blood culture. bacteremia: types transient: disruption of mucosal surfaces (dental or surgical...
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Blood Culture
Bacteremia: Types
Transient: Disruption of mucosal surfaces (dental or surgical procedures)
Intermittent: Associated with abscesses
Continuous: Infective endocarditis
Bacteremia: Pathogens S. Aureus S. Pyogenes S. Pneumoniae H. Influenzae Enterobacteriaceae Bacteroides Pseudomonas Aeruginosa Candida species
Occurrence of False Positive Blood Cultures (Trash)
True )%(
Trash )%(
Maybe )%(
S. aureus8766
Coag negative staph
12826
Enterococcus701614
Diphtheroids2962
C. perfringens2377
C. albicans9010
Blood Cultures: Methods 2 blood cultures for separate
venipuncture sites is adequate 3 sets of blood cultures for I.E. At least 10ml/ venipuncture BLD CX > 5ml blood: 92% yield BLD CX < 5 ml blood: 69% yield Diagnostic yield increased by 3% for
every 1 ml of blood drawn
Blood Cultures: Interpretation Organisms isolated > 72 hours are often
contaminants (+) BLD cultures not compatible with a
clinical syndrome are usually contaminants A single BLD CX with coagulase (-)
staphylococci is often a contaminant A single (+) BLD CX with S. Aureus, gm (-)
bacillie or candida is always a pathogen and requires therapy.
Bacteremia: Contaminants Coagulase (-) Staphylococci Corynebacterium species Bacillus species If multiple isolated from separate sites are
obtained, the organisms could be pathogenic
Viridans Streptococci can be a contaminant
Aim of the test Diagnosis of bacteremia by
aerobic and anaerobic cultivation of the blood, with identification and susceptibility test of the isolated organism (s).
Blood culture should be made for cases with suspected septicemia, endocarditis, and bacteremia secondary to localized infections (pneumonia, intraabdominal abscesses, pyelonephritis, epiglottitis, meningitis).
Aerobic/Anaerobic Blood Culture Bottles
Criteria of specimen rejection Blood collected in tubes or bottles
other than aerobic and anaerobic blood culture bottles.
If the information on the label does not match that of the request form.
Specimens for anaerobic blood culture received in aerobic bottles or vice versa.
Pathogens
Patient preparing
The major difficulty in interpretation of blood cultures is potential contamination by skin flora.
This difficulty can be markedly reduced by careful attention to the details of skin preparation and antisepsis prior to collection of the specimen.
Skin preparation
Obtaining Blood Culture Locate the vein Prep kit
Alcohol 5 sec. Dry 30-60 sec Tincture of Iodine-center to periphery. Dry 45-60 sec
Remove caps, clean with alcohol Put on gloves Without palpating, draw 20 ml and put 10 in
anaerobic and 10 in aerobic bottle Dispose of syringe in sharps container Label bottles and send to lab
Quantity of specimen
Method
Blood is injected to both aerobic and anaerobic bottles and incubated for up to 10 days at 37 C.
Discard as negative after the 10 days During the incubation period, a gram
stain and subculture onto appropriate media should be done.
Interpretation of Positive Blood Cultures
Virtually any organism, including normal flora, can cause bacteremia
A negative culture result does not necessarily rule out bacteremia;
false-negative results occur when pathogens fail to grow
A positive culture result does not necessarily indicate bacteremia;
false-positive results occur when contaminants grow.
Gram-negative bacilli, anaerobes, and fungi should be considered pathogens until proven otherwise.
The most difficult interpretation problem is to determine whether an organism that is usually considered normal skin flora is a true pathogen.
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