Impact of Reporting Gram Stain Results From Blood Cultures on the Selection of Antimicrobial Agents

Stone, Rebecca; Steele, John C.H.

doi:10.1309/ajcp9ruv0yglbvha

Cited by 5 publications

(5 citation statements)

References 7 publications

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“…), can be directly performed on single colonies on chocolate agar, while colony characteristics on Colorex Screen assist preliminary species identification and give additional information about mono and poly-microbial cultures. Early reporting has a high impact on the early selection of effective antimicrobials for patient treatments [7,21].…”

Section: Discussionmentioning

confidence: 99%

“…[6]. This step is crucial to give clinicians an orientation for initial treatment [7] but also to help lab technicians choose the most appropriate tests required for full pathogen identification and antibiotic resistance patterns. The capacity to recover the pathogen, plus time to results and accuracy are therefore important quality indicators in the first step of the process.…”

Section: Introductionmentioning

confidence: 99%

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Evaluation of InTray Cassettes Directly from Blood Cultures for the Diagnosis of Sepsis in Clinical Bacteriology Laboratories as an Alternative to Classic Culture Media

et al. 2023

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Culture media is fundamental in clinical bacteriology for the detection and isolation of bacterial pathogens. However, in-house media preparation could be challenging in low-resource settings. InTray® cassettes (Biomed Diagnostics) could be a valid alternative as they are compact, ready-to-use media preparations. In this study, we evaluate the use of two InTray media as a subculture alternative for the diagnosis of bloodstream infections: the InTray® Müller-Hinton (MH) chocolate and the InTray® Colorex™ Screen. The InTray MH chocolate was evaluated in 2 steps: firstly, using simulated positive blood cultures (reference evaluation study), and secondly, using positive blood cultures from a routine clinical laboratory (clinical evaluation study). The Colorex Screen was tested using simulated poly-microbial blood cultures. The sensitivity and specificity of the InTray MH chocolate were respectively 99.2% and 90% in the reference evaluation study and 97.1% and 88.2% in the clinical evaluation study. The time to detection (TTD) was ≤20 h in most positive blood cultures (99.8% and 97% in the two studies, respectively). The InTray® MH Chocolate agar showed good performance when used directly from clinical blood cultures for single bacterial infections. However, mixed flora is more challenging to interpret on this media than on Colorex™ Screen, even for an experienced microbiologist.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Evaluation of InTray Cassettes Directly from Blood Cultures for the Diagnosis of Sepsis in Clinical Bacteriology Laboratories as an Alternative to Classic Culture Media

et al. 2023

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“…The recovery of bacteria in diabetic wounds is one of the signs of infection along with clinical symptoms such as erythema, pain, tenderness and pus [9].The wounds were in the lower limbs in 94% of the cases and this in literature has been attributed to the vascular permeability that causes impaired blood supply to the peripheries during a diabetic state [27] and can result to limb amputations [7].The wounds were also noted mostly in the elderly (> 60 year) of which whose immune system is already compromised due to ageing [28] and diabetes thereby increasing the risk of bacterial infections [29] Biochemical tests are solely based on phenotypic properties of bacteria which are shared by most species [12,13,17], as a result misidentification is common, which can also account for the anomalies observed in table 3-5 whereby culture-based methods of identification (API) misinterpreted some of the results which were confirmed to be different by the 16S rDNA. In relation to this, several studies have reported that antimicrobial therapy may affect the bacterial cell wall without killing the bacteria leading to altered cell morphology thus misidentification is common especially in the Gram-stain [30,31]. Gramviable bacteria stain opposite from their true Gramreaction therefore, limiting the use of the Gram-stain in bacteria identification [30].…”

Section: Discussionmentioning

confidence: 99%

“…In relation to this, several studies have reported that antimicrobial therapy may affect the bacterial cell wall without killing the bacteria leading to altered cell morphology thus misidentification is common especially in the Gram-stain [30,31]. Gramviable bacteria stain opposite from their true Gramreaction therefore, limiting the use of the Gram-stain in bacteria identification [30]. Catalase and oxidase tests play a crucial role in enzyme-based methods of identification however, some bacteria contain enzymes different from catalase or cytochrome oxidase c that alter these particular reactions thereby giving false results [14,17], therefore the 16S rDNA results were the considered results in this study because bacteria was accurately identified.…”

