Abstract: The diagnosis of bacteremia relies on the isolation and identification of the bacteria from blood cultures, whether they are community-acquired or nosocomial in origin. However, studies have shown that, in the Philippines alone, physicians have been found to underutilize these laboratory examinations. Objectives: The goal of this study was to determine the influence of positive blood cultures and sensitivity test results on the antibiotic choices of pediatrics residents at the University of the Philippines – Philippine General Hospital (UP-PGH). Methods: A chart review of patients with positive blood cultures, who were 18 years old and below, and admitted initially at the UP-PGH Pediatric Emergency Room (UP-PGH PER) from August 1, 2004 to July 31, 2005 was performed. Excluded were patients who died before the release of the blood culture reports or discharged per request or against medical advice, post-operative patients, patients with presumed polymicrobial sepsis, and patients with contaminated blood cultures. Results: One hundred twenty two (122) patients with positive blood cultures were included: 87 or 71.3% of the isolates were community-acquired, the most common pathogens of which were gram-positive bacteria, Staphylococcus epidermidis (18.3%), followed by gram-negative Salmonella (11.5%). Among the patients diagnosed with bacteremia at the UP-PGH PER, Staph. epidermidis was also the most common pathogen; with 34% of all isolates acquired nosocomially. Other significant isolates included Pseudomonas putida, Pseudomonas aeruginosa, and Klebsiella sp. Prior to the release of the blood culture and sensitivity results, 45 of the 122 patients were already discharged. Therapy at the time of discharge was of questionable efficacy, accounting to 73.3%. Of the 77 patients discharged after the release of blood culture and sensitivity (CS) results, only 21(27%) of the antibiotic therapies were modified, and 56 (73%) were not modified at all. It is imperative to know, however, that 50% of the antibiotic therapies were modified a day after the corresponding blood culture and sensitivity (CS) results came out for patients who presented with nosocomial infection. Conclusion In general, blood culture and sensitivity test results have a limited effect on the antibiotic choices of pediatric residents at the UP-PGH (University of the Philippines – Philippine General Hospital).
Bacteremia ; Blood Culture ; Anti-Bacterial Agents

OBJECTIVENeonatal sepsis is a common disease and the sepsis-related mortality rate is still high. Until now, there has no ideal diagnostic marker to early identify neonatal sepsis. Expression of neutrophil adhesion molecule CD(11b) was showed as the earlier reaction to the infection/inflammation, and may be applied as an early diagnostic marker for sepsis. This study was to investigate this antigen for early diagnosis of neonatal sepsis related to bacterial infection.

METHODSAccording to clinical symptoms, signs and four indices (WBC, PLT, plasma CRP and ratio of I/T), fifty-one neonates with established or suspected sepsis were allocated retrospectively into two groups of sepsis [n = 23, gestational age of (38.3 +/- 2.4) weeks, postnatal age of (12.7 +/- 8.8) days, body weight: (3.1 +/- 0.8) kg] and suspected sepsis [n = 28, gestational age of (38.8 +/- 1.6) weeks, postnatal age of (11.7 +/- 7.3) days, body weight: (3.3 +/- 0.6) kg]. Fifteen healthy neonates were served as controls [gestational age: (38.5 +/- 1.4) weeks, postnatal age: (8.2 +/- 5.5) days, body weight: (3.3 +/- 0.3) kg]. CD(11b) was quantified with the whole blood flow cytometry and direct immunofluorescence technique.

RESULTSThe expressions of neutrophil CD(11b) in neonates with sepsis and suspected sepsis were (320 +/- 189) MFI and (456 +/- 213) MFI, respectively, which was lower than that of controls [(1,090 +/- 338) MFI, t = -9.01 and -7.56, respectively; P < 0.001]. The expression of CD(11b) was lower in neonates with sepsis than that with suspected sepsis (t = -2.39, P < 0.05). The expression of CD(11b) in neonates with CRP >or= 30 mg/L was (211 +/- 164) MFI, which was lower than those with CRP < 30 mg/L [(505 +/- 265) MFI, t = 2.64, P < 0.05]. The detection of CD(11b) (blood culture test (17.6%, chi(m)(2) = 31.2, P < 0.05).

CONCLUSIONThe expression of CD(11b) in neonatal sepsis presented with a down-regulation and, the decreased CD(11b) expression might be related to the severity of infections. For the neonatal sepsis the serial measurements of neutrophil CD(11b) expression with the whole blood flow cytometry seemed feasible and reliable in the early diagnosis, evaluation of infection severity and observation of therapy reactions.

