(5-7,21) Laboratory-trained phlebotomists and blood culture teams can be better trained and focused on correct antiseptic technique. Accordingly, one can no longer judge the clinical significance of a CoNS isolate solely on the basis of its identity. Group A Streptococcus (GAS), or Streptococcus pyogenes, is the leading bacterial cause of tonsillopharyngitis in adults and children worldwide. The number of blood culture sets that grow a particular microorganism, especially when measured as a function of the total number of blood cultures obtained, has proved to be a very useful aid in interpreting the clinical significance of positive blood cultures (Figure). Ann Intern Med. Studies have shown that 90% of true bacteremia is detected with the first blood culture, and 99% with the first two cultures. However, 5 days later, the PCP was notified that both sets of blood cultures were growing Corynebacterium spp. [go to PubMed], 20. They can also be found as transient microbiota of the normal skin and often represent contaminants when isolated from blood cultures. A patient with multiple underlying medical problems that predispose to infection; Isolation of a microorganism from blood cultures that in most circumstances would represent contamination but, in this instance, represented a clinically important pathogen that caused a potentially life-threatening infection; Misinterpretation of the clinical significance of the positive blood culture result; Failure of the primary and covering physicians to communicate effectively, ultimately resulting in delayed diagnosis and increased patient morbidity. 2020 Sep 15;11:555465. doi: 10.3389/fmicb.2020.555465. Streptococcus anginosus is a Gram-positive bacterium that is present in the mouth, upper respiratory tract, gastrointestinal tract, and vagina as a normal inhabitant. 8600 Rockville Pike [Weinstein MP, Reller LB, Murphy JR, Lichtenstein KA. Three weeks later, the patient was readmitted after being shocked by his defibrillator (AICD). [go to PubMed], 10. No! Schifman RB, Pindur A. The value of multiple cultures largely flows from probability considerations: Most institutions have contamination rates in the range of 3% per blood culture drawn. Normally present in the oral flora of humans, S salivarius is the least pathogenic member of the viridans group streptococci and is often considered a contaminant when detected on blood culture. Simplified layouts make it easier to find what you need. 11. Writing Act, Privacy [go to PubMed], 2. Chlorhexidine compared with povidone-iodine as skin preparation before blood culture: a randomized controlled trial. Siegert C, Overbosch D. Carcinoma of the colon presenting as Streptococcus sanguis bacteremia. Amado C, Hidalgo MJ, Sedano C, Hebel A, Porte L, Braun S, Dabanch J, Fica A. Rev Chilena Infectol. [go to PubMed], 3. Another reason may be that they are considered part of human commensals and are therefore commonly considered a contaminant, especially in diagnostic samples of polymicrobial infections. A 62-year-old man with type 2 diabetes mellitus, chronic kidney disease, and a history of ventricular tachycardia with an automated implantable cardiac defibrillator (AICD) came to his primary care physician (PCP) with symptoms of shaking, weakness, and vomiting. The initial management of this patient—deeming the initial positive blood cultures to be significant—was reasonable in my judgment. Clin Perform Qual Health Care. eCollection 2020. The case history that forms the basis for this commentary illustrates several of the important complexities and inefficiencies of modern medicine, some of which resulted in medical errors. 1987;88:113-116. Hevroni G, Maryniak A, Cepeda-Mora D, Salifu MO, McFarlane SI. To reduce the risk of needlestick injury associated with changing needles, the standard culture method now employs a single needle that is used for obtaining blood and inoculating the culture vial. 1999;107:119-125. Clinical utility of blood cultures drawn from indwelling central venous catheters in hospitalized patients with cancer. This site needs JavaScript to work properly. Humar D, Datta V, Bast DJ, et al. It is also possible to get strep throat from contact with sores from group A strep skin infections. [go to PubMed], 6. 5600 Fishers Lane Arch Intern Med. Bacteremia with Streptococcus bovis and Streptococcus salivarius: clinical correlates of more accurate identification of isolates. 1999;131:834-837. 