Impact of Rapid Identification and Stewardship Intervention on Coagulase-Negative <i>Staphylococcus</i> Bloodstream Infection

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Abstract

We investigated the impact of rapid diagnostic testing with and without algorithm-based stewardship recommendations on antibiotic use for bloodstream infection with coagulase-negative staphylococci. A significant reduction in antibiotic days of therapy was achieved in the stewardship intervention group that was not seen with rapid diagnostic testing alone.

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The clinical significance of positive blood cultures in the 1990s: a prospective comprehensive evaluation of the microbiology, epidemiology, and outcome of bacteremia and fungemia in adults.

M Quartey, Aliyah M. Weinstein, L. Reller … (1997)

To assess changes since the mid-1970s, we reviewed 843 episodes of positive blood cultures in 707 patients with septicemia. The five most common pathogens were Staphylococcus aureus, Escherichia coli, coagulase-negative staphylococci (CNS), Klebsiella pneumoniae, and Enterococcus species. Although CNS were isolated most often, only 12.4% were clinically significant. Half of all episodes were nosocomial, and a quarter had no recognized source. Leading identifiable sources included intravenous catheters, the respiratory and genitourinary tracts, and intraabdominal foci. Septicemia-associated mortality was 17.5%. Patients who received appropriate antimicrobial therapy throughout the course of infection had the lowest mortality (13.3%). Multivariate analysis showed that age (relative risk [RR], 1.80), microorganism (RR, 2.27), source of infection (RR, 2.86), predisposing factors (RR, 1.98), blood pressure (RR, 2.29), body temperature (RR, 2.04), and therapy (RR, 2.72) independently influenced outcome. Bloodstream infections in the 1990s are notable for the increased importance of CNS as both contaminants and pathogens, the proportionate increase in fungi and decrease in anaerobes as pathogens, the emergence of Mycobacterium avium complex as an important cause of bacteremia in patients with advanced human immunodeficiency virus infection, and the reduction in mortality associated with infection.

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Clinical and economic impact of contaminated blood cultures within the hospital setting.

Philip McElnay, Patricia Kearney, Feras W Darwish Elhajji … (2011)

Blood cultures have an important role in the diagnosis of serious infections, although contamination of blood cultures (i.e. false-positive blood cultures) is a common problem within the hospital setting. The objective of the present investigation was to determine the impact of the false-positive blood culture results on the following outcomes: length of stay, hotel costs, antimicrobial costs, and costs of laboratory and radiological investigation. A retrospective case-control study design was used in which 142 false-positive blood culture cases were matched with suitable controls (patients for whom cultures were reported as true negatives). The matching criteria included age, comorbidity score and month of admission to the hospital. The research covered a 13-month period (July 2007 to July 2008). The findings indicated that differences in means, between cases and controls, for the length of hospital stay and the total costs were 5.4 days [95% CI (confidence interval): 2.8-8.1 days; P<0.001] and £5,001.5 [$7,502.2; 95% CI: £3,283.9 ($4,925.8) to £6,719.1 ($10,078.6); P<0.001], respectively. Consequently, and considering that 254 false-positive blood cultures had occurred in the study site hospital over a one-year period, patients with false-positive blood cultures added 1372 extra hospital days and incurred detrimental additional hospital costs of £1,270,381 ($1,905,572) per year. The findings therefore demonstrate that false-positive blood cultures have a significant impact on increasing hospital length of stay, laboratory and pharmacy costs. These findings highlight the need to intervene to raise the standard of blood-culture-taking technique, thus improving both the quality of patient care and resource use. Copyright © 2010 The Hospital Infection Society. Published by Elsevier Ltd. All rights reserved.

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Blood cultures positive for coagulase-negative staphylococci: antisepsis, pseudobacteremia, and therapy of patients.

Michelle Garrison, Andrew Campbell, Nicole Anderson … (1998)

A blood culture cohort study investigating issues related to isolation of coagulase-negative staphylococci (CoNS) and other skin microflora is reported. Data were collected over 12 weeks to determine the incidence of significant CoNS bacteremia versus that of pseudobacteremia (contaminants) and to evaluate drug therapy in patients with cultures positive for CoNS. In addition, the effectiveness of 0.2% chlorine peroxide as a bactericidal disinfectant was compared to that of 10% providone iodine. A total of 3,276 cultures of blood from 1,433 patients were evaluated in the study. Eighty-nine cultures were positive for skin flora, with 81 of 89 (91%) involving CoNS. The incidence of significant CoNS bacteremia was 20 of 81 (24.7%), that of indeterminate bacteremia was 10 of 81 (12.3%), and that of contamination was 59 of 81 (72.8%). The incidence of significant bacteremia involving CoNS was double the 10 to 12% rate based on previous estimations at our institutions. In tests with the two bactericidal disinfectants, 22 of 1,639 cultures (1.3%) in the chlorine peroxide group versus 37 of 1,637 (2.3%) in the providone iodine group were considered contaminated (P = 0.065). Rates of contamination for venipuncture versus catheter collection were not significantly different (P = 0.46). The overall contamination rate was 59 of 3,276 (1.8%), which is consistent with the lower end of published quality assurance benchmark standards. The low rate was believed to be due to the professional phlebotomy staff in our institutions. There was excellent agreement between retrospective analysis by reviewers, when formal criteria were used, and the attending physicians' intuitive clinical impressions in the classification of significant bloodstream infections (100% agreement) or contamination (95% agreement). However, physicians still used antimicrobial agents to treat nearly one-half of the patients with contaminated blood cultures, with vancomycin being misused in 34% of patients. In addition, 10% of patients with significant bacteremia were treated with inappropriate agents. There were no significant adverse events or prolonged hospital stays due to the unnecessary use of vancomycin; however, the additional costs of treating patients whose cultures contained CoNS contaminants was estimated to be $1,000 per patient. Measures to limit the unnecessary use of vancomycin (and other agents) are important.