Bacteremia ; blood ; diagnosis ; Biomarkers ; blood ; CD11b Antigen ; blood ; Female ; Flow Cytometry ; Humans ; Immunohistochemistry ; Infant, Newborn ; Male

BACKGROUND: Although many laboratories use automated blood culture systems, adequate skin disinfection and optimal blood volume are still critical for successful culture. The authors undertook a nationwide survey to understand the current situation and problems of blood culture in Korea. METHODS: A survey of blood culture was performed in March and April 2010, including disinfectants, blood collection intervals, and recommended blood volumes. The laboratory physicians described the storage condition of culture bottles before delivery to the equipment. For quality control, the positive rate and skin contamination rate were studied. RESULTS: Replies to the survey were collected from 74 Korean hospitals. Povidone iodine after either isopropyl alcohol or ethanol application was the most common means of skin disinfection. Sampling of a second set of cultures was performed simultaneously in 38% of hospitals and after a 30-min interval in 50%. The recommended blood volume was 10 mL in most cases (69%), but was 20 mL in 24% of cases. The bottles were stored at 37degrees C before installation in 23% of cases and at room temperature in 16%, whereas 57% were placed directly in the equipment during the night shift. Positive rates ranged 8-10% in 32% of hospitals, 5-8% in 23%, and <5% in 12%. Skin contamination rates were 2-3% in 32% of hospitals, 1-2% in 27%, and >3% in 13%. CONCLUSION: Skin disinfection methods were rather variable. Sampling interval, blood volume, and storage of bottles should be standardized. More than 10% of the hospitals require quality improvement in terms of positive rate and skin contamination rates.
2-Propanol ; Bacteremia ; Blood Volume ; Disinfectants ; Disinfection ; Ethanol ; Povidone-Iodine ; Quality Control ; Quality Improvement ; Sepsis ; Skin

Blood stream infection (BSI),a blood-borne disease caused by microorganisms such as bacteria,fungi,and viruses,can lead to bacteremia,sepsis,and infectious shock,posing a serious threat to human life and health.Identifying the pathogen is central to the precise treatment of BSI.Traditional blood culture is the gold standard for pathogen identification,while it has limitations in clinical practice due to the long time consumption,production of false negative results,etc.Nanopore sequencing,as a new generation of sequencing technology,can rapidly detect pathogens,drug resistance genes,and virulence genes for the optimization of clinical treatment.This paper reviews the current status of nanopore sequencing technology in the diagnosis of BSI.
Humans ; Nanopore Sequencing ; Sepsis/diagnosis* ; Bacteremia/microbiology* ; Bacteria ; Blood Culture/methods*

To study the pathogens incidences in cord blood and the efficiency of different detective methods, 60 samples were drawn and reserved from collected and processed cord blood, respectively. The BACTEC 9050 system, improved Martin/thioglycollate broth (22 degrees C) and thioglycollate broth (35 degrees C) were employed to detected bacteria (including fungus) at the same time. Two hundred and six cord blood serum samples were used to detect the HBV DNA and HCV RNA by molecular biology technique, HBsAg, Anti-HBC, Anti-HCV, Anti-HCMV-IgM, HTLV-1, HTLV-2, HIV-1 and HIV-2 by ELISA and RBC agglutination test were used to detect the TPHA. Results showed that using BACTEC 9050 system, the incidence of bacteria and fungus was 3.33% and 0% respectively in collected cord blood; in processed cord blood, the rates increased to 6.67% and 1.67%, respectively. The sensitivity of BACTEC 9050 was higher than that of Martin/thioglycollate broth (22 degrees C/35 degrees C) culture. In 206 serum samples, the positive rate of HBV DNA was 5.8%, HCV RNA was 2.4%, HBsAg was 2.4%, HCMV-IgM was 1.89%, HCV was 2.4% and Anti-HBC was 29.4%. In those samples that Anti-HBC was positive, the positive rate of HBV DNA was 6.7%. It was concluded that the incidences of microbiological contamination in cord blood were high. The routine culture system would lead to false negative results of obligate anaerobes. It was necessary to replace the current culture system with improved system, such as BACTEC 9050 system. The molecular biology technique would make up for the default of ELISA.
Bacteremia ; epidemiology ; Blood Specimen Collection ; Fetal Blood ; microbiology ; virology ; Fungemia ; epidemiology ; Humans ; Polymerase Chain Reaction ; Probability ; Viremia ; epidemiology

BACKGROUNDRapid detection of bacteremia is important for critically ill patients. Procalcitonin (PCT) has emerged as a marker of sepsis, but its characterization for predicting bacteremia is still unclear. This study aimed to investigate the role of change of PCT within 6 to 12 hours after new fever in predicting bacteremia.

