Vietnam National Children’s Hospital (Northern Vietnam)

Background. Sepsis is a life-threatening condition in response to an infectious agent, causing damage to organs. Sepsis causes serious consequences in neonates due to high rates of mortality, sequelae, and disability. The Southeast Asian country of Vietnam features on of the highest infectious disease rates in the world (high rates of infection, disability and mortality), as well as being a middle-income country with a stratified health care system. The aim of this study was to evaluate the clinical and laboratory characteristics of patients at the Vietnam National Childrens Hospital. Materials and methods. This descriptive study was conducted with 85 full-term infants with sepsis admitted to Vietnam National Childrens Hospital in the period from December 2019 to April 2021. Patients had at least 2 clinical symptoms and 2 laboratory signs according to the criteria for assessment of neonatal sepsis (European Medicines Agency in 2010) along with positive blood culture results. Results. Common clinical symptoms in neonates with sepsis included poor feeding (89.4%), respiratory failure (69.4%), fever (51.8%), tachycardia (52.8%), and shock (25%). Anemic patients accounted for many (72.9%). Patients with increased white blood counts accounted for 41.2%. Newborns with a low white blood count accounted for 15.4%. Patients with thrombocytopenia were 49.6%. Most patients had elevated CRP (88.3%). The mean value of nCD64 was 10167.16136.9 molecules bound/cell. mHLA-DR was 9898.414173.9 molecules bound/cell. The Sepsis Index was 274.6287.5. Conclusions. We recorded differences in clinical characteristics and laboratory tests in full-term neonates with sepsis at National Childrens Hospital, of which, nCD64, mHLA-DR, and Sepsis Index should be further investigated and referred to as prospective routine biomarkers in diagnosis of neonatal sepsis.

Factors Associated with Antimicrobial Use at the End-Of-Life Among Hospitalized Cancer Patients.

Background: Antimicrobials are frequently administered at end-of-life (EOL) and their non-beneficial use may subject patients to unnecessary harms. Studies analyzing factors for antimicrobial prescribing in solid tumor cancer patients at the EOL are lacking. Thus, we aimed to identify factors and patterns associated with antimicrobial use in hospitalized adults with cancer at EOL. Methods: We used a retrospective cohort design to review electronic medical records of terminal hospitalized patients ≥18 years with solid tumors admitted to non-intensive care units in a metropolitan comprehensive cancer center during 2019 and assessed antimicrobial use in the last 7 days of life. Results: Among 633 cancer patients, 59% (n = 376) received antimicrobials (AM+) within the last 7 days of life. AM + patients were older (P = .012), mostly of male gender (55%), and non-Hispanic ethnicity (87%). AM + patients were significantly more likely to have a foreign device, suspected signs of infection, neutropenia, positive blood culture result, documented advance directive; receive laboratory or radiologic testing, and a palliative care or infectious disease consultation (all P < .05). No statistically significant differences were observed in the presence of documented goals of care discussions, or EOL discussions/EOL care orders. Conclusion: Antimicrobial use at the EOL is common in solid tumor cancer patients at the EOL and is associated with increased utilization of invasive interventions. There is an opportunity for infectious disease specialists to build primary palliative care skills and partner with antimicrobial stewardship programs to better advise patients, decision makers, and primary teams on the use of antimicrobials at the EOL.

Evaluation of the influence of the analytical characteristics of the microbiological blood study in bacteremia in a multidisciplinary hospital.

The culture method continues to be the "gold" standard for microbiological diagnosis of bloodstream infections. This is primarily due to the fact that the definition of the etiology of a generalized infectious process determines the etiotropic antibiotic therapy. To do this, it is necessary to conduct periodic microbiological monitoring of the prevailing microflora. To do this, in the present study, a retrospective analysis of the results of a microbiological blood test for sterility was performed in case of suspected bloodstream infections in a multidisciplinary hospital to assess the influence of analytical stage factors on the laboratory data obtained. Automatic hematological cultivators were used, identification was carried out based on the biochemical characteristics of microorganisms, as well as using time-of-flight mass spectrometry with matrix-activated laser desorption / ionization (MALDI-TOF MS). More than 10,000 research results were analyzed, the average microflora seeding rate was 15.1%. The analysis of the isolated microflora was carried out in 2 groups of positive results: at the beginning, the data obtained in the presence of growth in two vials at once were evaluated, then the positive results of blood cultures obtained in any one vial from a pair were studied. The predominance of gram-positive flora in the structure of microorganisms isolated from whole blood was revealed, the influence of cultivation conditions and the composition of thenutrient medium on the isolated flora was not found, however, a number of microorganisms, due to the specific characteristics of metabolism, were characterized by growth under strictly defined cultivation conditions. The presented study actualizes the need for constant microbiological monitoring in order to determine the prevailing hospital microflora, which can contribute to a timely response in order to limit the spread of highly virulent, aggressive, resistant strains of microorganisms leading to the development of generalized bloodstream infections.