7. Up to five or six different species of bacteria (Trueperella, Streptococcus, Bacteroides, Peptostreptococcus, and Fusobacterium genera) may be present concurrently in the disease. (16) Microorganisms that always or nearly always (greater than or equal to 90%) represent true infection when isolated from blood cultures include S. aureus, S. pyogenes, S. agalactiae, S. pneumoniae, E. coli and other members of the family Enterobacteriaceae, P. aeruginosa, B. fragilis group, and Candida species. Uncertain of how to interpret the result (as this bacteria may represent contaminated blood cultures rather than a true cause of disease), the PCP contacted an infectious disease specialist, who recommended hospitalization. … It is a beta- hemolytic, catalase -negative, and facultative anaerobe. In contrast, coagulase-negative staphylococci (CoNS), Corynebacterium species, Bacillus species other than anthracis, and P. acnes usually represent contamination. (8-11) A third factor is the means by which blood is obtained for culture. (5-7) A second factor is the antiseptic agent itself; tincture of iodine and chlorhexidine gluconate are more effective at skin sterilization than iodophor (povidone iodine) preparations. 1997;92(9):1541-1542. 1993;25(4):403-8 Sometimes, the bacteria invade the lungs (pneumonia), blood (septicemia), or spread along the layers of tissue that surround muscle (called the fascia). [go to PubMed]. Strep throat is an infection in the throat and tonsils caused by group A Streptococci. Microorganisms that are most often contaminants can, in the right clinical setting, be clinically significant pathogens. Contaminant blood cultures and resource utilization. Clin Infect Dis. Abstract. Guidelines for early differentiation of contaminated from valid positive cultures. Get there fast with our new streamlined navigation. Patterns of positivity in sequential blood cultures as an aid to the differentiation of clinically important infection versus contamination. 1992;267:1962-1966. Laboratory and epidemiologic observations. A 62-year-old man with type 2 diabetes mellitus, chronic kidney disease, and a history of ventricular tachycardia with an automated implantable cardiac defibrillator (AICD) came to his primary care physician (PCP) with symptoms of shaking, weakness, and vomiting. New Microbes New Infect. J Formos Med Assoc. Patients with S. salivarius bacteremia were younger than those with S. bovis bacteremia (57 vs. 67 years; p<0.01). Studies have shown that trained phlebotomists or blood culture teams have fewer contaminated blood cultures than other HCWs. 2003;41:2275-2278. 2000;19:297-300. 1997;35:563-565. Is coagulase negative staphylococcus always a contaminant? Blood culture contamination: persisting problems and partial progress. below. That evening, the results were reported to a covering physician who was unfamiliar with the patient or previous culture results. 1997;24:584-602. Streptococcus constellatus is a Gram-positive microaerophilic coccus. 1995 May;20(5):1169-73 Updates, Electronic To some extent, the rising incidence of positive blood cultures mayreflect the morefrequent use ofblood … The physician ordered routine blood tests and 2 peripheral blood cultures, diagnosed the patient with a nonspecific viral syndrome, and sent him home. 2004 Feb;103(2):118-23. ISBN: 1562386417. Am J Med. The clinical significance of positive blood cultures: a comprehensive analysis of 500 episodes of bacteremia and fungemia in adults. Generally CNST requires treatment with vancomycin. 1997;24:584-602. Isolation and Characterization of Nitrate-Reducing Bacteria as Potential Probiotics for Oral and Systemic Health. 6. J Clin Microbiol. However, if two sets are ordered, and only one is positive for coagulase-negative staphylcocci, this most likely represents contamination. Abundance, Diversity and Role of ICEs and IMEs in the Adaptation of. 1993;269:1004-1006. Wayne, PA: Clinical and Laboratory Standards Institute; 2007. Patients with S. salivarius bacteremia and patients with S. bovis II bacteremia had similar rates of endocarditis, colon tumors, and non-colon cancer. He denied fevers. Bates DW, Lee TH. contaminant in blood cultures in 10 –15 % of cases [ 3, 5]. Principles and Procedures for Blood Cultures; Approved Guideline. JAMA. Microorganisms Isolated from Blood Categorized According to Clinical Significance. Blood culture contamination is common, constituting up to half of all positive blood cultures at some institutions. Prospective validation of a multivariate algorithm. These infections are called invasive Group A streptococcal (iGAS) disease and are very serious, even life-threatening. S. anginosus belongs to the anginosus subgroup of viridans streptococci which was traditionally called the ‘milleri group’. Clin Infect Dis. The patient was clinically stable, so the antibiotics were stopped and the patient was discharged to