Oral streptococcal bacteremia in hospitalized patients: taxonomic identification and clin…

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How should long-term tunneled central venous catheters be managed in microbiology laborat…

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Clinical impact of a real-time PCR assay for rapid identification of staphylococcal bacte…

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Beta-D-glucan detection as a diagnostic test for invasive aspergillosis in immunocompromi…

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Epidemic methicillin-susceptible Staphylococcus aureus lineages are the main cause of inf…

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Blood cultures at central line insertion in the intensive care unit: comparison with peripheral venipuncture.
J Clin Microbiol. 2011 Jul;49(7):2398-403
Authors: Stohl S, Benenson S, Sviri S, Avidan A, Block C, Sprung CL, Levin…

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Isopropyl alcohol compared with isopropyl alcohol plus povidone-iodine as skin preparation for prevention of blood culture contamination.

J Clin Microbiol. 2009 Jan;47(1):54-8

Authors: Kiyoyama T, Tokuda Y, Shiiki S, Hachiman T, Shimasaki T, Endo K

Despite a number of studies on the efficacies of antiseptics for the prevention of blood culture contamination, it still remains unclear which antiseptic should be used. Although the combination of povidone-iodine and isopropyl alcohol has been traditionally used in many institutions, the application of povidone-iodine needs extra time, and there is little evidence that this combination could have an additive effect in reducing contamination rates. To elucidate the additive efficacy of povidone-iodine, we compared two antiseptics, 70% isopropyl alcohol only and 70% isopropyl alcohol plus povidone-iodine, in a prospective, nonrandomized, and partially blinded study in a community hospital in Japan between 1 October 2007 and 21 March 2008. All blood samples for culture were drawn by first-year residents who received formal training on collection techniques. Skin antisepsis was performed with 70% isopropyl alcohol plus povidone-iodine on all inpatient wards and with only 70% isopropyl alcohol in the emergency department. For the group of specimens from inpatient wards cultured, 13 (0.46%) of 2,797 cultures were considered contaminated. For the group of specimens from the emergency department cultured, 12 (0.42%) of 2,856 cultures were considered contaminated. There was no significant difference in the contamination rates between the two groups (relative risk, 0.90; 95% confidence interval, 0.41 to 1.98; P = 0.80). In conclusion, the use of a single application of 70% isopropyl alcohol is a sufficient and a more cost- and time-effective method of obtaining blood samples for culture than the use of a combination of isopropyl alcohol and povidone-iodine. The extremely low contamination rates in both groups suggest that the type of antiseptic used may not be as important as the use of proper technique.

PMID: 18971366 [PubMed - indexed for MEDLINE]

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Empyema necessitatis due to methicillin-resistant Staphylococcus aureus: case report and review of the literature.

J Clin Microbiol. 2008 Oct;46(10):3534-6

Authors: Mizell KN, Patterson KV, Carter JE

Empyema necessitatis is a rare complication of empyema in which the pleural infection spreads outside of the pleural space to involve the soft tissues of the chest wall. Most cases of empyema necessitatis are related to Mycobacterium tuberculosis and, less commonly, to Actinomyces spp. and Streptococcus spp. Staphylococcus aureus has rarely been reported as the causative agent of empyema necessitatis, with the majority of S. aureus isolates being methicillin sensitive. Only two cases of empyema necessitatis due to methicillin-resistant S. aureus (MRSA) have been reported in the medical literature. We report the case of a 59-year-old Caucasian male who presented to our institution with complaints of pain in and swelling of his left upper chest of 2-months duration. A computed tomography scan of the chest showed an 8.1- by 6.5-cm lesion which extended from the left upper lobe of the lung into the extrathoracic soft tissues beneath the left upper pectoralis muscle. A wedge resection of the left upper lung lobe revealed lung tissue with an organized pneumonia-like pattern associated with marked acute pleuritis. Blood and urine cultures and cultures of the left chest soft tissue mass grew MRSA. The patient was successfully treated with vancomycin followed by a 10-day outpatient course of ciprofloxacin and trimethoprim-sulfamethoxazole. This case represents an extremely rare manifestation of an increasingly dangerous bacterial pathogen.

PMID: 18667598 [PubMed - indexed for MEDLINE]

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Impact of mecA gene testing and intervention by infectious disease clinical pharmacists on time to optimal antimicrobial therapy for Staphylococcus aureus bacteremia at a University Hospital.

J Clin Microbiol. 2008 Jul;46(7):2381-3

Authors: Carver PL, Lin SW, DePestel DD, Newton DW

In patients with Staphylococcus aureus bacteremia, intervention by infectious disease clinical pharmacists on the basis of the results of tests for mecA resulted in a 25.4-h reduction in the time to optimal antimicrobial therapy, from 64.7 +/- 36.8 to 39.3 +/- 15.5 h (P = 0.002), which may result in decreased mortality.

PMID: 18463221 [PubMed - indexed for MEDLINE]

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Time to blood culture positivity as a marker for catheter-related candidemia.

J Clin Microbiol. 2008 Jul;46(7):2222-6

Authors: Ben-Ami R, Weinberger M, Orni-Wasserlauff R, Schwartz D, Itzhaki A, Lazarovitch T, Bash E, Aharoni Y, Moroz I, Giladi M

Candida spp. are important causes of nosocomial bloodstream infections. Around 80% of patients with candidemia have an indwelling central venous catheter (CVC). Determining whether the CVC is the source of candidemia has implications for patient management. We assessed whether the time to detection of Candida species in peripheral blood (time to positivity [TTP]) can serve as a marker for catheter-related candidemia. Prospective surveillance of Candida bloodstream infection was conducted in two medical centers. TTP was recorded by the BacT/Alert automated system. Sixty-four candidemia episodes were included. Fifty patients (78%) had an indwelling CVC. Thirteen patients (20.3%) had definite catheter-related candidemia. TTP was shorter for definite catheter-related candidemia (17.3 +/- 2 h) than that for candidemia from other sources (38.2 +/- 3 h; P < 0.001). A TTP cutoff of 30 h was 100% sensitive and 51.4% specific for catheter-related candidemia (area under the receiver-operator characteristic curve of 0.76). We conclude that TTP in peripheral blood is a sensitive but nonspecific marker for catheter-related candidemia and that a TTP of more than 30 h can help exclude an intravascular catheter as the possible source of candidemia.

PMID: 18480222 [PubMed - indexed for MEDLINE]

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Bacteremia and infective endocarditis caused by a non-daptomycin-susceptible, vancomycin-intermediate, and methicillin-resistant Staphylococcus aureus strain in Taiwan.

J Clin Microbiol. 2008 Mar;46(3):1132-6

Authors: Huang YT, Hsiao CH, Liao CH, Lee CW, Hsueh PR

We describe the development of nonsusceptibility to daptomycin and vancomycin during treatment for methicillin-resistant Staphylococcus aureus (MRSA) bacteremia associated with infective endocarditis and probable septic thrombophlebitis in a uremic patient. MRSA bacteremia persisted during glycopeptide and subsequent daptomycin treatment but cleared after 5 days’ treatment with linezolid and fusidic acid.

PMID: 18199793 [PubMed - indexed for MEDLINE]

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