181. Impact of Rapid Diagnostic Technology on Patients with Candidemia

Abstract Background Candida spp. are the fourth most common cause of bloodstream infections (BSI) in the United States and have an associated mortality rate of 19-40.5%. Mortality rates are further impacted by delay in time to adequate antifungal therapy, historically due to delayed time to identification on culture. The utilization of rapid diagnostic technology (RDT) has been effective in timely identification of bacterial pathogens causing BSI, but RDT for fungal organisms has demonstrated mixed results. At AdventHealth Central Florida Division South (CFD-S), pharmacists provide 24-hour coverage for real-time notification of all positive blood culture results. The objective of this study was to evaluate the clinical impact of the GenMark ePlex Blood Culture Identification Panels (BCID) fungal pathogen (FP) panel paired with 24/7, pharmacist-driven response in patients with candidemia. Methods This multi-site, pre/post, retrospective chart review included adult patients admitted to CFD-S with at least one positive blood culture with Candida spp. from June 2019 through May 2020 (pre-RDT), and August 2020 through July 2021 (post-RDT). Patients receiving systemic antifungal prophylaxis, with known candidiasis at time of index RDT result, or who discharged prior to culture positivity were excluded. The primary outcome was time to effective antifungal therapy in patients with candidemia. Results A total of 200 patients were included in the study (100 pre-RDT and 100 post-RDT). Overall, patients had a median age of 61 years and 50% were male. Patient characteristics are summarized in Table 1; median APACHEII score differed by three points (13.5 vs. 16.5). Time to effective therapy was similar between groups (39.8 vs. 38.5 hours, p=0.217). There was no difference in secondary outcomes (Table 2) other than ICU length of stay (2.5 vs. 6.0 days, p=0.033) and all-cause in-hospital mortality (15% vs. 30%, p=0.011). Conclusion Pharmacist-driven, real-time response to RDT did not significantly impact time to effective antifungal therapy in patients with candidemia. Higher rate of in-hospital mortality was likely a reflection of increased severity of illness in the post-RDT group. Disclosures Amy L. Carr, PharmD, BCIDP, Shionogi: Advisory Board.

Double Blood Culture Policy Is More Effective Than Single In Neonatal Intensive Units

Aim: Blood culture (BC) sampling and antibiotic administration are common practices in Neonatal Intensive Care Units(NICUs). However, false positive BC results might affect clinician’s decision and lead to inappropriate antibiotic treatments. The aim of this study was to investigate the effect of double culture on clinical application.&#x0D; Material and Methods: The study was conducted retrospectively. The blood culture results of the patients admitted to the NICU between 2016-2019 were analyzed. Considering sepsis before 2017, we took only one sample from the patient. After this period, we started to take double blood cultures. Time frames of BCs were investigated to two groups as early and late onset sepsis fistly, and then subgroups as; a-) Group 1, BCs in the first 24 hours, b-)Group 2, between 24 to 72 hours, and c-)Group 3, after 72 hours. &#x0D; Results: Total of 1747 BC samples were taken in study. Majority of BCs were in Group 3(62%). Male/female ratio was 1.3:1. Staphylococcus Epidermidis(S. Epi) was major source for the contamination. But, by taking dBCs, we were able to eliminate most S.Epi contamination in Group 2 (11%vs.3%) and in Group 3(41%to14%). We were able to identify some resistant Gr(-) pathogens in one arm although the other arm was negative, by taking dBC.&#x0D; Conclusions: Our study indicates that dBC policy in NICUs could help to clinicians for judicious decision in antibiotic use and decrease unnecessary antibiotic exposure of infants. Also it could be enable to detect some highly pathogen microorganism easily.&#x0D; Key words: Newborn, Septicemia, Blood culture, Coagulase Negative Staphylococci, contamination

Higher nursing care level is associated with higher incidence of blood culture contamination in the emergency department: A case-control study.

Blood culture is critical in treating infectious diseases. This leads to unnecessary intervention, inappropriate antibiotic use, and excess cost. Few studies have tackled patient factors that could possibly affect contamination rates. This study aimed to explore the association between patients' nursing care levels and blood culture contamination. This is a single-centered, retrospective, case-control study of adult patients whose blood culture specimens were taken in the emergency department between April 2018 and July 2019. The study was conducted in an acute care community hospital in Japan. The case group included patients with false-positive blood culture results with contamination; the control group included patients with true-positive or true-negative blood culture results without contamination. We randomly selected two control patients per case. Patients' age, gender, nursing care level, ambulance use, housing status, Glasgow Coma Scale, hospital arrival time, and puncture sites were obtained from the patients' medical charts. Of the 5130 patients, 686 patients got positive blood culture results. Of the 686 patients, 35 patients were included in the case group, and 70 were randomly selected from the noncontaminated group and included in the control. In multivariate analysis, patients with contaminated blood cultures had a higher nursing care level (adjusted odds ratio: 8.50; 95% confidence interval: 1.65-43.7; p=0.01). A higher nursing care level is associated with a higher incidence of blood culture contamination in the emergency department. Careful and appropriate procedures are required for patients with a higher nursing care level.