Although venipuncture is the preferred method for obtaining blood cultures, specimens often are obtained from intravenous catheters (IVC). For IVC-drawn blood cultures, some authorities recommend discarding the initial 5 to 10 ml of blood to reduce contamination and remove potential inhibitory substances. To determine whether this practice reduced contamination rates (CR), we assessed the results of IVC-drawn blood cultures for adults. Thirty milliliters of blood was obtained aseptically. The first 10 ml, rather than being discarded, was inoculated into an aerobic culture vial. Using a second sterile syringe, 20 ml of blood was obtained and inoculated in 10-ml aliquots to aerobic and anaerobic culture vials. Positive cultures were evaluated to assess clinical significance (true versus contaminant). Out of 653 IVC-drawn blood culture pairs, both vials were contaminated in 38 pairs (5.8%); only the "discard" vial was contaminated in 33 (5.1%); and only the "standard" vial was contaminated in 31 (4.7%). Overall CR were 10.9% for the discard vial versus 10.5% for the standard vial (P ؍ 0.90). We conclude that discarding an initial aliquot of blood when obtaining blood cultures from IVCs does not reduce CR.The standard method for obtaining blood for culture is venipuncture using aseptic techniques. With greater utilization of intravenous access catheters (e.g., PICC, Hickman, etc.), blood cultures often are obtained from these devices, yet there is no standardized method for obtaining blood for culture by this technique. Several reports have demonstrated increased blood culture contamination rates (i.e., false-positive results) when blood cultures are obtained from catheters (4,8,10,15), which, in turn, can lead to inappropriate antibiotic administration as well as additional unnecessary diagnostic testing. Some authorities recommend discarding the first 5 to 10 ml of blood when obtaining blood from intravenous catheters (IVCs) prior to inoculating the blood culture vials (17), whereas others do not (1, 9, 16). The purpose of discarding these aliquots of blood is to remove any substances that could potentially inhibit microbial growth (e.g., heparin) (6, 19) and to reduce blood culture contamination rates. However, there are few published systematic assessments of this issue, no consensus recommendations on how to draw blood cultures from an IVC, and no controlled comparative evaluations of different techniques to obtain blood culture samples from an IVC.It has been standard practice at our institution to discard the first 10 ml of blood prior to obtaining blood for culture from IVCs. If patients have repeated blood cultures, in which 10 ml of blood is discarded with each culture, nosocomial anemia may occur or worsen and result in added morbidity (1,3,11,18,21). To determine whether discarding the initial aliquot of blood from IVC-drawn blood cultures reduces contamination, we inoculated the initial 10-ml sample of blood that would have been discarded into an aerobic blood culture vial and compared contamination r...
Patient: Female, 81Final Diagnosis: Liver abscesSymptoms: Diarrhea • jaundice • vomiting • weaknessMedication: —Clinical Procedure: CT scan guided drainageSpecialty: Gastroenterology and HepatologyObjective:Rare diseaseBackground:Clostridium perfringens is an unusual pathogen responsible for the development of a gas-forming pyogenic liver abscess. Progression to septicemia with this infection has amplified case fatality rates.Case Report:We report a case of an 81-year-old lady with pyogenic liver abscess with gas formation that was preceded by an acute gastroenteritis. The most common precipitating factors are invasive procedures and immunosuppression. Clostridium perfringens was unexpectedly isolated in the drained abscess, as well as blood. It is a normal inhabitant of the human bowel and a common cause of food poisoning, notoriously leading to tissue necrosis and gas gangrene.Conclusions:We report a case of gas-forming pyogenic liver abscess and bacteremia progressing to fatal septic shock, caused by an uncommon Clostridium perfringens isolate.
Introduction: The most common cause of acute myocarditis in developed countries is viruses. Bacterial myocarditis is very rare and caused by various bacteria, but only three cases have been reported in the past where Shigella sonnei was the aetiology. Two out of the three cases reported were in a paediatric population. Case Presentation: A 38-year-old female was presenting with chest pain and an increased level of troponins with the EKG (electrocardiogram) showing non-specific T-wave changes. Preceding the chest pain, the patient had Shigella sonnei gastroenteritis confirmed by stool culture. The patient's cardiac catheterization showed normal findings. Thus a diagnosis of bacterial myocarditis was made. The event resolved after successful treatment of the gastroenteritis with ciprofloxacin. Conclusion: We are reporting a very rare case of Shigella sonnei gastroenteritis that resulted in the development of acute myocarditis and was successfully treated with antibiotics.
Background A surgical site infection (SSI) is defined as an infection that occurs up to 30 days after surgery without an implant (or within one year if an implant is placed). The infection also must appear to be related to surgery. In 2021, there were 19 SSIs reported at Ocean University Medical Center (OUMC). These SSIs were associated with colorectal and hip/knee arthroplasty cases. The primary objective of this study is to evaluate appropriate preoperative antibiotic administration based on the type of surgical procedure. Some secondary objectives include the number of preoperative antibiotics administered and the appropriate timing of preoperative antibiotic administration. Methods A retrospective observational evaluation was conducted on patients identified to have a SSIs from January 1, 2021, to December 31, 2021. Appropriate preoperative antibiotics were defined as the administration of guideline-recommended antibiotics for the given procedure. Appropriate timing of antibiotics was defined as antibiotics administered within guideline-recommended time frames prior to procedure start time. Descriptive statistics were used to analyze the results. Results Of the 19 infections, ten were associated with colorectal procedures, and nine were associated with hip/knee arthroplasty procedures. Patients received preoperative antibiotics in 89% of the surgeries (17 of 19). We found that 71% (12 of 17) of patients received appropriate antibiotics determined by the surgical procedure. Of the five inappropriate antibiotic selection instances, two lacked appropriate bacterial coverage, while the other three covered the suspected pathogens but were not guideline-recommended agents. The timing of preoperative antibiotics was found to be appropriate in 76% of all surgeries. When assessing the overall compliance with antibiotic selection and timing, 58% (11 of 19) of cases followed all guideline recommendations. Conclusion This study has identified areas of improvement regarding the antimicrobial selection and timing, documentation process of administration, and the use of order sets to combat inappropriate prescribing of surgical antimicrobial prophylaxis. Educational materials and in-services have been provided at OUMC. Disclosures All Authors: No reported disclosures.
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