METHODSAn observational study was conducted in the ICU of our hospital from January 2009 to March 2010. Adult patients with new fever were included and grouped as bacteremia and non bacteremia group. Serum PCT concentration was measured at admission and within 6 to 12 hours after new fever (designated PCT0 and PCT1). Other results of laboratory tests and therapeutic interventions were recorded. Multivariate Logistic regression analysis was used to identify the risk factors of bacteremia. The area under the ROC curve (AUC) was constructed to evaluate the discriminative power of variables to predict bacteremia.

RESULTSTotally 106 patients were enrolled, 60 of whom had bacteremia and 46 did not have bacteremia,. The acute physiology and chronic health evaluation II (APACHE II) and sequential organ failure assessment (SOFA) scores were 13.1 ± 7.8 and 5.0 ± 2.2 at admission, respectively. There was no significant difference in PCT0 between the bacteremia group and nonbacteremia group; 1.27 µg/L (range, 0.10 - 33.3) vs. 0.98 µg/L (range, 0.08 - 25.7), (P = 0.157). However, the PCT1 and the rate of change of PCT were significantly higher in bacteremia group; PCT1 was 6.73 µg/L (1.13 - 120.10) vs. 1.17 µg/L (0.10 - 12.10) (P = 0.001), and the rate of change was 5.62 times (1.05 - 120.6) vs. 0.07 times (-0.03 - 0.18) (P < 0.001). The area under the ROC curve (AUC; 95% confidence interval) of the rate of change of PCT was better for predicting bacteremia than that of PCT1; 0.864 (range, 0.801 - 0.927) vs. 0.715 (range, 0.628 - 0.801), (P < 0.05). The AUCs of PCT0 and other parameters (such as WBC count, granulocyte percentage and temperature) were not significantly different (all P > 0.05). The best cut-off value for the rate of change was 3.54 times, with a sensitivity of 88.5% and a specificity of 98.0%. It was also an independent predictor of bacteremia (odds ratio 29.7, P < 0.0001) and wasn't correlated with the presence or absence of co-infection, neutropenia or immunodeficiency (P > 0.05).

CONCLUSIONThe rate of change of PCT is useful for early detection of bacteremia during new fever and superior to the PCT absolute value and other parameters in non-selected ICU patients.

Aged ; Aged, 80 and over ; Bacteremia ; blood ; Calcitonin ; blood ; Calcitonin Gene-Related Peptide ; Female ; Fever ; blood ; Humans ; Intensive Care Units ; Male ; Middle Aged ; Prospective Studies ; Protein Precursors ; blood

BACKGROUND: Bloodstream infection (BSI) is associated with a high mortality rate. Since the origin of infection is demonstrated in approximately 2/3rds of cases, early and established biomarkers are warranted. We evaluated the clinical performances of automated procalcitonin (PCT) and C-reactive protein (CRP) assays for the quantitative detection of BSI. Analytical performance of the VIDAS(R) B.R.A.H.M.S PCT assay (bioMerieux, France) was assessed and also compared with the semi-quantitative PCT-Q test (B.R.A.H.M.S Aktiengesellschaft, Germany). METHODS: We prospectively included consecutive patients divided into 3 groups at the Dong-A University Medical Center. Patients were categorized according to the criteria of the American College of Chest Physicians/Society of Critical Care Medicine Consensus Conference (ACCP/SCCM), and also on the basis of catheter-associated bacteremia. RESULTS: A total 77 patients were enrolled. All mean values of PCT and PCT-Q were consistent with the reference value. Measured PCT concentrations showed good linearity (r=0.983). The between-run, within-run, and total imprecisions were below 5%. The PCT levels in gram-negative bacteremia were significantly higher than those in gram-positive bacteremia. Furthermore, the PCT concentrations were significantly different among non-infection, bacteremia, sepsis, severe sepsis, and septic shock groups. Our study showed that PCT >0.3 ng/mL had 95.0% sensitivity and 97.3% specificity, whereas CRP >5.46 mg/dL had 85.0% sensitivity and 86.5% specificity for diagnosing sepsis. CONCLUSIONS: We suggest that, compared with CRP, PCT is a better diagnostic and discriminative biomarker of sepsis categorized according to the ACCP/SCCM. Moreover, catheter-associated bacteremia could be discriminated from sepsis using PCT concentration.
Adult ; Bacteremia/*diagnosis ; Biological Markers/analysis/blood ; C-Reactive Protein/analysis ; Calcitonin/*blood ; Female ; Humans ; Male ; Middle Aged ; Protein Precursors/*blood ; ROC Curve ; Sensitivity and Specificity ; Sepsis/diagnosis

BACKGROUNDBoth procalcitonin (PCT) and plasma endotoxin levels cannot be solely used for a definite diagnosis of bacteremia or sepsis, and there has been few study comparing the values of the two biomarkers for the diagnosis of bacteremia. The aim of this study was to identify bacteria causing bacteremia and evaluate the role of the two biomarkers in the diagnosis of bacteremia in Intensive Care Unit (ICU).

