Clonal Diversity in Episodes with Multiple Coagulase-Negative Staphylococcus Bloodstream Isolates Suggesting Frequent Contamination

Seybold, Ulrich; Reichardt, Christiane; Halvosa, J. Sue; Blumberg, Henry M.

doi:10.1007/s15010-008-8020-4

Cited by 14 publications

(8 citation statements)

References 17 publications

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“…Contamination is generally presumed if only one of at least two sets of blood cultures is positive for CoNS, whereas true BSI is assumed if at least two blood cultures yield CoNS [10][11][12]. However, several studies reported that about one-third of patients with true BSI had only one positive blood culture [13,14], and that contamination was possible even if two or more sets were positive [10,13]. In the literature, various clinical or laboratory definitions have been proposed to determine the clinical relevance of bacteraemia [15][16][17][18][19][20].…”

Section: Introductionmentioning

confidence: 99%

How to discriminate contamination from bloodstream infection due to coagulase-negative staphylococci: a prospective study with 654 patients

Elzi

Babouee

Vögeli

et al. 2012

Clinical Microbiology and Infection

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Clin Microbiol Infect 2012; 18: E355–E361 Abstract Coagulase‐negative staphylococci (CoNS) are frequent contaminants of blood cultures. We aimed to evaluate the systemic inflammatory response syndrome (SIRS) criteria in patients with CoNS bacteraemia for discrimination between true bloodstream infection (BSI) and contamination. Prospective evaluation was carried out of clinical and laboratory parameters in adults with at least one positive blood culture with CoNS at the University Hospital of Basel between 2003 and 2007. Of 3060 positive blood cultures, 654 episodes of CoNS bacteraemia were identified. Of these, 232 (35%) were considered to be true BSI and 422 (65%) were considered to be contamination. Overall, 80% of study participants had at least one SIRS criterion, fever being the most common, and 49% had at least two SIRS criteria. In the multivariate analysis, independent predictors of BSI were fever or hypothermia (OR 2.93, 95% CI 1.91–4.5), tachycardia (OR 2.29, 95% CI 1.50–3.50), tachypnoea (OR 2.4, 95% CI 1.30–4.43), leucocytosis or leucopenia (OR 4.15, 95% CI 2.17–6.36) and the presence of a central venous line (OR 5.38, 95% CI 3.25–8.88). The probability of BSI increased with each additional SIRS criterion, ranging from 42.4% in patients with only one SIRS criterion to 56.7% for those with two criteria, and 72.3% for patients with three SIRS criteria. A positive blood culture with CoNS most likely represents true BSI if the patient has at least three SIRS criteria or two SIRS criteria and a central venous catheter. These simple bedside criteria may guide decision to treat, decreasing the use of glycopeptides.

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Section: Introductionmentioning

confidence: 99%

How to discriminate contamination from bloodstream infection due to coagulase-negative staphylococci: a prospective study with 654 patients

Elzi

Babouee

Vögeli

et al. 2012

Clinical Microbiology and Infection

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“…When cultures are positive from multiple blood draws, the positive predictive value (PPV) for bacteremia improves (20). It has been proposed that identification of the true cause of infection can be improved by determining species relatedness between blood culture bottles; when the organisms in the bottles are found to be of the same species, it is highly likely that that species represents the true cause of infection (17,34). However, phenotypic identification methods require subculturing, adding significant time to the process of identifying true infections.…”

Section: Discussionmentioning

confidence: 99%

Staph ID/R: a Rapid Method for Determining Staphylococcus Species Identity and Detecting the mecA Gene Directly from Positive Blood Culture

Pasko¹,

Hicke²,

Dunn³

et al. 2012

J Clin Microbiol

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Rapid diagnosis of staphylococcal bacteremia directs appropriate antimicrobial therapy, leading to improved patient outcome. We describe herein a rapid test (<75 min) that can identify the major pathogenic strains of Staphylococcus to the species level as well as the presence or absence of the methicillin resistance determinant gene, mecA. The test, Staph ID/R, combines a rapid isothermal nucleic acid amplification method, helicase-dependent amplification (HDA), with a chip-based array that produces unambiguous visible results. The analytic sensitivity was 1 CFU per reaction for the mecA gene and was 1 to 250 CFU per reaction depending on the staphylococcal species present in the positive blood culture. Staph ID/R has excellent specificity as well, with no cross-reactivity observed. We validated the performance of Staph ID/R by testing 104 frozen clinical positive blood cultures and comparing the results with rpoB gene or 16S rRNA gene sequencing for species identity determinations and mecA gene PCR to confirm mecA gene results. Staph ID/R agreed with mecA gene PCR for all samples and agreed with rpoB/16S rRNA gene sequencing in all cases except for one sample that contained a mixture of two staphylococcal species, one of which Staph ID/R correctly identified, for an overall agreement of 99.0% (P < 0.01). Staph ID/R could potentially be used to positively affect patient management for Staphylococcus-mediated bacteremia.

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“…García [12] showed that patients with two or more blood cultures positive for CoNS were more likely to have true bacteraemia than those with only one; however, Seybold et al. [13] showed that even two consecutive cultures may represent contamination. Consequently, having more than two positive cultures may be a good predictor for CoNS bloodstream infection.…”

Section: Comparison Of Categorical Variables Between Patients With Imentioning

confidence: 99%

“…If patients had more than two positive blood culture sets for CoNS they were more likely to have a true genotypically proven bacteraemia by univariate and multivariate analysis. García [12] showed that patients with two or more blood cultures positive for CoNS were more likely to have true bacteraemia than those with only one; however, Seybold et al [13] showed that even two consecutive cultures may represent contamination. Consequently, having more than two positive cultures may be a good predictor for CoNS bloodstream infection.…”

mentioning

confidence: 99%

Comparing clinical and microbiological methods for the diagnosis of true bacteraemia among patients with multiple blood cultures positive for coagulase-negative staphylococci

Wohoush

Rivera²,

Cairo

et al. 2011

Clinical Microbiology and Infection

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Clonal Diversity in Episodes with Multiple Coagulase-Negative Staphylococcus Bloodstream Isolates Suggesting Frequent Contamination

Abstract: Contamination may frequently be present even in the setting of the recovery of CoNS from two or more blood culture sets within 24 h. Speciation of CoNS bloodstream isolates is rapid and may improve patient care as well as reduce unnecessary antibiotic use.

Cited by 14 publications

References 17 publications

How to discriminate contamination from bloodstream infection due to coagulase-negative staphylococci: a prospective study with 654 patients

How to discriminate contamination from bloodstream infection due to coagulase-negative staphylococci: a prospective study with 654 patients

Staph ID/R: a Rapid Method for Determining Staphylococcus Species Identity and Detecting the mecA Gene Directly from Positive Blood Culture

Comparing clinical and microbiological methods for the diagnosis of true bacteraemia among patients with multiple blood cultures positive for coagulase-negative staphylococci

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