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Author and article information

Contributors

Eli S Goshorn

J Alex Viehman

J Ryan Bariola

Tina Khadem:

ORCID: https://orcid.org/0000-0002-9716-580X

Brian A Potoski

Ryan K Shields:

ORCID: https://orcid.org/0000-0001-9794-5665

Journal

Journal ID (nlm-ta): Open Forum Infect Dis

Journal ID (iso-abbrev): Open Forum Infect Dis

Journal ID (publisher-id): ofid

Title: Open Forum Infectious Diseases

Publisher: Oxford University Press (US )

ISSN (Electronic): 2328-8957

Publication date Collection: August 2023

Publication date (Electronic): 31 July 2023

Publication date PMC-release: 31 July 2023

Volume: 10

Issue: 8

Electronic Location Identifier: ofad416

Affiliations

Department of Medicine, Division of Infectious Diseases, Rutgers New Jersey Medical School , Newark, New Jersey, USA

Department of Medicine, Division of Infectious Diseases, University of Pittsburgh , Pittsburgh, Pennsylvania, USA

Antibiotic Management Program, University of Pittsburgh Medical Center , Pittsburgh, Pennsylvania, USA

Department of Medicine, Division of Infectious Diseases, University of Pittsburgh , Pittsburgh, Pennsylvania, USA

Antibiotic Management Program, University of Pittsburgh Medical Center , Pittsburgh, Pennsylvania, USA

Department of Medicine, Division of Infectious Diseases, University of Pittsburgh , Pittsburgh, Pennsylvania, USA

Antibiotic Management Program, University of Pittsburgh Medical Center , Pittsburgh, Pennsylvania, USA

Department of Pharmacy and Therapeutics, University of Pittsburgh School of Pharmacy , Pittsburgh, Pennsylvania, USA

Department of Medicine, Division of Infectious Diseases, University of Pittsburgh , Pittsburgh, Pennsylvania, USA

Antibiotic Management Program, University of Pittsburgh Medical Center , Pittsburgh, Pennsylvania, USA

Center for Innovative Antimicrobial Therapy, University of Pittsburgh , Pittsburgh, Pennsylvania, USA

Author notes

Correspondence: Ryan K. Shields, PharmD, MS, Department of Medicine, University of Pittsburgh, 3601 Fifth Ave, Falk Medical Bldg, Suite 5B, Pittsburgh, PA 15213 ( shieldsrk@ 123456upmc.edu ); Eli S. Goshorn, MD, Department of Medicine, Division of Infectious Diseases, Rutgers New Jersey Medical School, 140 Bergen St, ACC Level D, Newark, NJ 07103 ( goshorel@ 123456njms.rutgers.edu ).

Author information

Tina Khadem https://orcid.org/0000-0002-9716-580X

Ryan K Shields https://orcid.org/0000-0001-9794-5665

Article

Publisher ID: ofad416

DOI: 10.1093/ofid/ofad416

PMC ID: 10433923

PubMed ID: 37601727

SO-VID: bf44bba9-d357-4d9f-87f2-001d4413e39e

License:

This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs licence ( https://creativecommons.org/licenses/by-nc-nd/4.0/), which permits non-commercial reproduction and distribution of the work, in any medium, provided the original work is not altered or transformed in any way, and that the work is properly cited. For commercial re-use, please contact journals.permissions@oup.com

History

Date received : 29 May 2023

Date: 24 July 2023

Date accepted : 28 July 2023

Date: 17 August 2023

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Pages: 4

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Impact of Rapid Identification and Stewardship Intervention on Coagulase-Negative Staphylococcus Bloodstream Infection

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Most cited references 11

The clinical significance of positive blood cultures in the 1990s: a prospective comprehensive evaluation of the microbiology, epidemiology, and outcome of bacteremia and fungemia in adults.

Clinical and economic impact of contaminated blood cultures within the hospital setting.

Blood cultures positive for coagulase-negative staphylococci: antisepsis, pseudobacteremia, and therapy of patients.

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