Differentiation of enterobacteriaceae, pseudomonas aeruginosa, and Bacteroides and Haemophilus species in gram-stained direct smears

Bartlett, Raymond C.; Mazens-Sullivan, Mary F.; Lerer, Trudy

doi:10.1016/0732-8893(91)90032-b

Cited by 4 publications

(1 citation statement)

References 4 publications

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“…Differentiation of P . aeruginosa from other Gram-negative rods by Verigene tests might also have contributed to the more appropriate antibiotic selections, as differentiation based on morphological characteristics is not always accurate [14]. In our study setting, in which Verigene tests were not conducted at night, might have resulted in an underestimation of the positive impacts of Verigene tests on the rapid identification of causative pathogens of bacteremia.…”

Section: Discussionmentioning

confidence: 92%

Impact of rapid identification of positive blood cultures using the Verigene system on antibiotic prescriptions: A prospective study of community-onset bacteremia in a tertiary hospital in Japan

et al. 2017

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BackgroundRapid identification of positive blood cultures is important for initiation of optimal treatment in septic patients. Effects of automated, microarray-based rapid identification systems on antibiotic prescription against community-onset bacteremia (COB) remain unclear.MethodsWe prospectively enrolled 177 patients with 185 COB episodes (occurring within 72 h of admission) over 17 months. Bacteremia episodes due to gram-positive bacteria (GP) and gram-negative bacteria (GN) in the same patient were counted separately. For GP bacteremia, patients with ≥2 sets of positive blood cultures were included. The primary study objective was evaluating the rates of antibiotic prescription changes within 2 days of rapid identification using the Verigene system.ResultsBacteremia due to GN and GP included 144/185 (77.8%) and 41/185 (22.2%) episodes, respectively. Antibiotic prescription changes occurred in 51/185 cases (27.6% [95%CI:21.3–34.6%]) after Verigene analysis and 70/185 cases (37.8% [30.8–45.2%]) after conventional identification and susceptibility testing. Prescription changes after Verigene identification were more frequent in GP (17/41[41.5%]) than in GN (34/144[23.5%]). Among bacteremia due to single pathogen targeted by Verigene test, bacterial identification agreement between the two tests was high (GP: 38/39[97.4%], GN: 116/116[100%]). The Verigene test correctly predicted targeted antimicrobial resistance. The durations between the initiation of incubation and reporting of the results for the Verigene system and conventional test was 28.3 h (IQR: 25.8–43.4 h) and 90.6 h (68.3–118.4 h), respectively. In only four of the seven episodes of COB in which two isolates were identified by conventional tests, the Verigene test correctly identified both organisms.ConclusionWe observed a high rate of antibiotic prescription changes after the Verigene test in a population with COB especially in GP. The Verigene test would be a useful tool in antimicrobial stewardship programs among patients with COB.

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Section: Discussionmentioning

confidence: 92%

Impact of rapid identification of positive blood cultures using the Verigene system on antibiotic prescriptions: A prospective study of community-onset bacteremia in a tertiary hospital in Japan

et al. 2017

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Cervical necrotizing fasciitis in an infant caused byHaemophilus non influenzae

et al. 1997

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We describe a rare case of cervical necrotizing fasciitis caused by Haemophilus non influenzae in a 5-month-old infant who was concomitantly affected by bacteremia, pneumonia and meningitis. The patient had a satisfactory evolution after treatment with antibiotics, intensive clinical support, and five surgical debridements of the lesion. A previously healthy 5-month-old boy was brought to the Emergency Room with fever and enlargement of the neck associated with vomiting and irritability during the 3 previous days. There was no history of previous trauma nor significant infections. The immunization schedule had not included a vaccine against Haemophilus. The infant was found to be febrile, irritable, pale and dehydrated, with signs of respiratory distress and upper airway obstruction. Examination of the oral cavity revealed the presence of a purulent secretion covering the pharynx. The skin in the cervical region appeared stretched and erythematous, and there were dark purple spots in the right submandibular area. The tissues had a hard consistency without fluctuation points. Lung auscultation showed bilateral rales and inspiratory stridor. X-rays of the cervical area showed a hyperextended cervical lordosis and a diffuse radiolucent area in the retropharyngeai region. Ultrasonographic and computerised tomography (CT) of the neck and skull revealed extensive swelling of the soft cervical tissues. The chest scan disclosed condensations in the lower two thirds of the right lung and in the left pulmonary base, which were barely visible in the X-ray. The infant was admitted to the Intensive Care Unit where laboratory tests conducted showed some abnormal blood results: anaemia, leukopenia withneutrophilia, increased prothrombin and activated partial thromboplastin time, and analysis of the arterial gases revealed hypoxemia. The cerebrospinal fluid yielded an elevated cellularity mostly of polymorphonuclear cells, as well as high protein and low glucose content. CSF bacterioscopy presented intra-and extra-cellular gram-negative pleomorphic bacilli, but the culture was found to be negative. Three blood cultures in brain heart infusion (BHI) medium were performed and subsequently replicated in chocolate agar incubated in carbon dioxide [1]. Samples for culture in tryptic soy broth (TSB) with polianetol sodium sulphonate in anaerobiosis were also collected. The clinical laboratory picture led to a diagnosis of necrotizing fasciitis of the cervical region with meningitis and bilateral bronchopneumonia. Due to his respiratory insufficiency, the infant was submitted to orotracheal intubation and mechanical ventilation. Parenteral antimicrobial therapy was started with clindamycin and ceftriaxone. Surgical intervention was subsequently performed to decompress the airways and remove necrotic tissues. Bacterioscopic examination of the secretion showed the presence of gram-negative coccobacilli which, however, did not grow either in BHI subcultured in chocolate agar under CO 2 or in TSB under anaerobiosis. The patient's initial o...

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Best laboratory practices for respiratory cultures

McCarter

Sharp

2013

Clinical Microbiology Newsletter

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Differentiation of enterobacteriaceae, pseudomonas aeruginosa, and Bacteroides and Haemophilus species in gram-stained direct smears

Cited by 4 publications

References 4 publications

Impact of rapid identification of positive blood cultures using the Verigene system on antibiotic prescriptions: A prospective study of community-onset bacteremia in a tertiary hospital in Japan

Impact of rapid identification of positive blood cultures using the Verigene system on antibiotic prescriptions: A prospective study of community-onset bacteremia in a tertiary hospital in Japan

Cervical necrotizing fasciitis in an infant caused byHaemophilus non influenzae

Best laboratory practices for respiratory cultures

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