Improving Blood Culture Sensitivity WHEN AND WHY Blood ...
Improving Blood Culture Sensitivity WHEN AND WHY Blood ...
Improving Blood Culture Sensitivity WHEN AND WHY Blood ...
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Patients on Antibiotics<br />
• Four blood culture studies reported the<br />
number of patients on antibiotics when<br />
blood cultures were obtained<br />
– 36% (J Clin Micro 35:2634-2638, 2638 1997)<br />
– 32.9% (J Clin Micro 35:53-58, 1997)<br />
– 28.6% (Clin Infec Dis 24:584-602, 1997)<br />
– 63% (J Clin Micro 33:2856-2858, 1995)<br />
Break-Through Bacteremia (BTB)<br />
Occurs when patient is receiving antibiotics to which<br />
offending organism is susceptible, but still has bacteria in<br />
the bloodstream.<br />
Critical to patient management and survival and<br />
reimbursements to know if patient has BTB.<br />
Concentration of antibiotic(s) may be too low.<br />
Inadequate drainage or major problems at<br />
focus of infection that must be addressed.<br />
BACTEC RESIN vs<br />
BACT/ALERT ST<strong>AND</strong>ARD<br />
Smith et al. JCM 33:1905-1908 (1995)<br />
• 10,000 bottle study<br />
• Bact/Alert std missed 33% of Staph<br />
aureus. Staph aureus detected t d by<br />
Bactec resin<br />
• Bact/Alert standard missed 25% of<br />
cases of Pseudomonas<br />
• Large sepsis reimbursement losses<br />
Clinical Comparion of BACTEC Resin<br />
Media and BacT/Alert FAN Media<br />
• Comparative Yield of<br />
Clinically Important<br />
Bacteria and Yeast from<br />
Patients Receiving<br />
Antibiotic Therapy<br />
– BACTEC recovered approx.<br />
8% more isolates from<br />
patients receiving<br />
antimicrobial therapy.<br />
– More of the isolates were<br />
those that were among the<br />
top 10 isolates that typically<br />
occur in blood cultures.<br />
Greater recovery of<br />
gram neg bacilli<br />
BacT/Alert had higher<br />
recovery of:<br />
S. Aureus S. pneumoniae<br />
E. faecalis C. albicans<br />
E. faecium C. neoformans<br />
E. Coli C. glabrata<br />
E. cloacae<br />
Other enterics<br />
P. aeruginosa<br />
Other Gram-bacili<br />
H. capsulatum<br />
Jorgenson, et al. JCM, Vol 35, No. 1, p. 53-58, Jan 1997<br />
FAN BOTTLE vs.<br />
BACT/ALERT ST<strong>AND</strong>ARD<br />
McDonald et al. JCM 34:2180-87 (1996)<br />
• Analyzed 1,047 positive blood cultures<br />
• Bact/Alert standard missed 126 cases of<br />
septicemia<br />
• Chart review showed that 65% of the<br />
cases missed by standard bottle clinically<br />
significant. Lost reimbursements.<br />
Fan Bottle Helpful Hint<br />
• Tilt slide slightly<br />
• Put blood culture fluid at top of the tilt<br />
• Put blood culture fluid at top of the tilt<br />
• Charcoal particles should run down toward<br />
bottom of tilt<br />
• Bacteria should stay near the top<br />
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