Prevalence of microbial pathogens in blood cultures: an etiological and histopathological study

El-Din, Al-Zahraa A. Karam; Mohamed, A.Mohamed; Walaa, Hussien; Ghada, S.Lotfy

doi:10.1016/s1658-3655(12)60017-x

Cited by 6 publications

(6 citation statements)

References 26 publications

(23 reference statements)

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“…Furthermore, our study increased BC sampling from 24 to 63 BC per month. These findings are in accordance with other studies in resource-limited settings (12,20). Additionally, the proportion of false-positive BC and therefore the workload could be reduced with automated BC significantly.…”

Section: Discussionsupporting

confidence: 92%

“…Contamination of BC was high in automated and manual BC (48 and 43%, respectively), although clinical training on good practice BC sampling supported our study. The proportion of contaminated BC was higher in our study than in comparable studies in resource-limited settings and above the targeted 3% (20,(22)(23)(24). As most contaminants belonged to the typical flora of the skin, we assume that contamination occurred during sampling due to insufficient disinfection.…”

Section: Discussioncontrasting

confidence: 58%

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Implementation of Automated Blood Culture With Quality Assurance in a Resource-Limited Setting

Laer

N'Guessan²,

Touré³

et al. 2021

Front. Med.

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Background: Blood cultures (BC) have a high clinical relevance and are a priority specimen for surveillance of antimicrobial resistance. Manual BC are still most frequently used in resource-limited settings. Data on automated BC performance in Africa are scarce. We implemented automated BC at a surveillance site of the African Network for improved Diagnostics, Epidemiology and Management of Common Infectious Agents (ANDEMIA).Methods: Between June 2017 and January 2018, pairs of automated BC (BacT/ALERT®FA Plus) and manual BC (brain-heart infusion broth) were compared at a University hospital in Bouaké, Côte d'Ivoire. BC were inoculated each with a target blood volume of 10 ml from the same venipuncture. Automated BC were incubated for up to 5 days, manual BC for up to 10 days. Terminal subcultures were performed for manual BC only. The two systems were compared regarding yield, contamination, and turnaround time. For quality assurance, isolates were retested in a German routine microbiological laboratory.Results: BC sampling was increased from on average 24 BC to 63 BC per month. A total of 337 matched pairs of BC were included. Automated BC was positive in 36.5%, manual BC in 24.0% (p-value < 0.01), proportion of contamination was 47.9 and 43.8%, respectively (p-value = 1.0). Turnaround time of positive BC was shortened by 2.5 days with automated compared to manual BC (p < 0.01). Most common detected pathogens in both systems were Klebsiella spp. (26.0%) and Staphylococcus aureus (18.2%). Most contaminants were members of the skin flora. Retesting of 162 isolates was concordant in 79.6% on family level.Conclusions: Implementing automated BC in a resource-limited setting is possible and improves microbiological diagnostic performance. Automated BC increased yield and shortened turnaround times. Regular training and mentorship of clinicians has to be intensified to increase number and quality of BC. Pre-analytical training to improve diagnostic stewardship is essential when implementing a new microbiological method. Retesting highlighted that manual identification and antimicrobial susceptibility testing can be of good quality and sustainable. The implementation of automated tools should be decided individually according to economic considerations, number of samples, stable supply chain of consumables, and technical sustainability.

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Section: Discussionsupporting

confidence: 92%

Section: Discussioncontrasting

confidence: 58%

Implementation of Automated Blood Culture With Quality Assurance in a Resource-Limited Setting

Laer

N'Guessan²,

Touré³

et al. 2021

Front. Med.

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“…This is obviously longer than what is currently seen with automated systems, where 82–91.6% of growth is detected within 24 h (249–251). Some recent studies from LMICs, directly comparing manual with automated systems, also found higher sensitivity, specificity and especially much lower time-to-detection with the automated system (24–26).…”

Section: Challengesmentioning

confidence: 99%

“…During incubation, the bottles are continuously agitated in the automated equipment. The current automated systems show better performance than manual systems in terms of yield and especially speed of growth, as recent studies from LMICs such as Egypt, Pakistan, and India have shown (24–26). However, these automated systems are costly, require regular maintenance and are not adapted to tropical, dusty environments, impeding the sustainable implementation of this technique in many LMICs outside of study sites, large reference laboratories or private laboratories in the capital cities (1, 27).…”

