Reevaluation of Anaerobic Blood Cultures in a Veteran Population

Chandler, Thomas M.; Morton, Steven E.; Byrd, Ryland P.; Fields, Cheryl M.; Roy, Thomas M.

doi:10.1097/00007611-200010000-00008

Cited by 10 publications

(4 citation statements)

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“…The need for objective microbiological diagnosis of anaerobic bacteraemia still remains controversial. It has been proposed that the clinical characteristics of anaerobic infections should guide the empirical choice of antimicrobial therapy [4–6], and the value of performing anaerobic blood cultures routinely has been questioned in several recent studies [5,7,8]. However, other studies have shown that anaerobic bacteraemia often remains unsuspected on clinical grounds, and that a substantial proportion of patients with anaerobic bacteraemia do not receive appropriate antimicrobial treatment on an empirical basis alone [2,4].…”

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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A 62-month retrospective epidemiological survey of anaerobic bacteraemia in a university hospital

Blairon

Gheldre

Delaere

et al. 2006

Clinical Microbiology and Infection

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The incidence of anaerobic bacteraemia was studied retrospectively over 62 months at Mont-Godinne University Hospital, Yvoir, Belgium. The distribution of organisms, clinical presentations, choice of antimicrobial therapy and clinical outcome were analysed. The proportion of positive blood cultures yielding obligate anaerobes was 3.3%. The overall incidence of clinically significant anaerobic bacteraemia was 0.51 cases/1,000 patient admissions (0.61 cases/10,000 hospital-days), but was significantly higher in patients with active haematological malignancies than in other groups (5.97/10,000 vs. 0.33/10,000 hospital-days; p < 0.05). The Bacteroides fragilis group accounted for 61% of isolates, followed by Clostridium spp. (12.2%), Peptostreptococcus spp. and Leptotrichia spp. (7.3% each) and Fusobacterium spp. (4.8%). The most common risk-factors were gastrointestinal surgery (49%) and active haematological malignancies with chemotherapy and/or bone marrow graft (47%). One or more co-morbidities were present in 30 (77%) of 39 patients. The lower gastrointestinal tract (41%) and the oropharynx (23%) were the two most frequent presumed or proven sources for bacteraemia, with the origin remaining unknown in eight (20.5%) cases. The overall mortality rate (evaluated 7 days after the occurrence of bacteraemia) was 13%. Fatal outcome correlated with the severity of underlying diseases and the immunosuppressed status of the patients rather than with the causative pathogen or the effectiveness of antimicrobial therapy. Likewise, there was no difference in the mortality rate between patients with monomicrobial and polymicrobial bacteraemia. Overall, the data re-emphasise the importance of anaerobic bacteraemia, especially in patients with haematological malignancies.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

A 62-month retrospective epidemiological survey of anaerobic bacteraemia in a university hospital

Blairon

Gheldre

Delaere

et al. 2006

Clinical Microbiology and Infection

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“…Blood culture sets usually include two bottles, one for aerobic culture and one for anaerobic culture; however, controversy exists about the added benefit of including the anaerobic bottle. Although anaerobes were isolated very infrequently from blood cultures in one study , another study found that about 14% of blood culture sets had growth in only the anaerobic bottle, mostly with organisms that were not strictly anaerobic . In light of the suggestion of benefit from some studies, including both aerobic and anaerobic bottles in a blood culture set is recommended; however, if only a limited amount of blood is available, clinicians should consider inoculating the aerobic bottle first to ensure that bottle receives an adequate amount of blood for culture .…”

Section: Blood Culture Techniquementioning

confidence: 99%

Identifying and Classifying Bloodstream Infections Among Hemodialysis Patients

Kallen

2013

Seminars in Dialysis

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Bloodstream infections (BSIs) are a prominent clinical problem in patients undergoing hemodialysis. These infections appear to be more common among patients who have a central line as their dialysis access and can be associated with substantial morbidity and mortality. Accurately diagnosing BSIs clearly influences patient management, but is also an important part of an infection prevention program; particularly as facility BSI rates are becoming a recognized quality measure for which dialysis facilities might be held accountable. Blood cultures remain the gold standard for diagnosing BSIs and a number of practices can affect the sensitivity and specificity of this important laboratory test. Optimizing the collection of blood cultures can assist providers with interpretation of positive blood cultures and can help minimize the impact of false-positive and false-negative cultures. This review will describe differences between BSI definitions, examine the use of blood cultures to identify these infections including the use of recommended best practices to maximize culture yield, and highlight characteristics that can assist in the clinical interpretation of positive blood cultures.

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“…There have been multiple retrospective cohort studies in academic and community hospitals, both in the United States and abroad, which reviewed the impact of routine aerobic and anaerobic blood cultures on choice of definitive regimens. Many of these studies show that results of anaerobic blood cultures infrequently lead to changes in patient management, because recognition of the presence of clinical risk factors for anaerobic bacteremia has already led to inclusion of anaerobic coverage in the initial, empiric antimicrobial regimen [ 1–3 ]. Salonen et al [ 4 ] evaluated the impact of positive anaerobic blood culture results and found that 57% of the patients with positive cultures were already on appropriate treatment, 33% of patients had their treatment modified based on the culture results, but approximately 20% of patients with positive anaerobic blood cultures still did not have their treatment appropriately altered when results became available.…”

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Do Positive Anaerobic Culture Results Affect Physicians’ Clinical Management Decisions?

Bhowmick

Varughese

Arakali

et al. 2017

Open Forum Infectious Diseases

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Background.Aerobic and anaerobic cultures from body fluids, abscesses, and wounds are ordered routinely. Prior studies have shown that the results of anaerobic blood cultures do not frequently lead to changes in patient management.Methods.We performed a retrospective chart review to determine whether positive results of anaerobic tissue and fluid cultures (excluding blood) affect physicians’ treatment approaches. Of 3234 anaerobic cultures, 174 unique patient admissions had positive cultures and met inclusion criteria.Results.Only 18% (n = 31) of patient charts with positive cultures had documented physician acknowledgment (90.3% of acknowledgments by infectious diseases physicians), with 9% (n = 15) leading to change in antibiotic regimens based on results. Seventy percent of all patients received initial empiric antibiotics active against anaerobes. Of the remaining 30% (inappropriate, unknown, or no empiric coverage), 1 regimen change was documented after culture results were known.Conclusions.Given the lack of management change based on results of anaerobic wound cultures, the value of routine anaerobic culturing is of questionable utility.

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Reevaluation of Anaerobic Blood Cultures in a Veteran Population

Cited by 10 publications

References 0 publications

A 62-month retrospective epidemiological survey of anaerobic bacteraemia in a university hospital

A 62-month retrospective epidemiological survey of anaerobic bacteraemia in a university hospital

Identifying and Classifying Bloodstream Infections Among Hemodialysis Patients

Do Positive Anaerobic Culture Results Affect Physicians’ Clinical Management Decisions?

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