home. Sites, Contact Department of Health & Human Services. On the other hand, when compared with S. bovis I bacteremia… iGBS incidence was highest in older patients and women of childbearing age. Rosier BT, Moya-Gonzalvez EM, Corell-Escuin P, Mira A. Rupp ME, Archer GL. In our patient the only culprit of strep viridans bacteremia was his community acquired pneumonia. Spontaneous Bacterial Peritonitis and Bacteremia in Patients with End-Stage Liver Disease Received January 8, 2008; accepted February 4, 2008. Suggestive of Contamination. Rockville, MD 20857 As the Figure illustrates and this statement implies, this diagnostic maxim has no utility if only a single blood culture is obtained. MacGregor RR, Beaty HN. For example, if one set is ordered and is positive for coagulase-negative staphylococci, a common contaminant, it is impossible to determine if this represents contamination or infection. Patients with Staph. Apparently, the PCP was not made aware of this event (a communication error), and no medical intervention occurred, leading to delayed diagnosis and treatment of the patient. Am J Clin Pathol. Streptococcus sanguis bacteremia associated with cecal carcinoma: case report and review of the literature. 1994;19:231-243. We read with great interest on the studies by Kwong et al1 that observed an increased risk of colorectal carcinoma among hospitalized patients in Hong Kong with bacteremia from, among others, the Streptococcus bovis group. Clin Microbiol Rev. Medicina (Kaunas). Further complicating the situation is that in very busy EDs, a second blood culture may not be drawn, and, even if the organism is not a contaminant, it -, Diagn Microbiol Infect Dis. Note of any indwelling devices, implants or hardware should be made to ensure that they do not have . There are several antimicrobial resistant strains of this bacterium. In the pre-HIV era, the needle used to obtain the blood culture was removed and a second sterile needle was placed on the syringe for inoculation of the blood culture bottles. Do I need to get an infectious disease consult? [go to PubMed]. Am J Gastroenterol. Certain Streptococci. Use quotes to search for an exact match of a phrase: Use the "+" sign before the search term to ensure all keywords appear in the search result: Use the && symbol (AND operator) to ensure both search phrases appear within a single post/article: Perkins C, Balma D, Garcia R, et al. [go to PubMed], 4. 1992 Jul;15(1):33-48 ]), Figure. ; 2007, Archives of pathology & laboratory medicine, Search All AHRQ Clinical Significance of Isolates Known to Be Blood Culture Contaminants in Pediatric Patients. While rare, it has been shown in the literature to cause clinically relevant bacteremia and other invasive infections typically in the immunocompromised. Am J Med. 1997 Dec;29(4):277-80 A devastating ocular pathogen: beta-streptococcus Group G. Cornea. Neonatal sepsis caused by Streptococcus bovis variant (biotype II/2): report of a case and review. Identification of these species, however, was reached through traditional biochemical reactions that may be variable and overlapping among different as well as closely related species. [Streptococcus gallolyticus (ex S. bovis) bacteremia and its relationship with colonic or hepatobiliary disease and endocarditis]. However, blood cultures obtained in this fashion are contaminated more frequently than those obtained by peripheral venipuncture. Bacteremia caused by S. salivarius occurred mostly in patients who showed relevant disruption of the mucous membranes and/or serious underlying diseases. However, most strains studied have been shown to be susceptible to penicillin, ampicillin, erythromycin, and … Rev Infect Dis. 2019 Apr 18;30:100560. doi: 10.1016/j.nmni.2019.100560. Contamination of catheter-drawn blood cultures. The effect of skin disinfection materials on reducing blood culture contamination. (Adapted with permission. Gavin PJ, Thomson RB Jr, Horng SJ, Yogev R. J Clin Microbiol. represent contaminants when isolated from blood cultures, determining the likelihood of true bacteremia can be challeng-ing for clinicians. Rapid classification of positive blood cultures. For example, if 2 sets of blood cultures obtained by separate venipunctures in the same time frame are positive with the same organism, the probability of contamination is less than 1 in 1000. 1998;6:60-62. However, 1 month later, the patient again had 2 of 2 blood cultures positive for Corynebacterium spp. Perhaps the most important factor is the failure of the health care worker (HCW) to use strict aseptic technique when obtaining the blood specimen. 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