Section: Discussionmentioning

confidence: 99%

The bacteria profiles of wounds in diabetic patients hospitalized in northern Kwazulu-Natal, South Africa

Mthembu¹,

Penduka²,

Mosa³

et al. 2017

Af J Clin Exp Micro

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Diabetic wound infections still remain a health concern such that correct identification of bacteria is essential in monitoring the spread of the infections as well as in the administration of the correct treatment. This study therefore focuses on isolating and identifying bacteria present in diabetic wounds of hospitalized patients in northern KwaZulu-Natal and assessing their distribution.The wound specimen were collected and swabbed onto selective and differential media. The bacteria identities were presumptively ascertained through biochemical characterization (Gram-stain, catalase test, oxidase test and API) and then confirmed through 16S rDNA sequencing.A total of 42 isolates were recovered from 83% of the patients sampled from the three participating hospitals (X, Y, and Z). Gram-negative bacilli from Enterobacteriaceaewere predominant followed by Staphylococci spp and Enterococcus faecaliswith 43% polymicrobial cases from hospital Z and 29% from hospital X. Distribution of some opportunistic pathogens and nosocomially-acquired pathogens were also observed across the patients with five bacterial identities distributed among hospital X and Z. The adverse effects associated with the recovered bacteria in diabetic wounds pose a serious health concern and preventive measure should be taken. Keywords: Diabetes mellitus, wounds, bacteria, infection LES BACTÉRIES ADULTE DES PLAIES CHEZ LES PATIENTS DIABÉTIQUES HOSPITALISÉS DANS LE

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“…The previously administered antibiotics likely disrupted the bacteria's cell wall affecting its Gram staining features. Clostridium species may stain as Gram-variable or even as Gram-negative rods as they are decolorized rapidly [ 20 ]. Moreover, with right-sided costovertebral tenderness on exam, right-sided nephrolithiasis with hydronephrosis on imaging, and purulent discharge on placement of his percutaneous nephrostomy tube, severe sepsis and bacteremia due to a urinary source are clinically supported.…”

Section: Case Presentationmentioning

confidence: 99%

Severe Sepsis due toClostridium perfringensBacteremia of Urinary Origin: A Case Report and Systematic Review

Millard

McManus

Wispelwey

2016

Case Reports in Infectious Diseases

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Clostridium perfringens bacteremia is an uncommon yet serious clinical syndrome that typically arises from a gastrointestinal source. However, clinicians should consider nongastrointestinal sources as well. We present a rare case of C. perfringens bacteremia of urinary origin that required surgical intervention for definitive treatment. A 61-year-old male presented with acute nausea and vomiting, altered mental status, and chronic diarrhea. His physical exam revealed right costovertebral tenderness and his laboratory work-up revealed acute renal failure. Percutaneous blood cultures grew C. perfringens. Cross-sectional imaging revealed a right-sided ureteral stone with hydronephrosis, which required nephrostomy placement. On placement of the nephrostomy tube, purulent drainage was identified and Gram stain of the drainage revealed Gram-variable rods. A urinary source of C. perfringens was clinically supported. Although it is not a common presentation, nongastrointestinal sources such as a urinary source should be considered in C. perfringens bacteremia because failure to recognize a nongastrointestinal source can delay appropriate treatment, which may include surgical intervention.

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Impact of Reporting Gram Stain Results From Blood Cultures on the Selection of Antimicrobial Agents

Cited by 5 publications

References 7 publications

Evaluation of InTray Cassettes Directly from Blood Cultures for the Diagnosis of Sepsis in Clinical Bacteriology Laboratories as an Alternative to Classic Culture Media

Evaluation of InTray Cassettes Directly from Blood Cultures for the Diagnosis of Sepsis in Clinical Bacteriology Laboratories as an Alternative to Classic Culture Media

The bacteria profiles of wounds in diabetic patients hospitalized in northern Kwazulu-Natal, South Africa

Severe Sepsis due toClostridium perfringensBacteremia of Urinary Origin: A Case Report and Systematic Review

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