2012
DOI: 10.1097/ccm.0b013e318270e771
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Current approaches to the diagnosis of bacterial and fungal bloodstream infections in the intensive care unit

Abstract: Healthcare systems spend considerable resources collecting and processing blood cultures for the detection of blood stream pathogens. The process is initiated with the collection of blood cultures that depend upon proper skin disinfection, collection of an adequate number of specimens and volume of blood, and prompt processing in a sensitive culture system. Complementing blood cultures and gaining in use are techniques such as nucleic acid amplification tests and mass spectroscopy that allow clinical laborator… Show more

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Cited by 112 publications
(90 citation statements)
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“…According to a small scale meta‐analysis14 comparing alcohol‐containing chlorhexidine gluconate with povidone iodine, chlorhexidine gluconate was shown to decrease contamination, but some of these studies used 2% chlorhexidine gluconate, which is not used in Japan. Povidone iodine requires ~2 min to take effect, and there is the concern that medical staff tasked with collecting specimens may not wait for a sufficient amount of time 15. In contrast, alcohol‐containing chlorhexidine gluconate has both immediate and sustained effects.…”
Section: Introductionmentioning
confidence: 99%
“…According to a small scale meta‐analysis14 comparing alcohol‐containing chlorhexidine gluconate with povidone iodine, chlorhexidine gluconate was shown to decrease contamination, but some of these studies used 2% chlorhexidine gluconate, which is not used in Japan. Povidone iodine requires ~2 min to take effect, and there is the concern that medical staff tasked with collecting specimens may not wait for a sufficient amount of time 15. In contrast, alcohol‐containing chlorhexidine gluconate has both immediate and sustained effects.…”
Section: Introductionmentioning
confidence: 99%
“…This is not possible with currently used methods, thus causing a significant delay in specific treatment and the empirical use of broad-spectrum antimicrobials (2-4). Nucleic acid-based assays are considered to be a potential adjuvant tool for improving the microbiological diagnosis of sepsis (5)(6)(7). These assays may be classified into one of two groups (5-7): (i) those using positive blood cultures, which are potentially useful but burdened by the usual culture-associated drawbacks (i.e., interfering effect of ongoing antibiotics, long time to positivity, and the presence of fastidious pathogens), and (ii) those using blood samples, which are promising but still not developed for the sensitive detection of resistance markers (5)(6)(7).…”
mentioning
confidence: 99%
“…On the other hand, high-throughput molecular techniques such as multiplexed PCR and mass spectrometry allow more rapid and less empiric pathogen identification nowadays [46]. These techniques should be evaluated in terms of cost effectiveness, sensitivity, and specificity as part of a multimodal stewardship program in the ICU that could encompass bioscores such as the one recently described by Gibot et al [47•].…”
Section: Resultsmentioning
confidence: 99%