Staphylococcus aureus bacteraemia is more likely to occur in certain ethnic groups, while mortality is associated with other identifiable risk factors and continues to be high. Intravenous catheters remain the most common and most preventable cause of SAB.
To assess the risk of contamination, we reviewed retrospectively 1,408 matched pairs of simultaneous catheter-drawn and venipuncture blood cultures. Catheter-drawn cultures were equally likely to be truly positive (14.4 versus 13.7%) but more likely to be contaminated (3.8 versus 1.8% [P ؍ 0.001]). Direct venipuncture cultures are preferred.Contamination of blood cultures causes diagnostic confusion and sometimes leads to unnecessary use of antimicrobial agents. Previous studies comparing contamination of blood drawn through an intravascular catheter with simultaneous direct venipuncture have shown mixed results and included small numbers of patients (1)(2)(3)(4)(5)(7)(8)(9). To conduct a morecomprehensive comparison of the frequencies of contamination for these two collection methods, we undertook a 2-year retrospective study at a tertiary-care medical center.Using a computerized database, we identified retrospectively all samples submitted for blood culture from adult or pediatric patients at our hospital between January 1997 and December 1998. From these samples, we identified matched pairs of blood cultures, each consisting of one sample labeled as being taken through an intravascular catheter and the other labeled as being taken by direct venipuncture, both of which were collected from the same patient within a 20-min time span. The specific type of intravascular catheter used was determined from the clinical notes if the label did not contain this information. During the study period, blood culture collection had been undertaken by various nursing and medical staff without standardization of technique. Blood for culture was inoculated into media for processing in a BACTEC 9240 or BacT/ALERT automated blood culture system and incubated either until microbial growth was detected or for 5 days; isolates from positive bottles were identified by standard techniques.Each positive blood culture isolate was categorized by either an adult or pediatric infectious diseases or medical microbiology physician as clinically significant, indeterminate, or a contaminant. This assessment of significance was based on the probability of each microorganism being a skin contaminant, the number of independently collected positive and negative blood cultures in an episode for a patient, the results of other concurrent microbiology tests (e.g., culture of other samples), and the compatibility of the patient's actual clinical features with typical features of infection with that microorganism as described previously by our group (10). An episode was defined as a period beginning with the first positive blood culture and ending when 7 days (2 days for coagulase-negative staphylococci) had passed without another positive blood culture with the same microorganism, regardless of whether negative cultures were drawn in the intervening days (6, 10). Blood cultures yielding one or more contaminants and one or more truly bacteremic organisms were counted under both categories. We calculated and compared true bloodstream infection rates a...
Our results, and those of others, show that prosthetic joint infections caused by streptococci have a relatively good outcome with primary antimicrobial therapy and, when necessary, drainage, lavage or debridement. Provided the prosthesis is stable and the patient can tolerate long-term antimicrobial therapy, this may be an effective alternative to excision arthroplasty.
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