METHODSThe medical records of 420 patients in ICU were retrospectively reviewed. Patients (n = 241) who met the inclusion criteria were subjected to blood culture (BC) for the analysis of the endotoxin or PCT levels. The exclusion criteria included the presence of infection with human immunodeficiency virus and/or AIDS, neutropenia without sepsis, pregnancy, treatment with immunosuppressive therapies, or blood diseases such as hematological tumors. Patients' BC episodes were divided into BC negative, Gram-negative (GN) bacteria, Gram-positive bacteria, and fungi groups. The PCT and plasma endotoxin levels were compared in the different groups.

RESULTSA total of 241 patients with 505 episodes of BC were analyzed. The GN bacteria group showed higher levels of PCT and endotoxin than the BC negative, Gram-positive bacteria, and fungi groups. GN bacteremia was more prevalent than Gram-positive bacteremia. The GN bacteremia caused by non-Enterobacteriaceae infection presented higher endotoxin level than that by Enterobacteriaceae, but no significant difference in PCT levels was observed between the two groups. The plasma endotoxin significantly differed among different groups and was bacterial species dependent.

CONCLUSIONSPlasma endotoxin was more related to GN than to Gram-positive bacteremia, and that endotoxin level was species dependent, but PCT level remained relatively more stable within the GN bacteria caused bacteremia. Both GN and positive bacteria caused bacteremia in the ICU patients in different regions of China. And PCT is a more valuable biomarker than endotoxin in the diagnosis of bacteremia.

Adult ; Aged ; Bacteremia ; blood ; diagnosis ; Calcitonin ; blood ; Endotoxins ; blood ; Female ; Gram-Negative Bacteria ; isolation & purification ; Humans ; Intensive Care Units ; Male ; Middle Aged

Patients undergoing dialysis are already at risk of certain types of infections resulting from underlying disease or condition. Dialysis-associated infections include access site infection, bacteremia, peritonitis and blood-borne pathogens. So, to prevent these infections, infection control should be recommended; hemodialysis water processing and distribution system: disinfection of dialysis machines; and step for prevention of blood-borne pathogen transmission in the dialysis setting. The causes of endoscopy associated infection are multi-factorial. So, to minimize the risk of infection, healthcare workers must ensure that equipment is designed and maintained properly and that guidelines for reprocessing are strictly followed.
Bacteremia ; Blood-Borne Pathogens ; Delivery of Health Care ; Dialysis ; Dietary Sucrose ; Disinfection ; Endoscopy ; Humans ; Infection Control ; Peritonitis ; Renal Dialysis ; Water

PURPOSE: Febrile neutropenia (FN) still remains a life-threatening cancer treatment-related toxicity and may compromise further chemotherapy in individual cancer patients. In this study, we sought to determine predictors of bacteremia in cancer patients with FN at the time of their visiting the emergency department. METHODS: Between January 1, 2007 and December 31, 2008, 392 episodes of FN in 342 cancer patients were retrospectively reviewed. We assessed clinical and laboratory features, and MASCC risk-index scores at admission to the emergency department. Statistical analysis was done using SPSS ver. 11.0. RESULTS: Among a total of 392 episodes, 34 (8.7%) showed bacteremia. There was a significant difference between bacteremic episodes and non-bacteremic episodes in tachycardia (56% vs. 31%), tachypnea (24% vs. 8%), high temperature (36% vs. 16%), hemoglobin (9.4 vs. 10.1 g/dL), platelet (73.3 vs. 117.5 x 10(3)/mm3), BUN (24 vs. 13 mg/dL), creatinine (1.2 vs. 0.8 mg/dL), and CRP (12.6 vs. 8.5 mg/dL). On multivariate analysis, low platelet count (OR 5.6, 95% CI 2.5-12.5, p<0.001), elevated BUN (OR 4.8, 95% CI 2.1-11.0, p<0.001), tachypnea (OR 3.2, 95% CI 1.2-8.3, p=0.020), and high temperature (OR 2.7, 95% CI 1.2-6.2, p=0.019) were independent factors associated with bacteremia. MASCC score < 21 was more frequent in bacteremic than non-bacteremic patients (32% vs. 10%, p=0.001). CONCLUSION: Low platelet count, elevated BUN, tachypnea, and high temperature are independent predictors of bacteremia in cancer patients with FN. Also, the MASCC risk-index score is a useful predictor of bacteremia.
Bacteremia ; Blood Platelets ; Creatinine ; Emergencies ; Fever ; Hemoglobins ; Humans ; Multivariate Analysis ; Neutropenia ; Platelet Count ; Retrospective Studies ; Tachycardia ; Tachypnea