Section: Introductionmentioning

confidence: 96%

Best Practices of Blood Cultures in Low- and Middle-Income Countries

et al. 2019

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Bloodstream infections (BSI) have a substantial impact on morbidity and mortality worldwide. Despite scarcity of data from many low- and middle-income countries (LMICs), there is increasing awareness of the importance of BSI in these countries. For example, it is estimated that the global mortality of non-typhoidal Salmonella bloodstream infection in children under 5 already exceeds that of malaria. Reliable and accurate diagnosis of these infections is therefore of utmost importance. Blood cultures are the reference method for diagnosis of BSI. LMICs face many challenges when implementing blood cultures, due to financial, logistical, and infrastructure-related constraints. This review aims to provide an overview of the state-of-the-art of sampling and processing of blood cultures, with emphasis on its use in LMICs. Laboratory processing of blood cultures is relatively straightforward and can be done without the need for expensive and complicated equipment. Automates for incubation and growth monitoring have become the standard in high-income countries (HICs), but they are still too expensive and not sufficiently robust for imminent implementation in most LMICs. Therefore, this review focuses on “manual” methods of blood culture, not involving automated equipment. In manual blood cultures, a bottle consisting of a broth medium supporting bacterial growth is incubated in a normal incubator and inspected daily for signs of growth. The collection of blood for blood culture is a crucial step in the process, as the sensitivity of blood cultures depends on the volume sampled; furthermore, contamination of the blood culture (accidental inoculation of environmental and skin bacteria) can be avoided by appropriate antisepsis. In this review, we give recommendations regarding appropriate blood culture sampling and processing in LMICs. We present feasible methods to detect and speed up growth and discuss some challenges in implementing blood cultures in LMICs, such as the biosafety aspects, supply chain and waste management.

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“…Carbon dioxide generated by the growing microorganism is measured in either a fluorescent or colorimetric way [17]. Although adopting such technologies showed substantially increased sensitivity [18][19][20], the high costs associated with the device and blood culture bottles, regular instrument maintenance, and the infrastructural issues prevent their wide usage in low-income and developing countries [17]. As a result, manual culture systems are more popular in these regions.…”

Section: Blood Culture Bottles: Automated or Manual?mentioning

confidence: 99%

Identification of Mycoses in Developing Countries

Arastehfar

Wickes

İlkit

et al. 2019

JoF

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Extensive advances in technology offer a vast variety of diagnostic methods that save time and costs, but identification of fungal species causing human infections remains challenging in developing countries. Since the echinocandins, antifungals widely used to treat invasive mycoses, are still unavailable in developing countries where a considerable number of problematic fungal species are present, rapid and reliable identification is of paramount importance. Unaffordability, large footprints, lack of skilled personnel, and high costs associated with maintenance and infrastructure are the main factors precluding the establishment of high-precision technologies that can replace inexpensive yet time-consuming and inaccurate phenotypic methods. In addition, point-of-care lateral flow assay tests are available for the diagnosis of Aspergillus and Cryptococcus and are highly relevant for developing countries. An Aspergillus galactomannan lateral flow assay is also now available. Real-time PCR remains difficult to standardize and is not widespread in countries with limited resources. Isothermal and conventional PCR-based amplification assays may be alternative solutions. The combination of real-time PCR and serological assays can significantly increase diagnostic efficiency. However, this approach is too expensive for medical institutions in developing countries. Further advances in next-generation sequencing and other innovative technologies such as clustered regularly interspaced short palindromic repeats (CRISPR)-based diagnostic tools may lead to efficient, alternate methods that can be used in point-of-care assays, which may supplement or replace some of the current technologies and improve the diagnostics of fungal infections in developing countries.

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Prevalence of microbial pathogens in blood cultures: an etiological and histopathological study

Cited by 6 publications

References 26 publications

Implementation of Automated Blood Culture With Quality Assurance in a Resource-Limited Setting

Implementation of Automated Blood Culture With Quality Assurance in a Resource-Limited Setting

Best Practices of Blood Cultures in Low- and Middle-Income Countries

Identification of Mycoses in Developing Countries

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