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Cardiovascular Disease
Published in John S. Axford, Chris A. O'Callaghan, Medicine for Finals and Beyond, 2023
Multiple blood cultures are the key investigation. At least three sets of cultures should be taken over a 12–24-hour period from different sites (including IV line if present), before antibiotics are given. About 80% will prove to be positive, but 20% will be negative. Negative blood cultures are usually found in patients who have been exposed to antibiotics early on in the illness, or in those with a chronic history where high levels of antibodies have developed. Specific culture mediums and serological markers may be required for rarer organisms. Indwelling IV lines and catheters should be removed and sent for culture. Culture-negative endocarditis is associated with a poorer prognosis.
Complications of open repair of ruptured abdominal aortic aneurysm
Published in Sachinder Singh Hans, Mark F. Conrad, Vascular and Endovascular Complications, 2021
Aortic graft infections are often difficult to diagnose as the patient may present with nonspecific symptoms such as generalized weakness, malaise, anorexia, back pain, and unexplained weight loss. Occasionally, the patient may present with overt sepsis.8 The laboratory and diagnostic studies are often nonspecific but may include leukocytosis with a shift to the left, elevated C-reactive protein and sedimentation rate. Blood culture may not give positive results. Common pathogens include Staphylococcus aureus and Staphylococcus epidermidis. Staphylococcus epidermidis infection produces biofilm and attracts foreign bodies like prosthetic graft. Biofilm contains a large number of persistent cells that protect the microorganism against neutrophil-dependent killing and complement system inactivation via deposition of C3b and immunoglobin G. Imaging studies such as CTA aid in confirming the diagnosis and help in evaluating the extent of infection.
Paper 1
Published in Amanda Rabone, Benedict Thomson, Nicky Dineen, Vincent Helyar, Aidan Shaw, The Final FRCR, 2020
Amanda Rabone, Benedict Thomson, Nicky Dineen, Vincent Helyar, Aidan Shaw
A 31 year old patient comes to the emergency department with worsening lower lumbar back pain over the past 7 weeks. The patient has no fixed abode and has a recent history of intravenous drug use. Inflammatory markers are raised and the patient has a temperature of 37.5 °C. Chest radiograph is normal and urine dip is negative. Blood cultures are sent to the laboratory. Radiograph of the spine shows reduction in disc space at L3/4. MRI reveals high T2 signal and post contrast enhancement in the L3/4 disc with low T1 and high T2 signal in the adjacent vertebral bodies. There is also an enhancing paravertebral collection which is inseparable from the left psoas muscle.
Blood cultures with one venipuncture instead of two: a prospective clinical comparative single-center study including patients in the ICU, haematology, and infectious diseases departments
Published in Infectious Diseases, 2023
Elina Andersson Norlén, Micael Widerström, Anna Lindam, Johanna Olsson, Ulf Ryding
Blood culture is the key diagnostic method for severe infections, sepsis, and septic shock to investigate the presence of bloodstream infections. Blood culture findings are of great value for pathogen identification, antimicrobial susceptibility testing, and the selection of appropriate antibiotics. The bacterial concentration in the bloodstream is considerably low; for example, patients with bacteraemia showed a bacterial density between 0.01 and 2 colony-forming units per millilitre of blood [1–3]. The probability of detecting bloodstream infections increases with increasing blood volume. The total blood volume is the most important factor, rather than the number of venipunctures [4,5]. Adequate blood volume to increase the detection rate can be achieved either by increasing the number of venipunctures or by increasing the blood volume from a single venipuncture.
Bacteremia in patients with diabetic ketoacidosis: a cross-sectional study
Published in Hospital Practice, 2023
Naoto Ishimaru, Toshio Shimokawa, Takahiro Nakajima, Yohei Kanzawa, Saori Kinami
In a prospective study of patients with DKA, mortality was significantly higher in patients with sepsis compared with those without [15], but the data on bacteremia in their study population was not reported. Bacteremia was identified as an independent risk factor for incomplete recovery of renal function at discharge in a retrospective study of patients with infection-precipitated DKA [16]. Bacteremia accounted for 18.1% of the study population, although the number from whom blood culture was obtained was unclear [16]. Blood culture is important for the diagnosis of infectious diseases and is essential for the diagnosis of bacteremia. Moreover, it is recommended that blood cultures are taken for patients with DKA as a septic screening [1,17]. Owing to the differences in previous studies in populations and outcomes, the blood culture positivity ratio within patients with DKA is unclear. This study therefore aims to determine the incidence of bacteremia in patients with DKA and to investigate the factors associated with the positive blood culture.
Increasing clinical impact and microbiological difficulties in diagnosing coagulase-negative staphylococci in infective endocarditis – a review starting from a series of cases
Published in Current Medical Research and Opinion, 2022
Nicoleta-Monica Popa-Fotea, Alexandru Scafa-Udriste, Grigore Iulia, Alina Ioana Scarlatescu, Nicoleta Oprescu, Cosmin Mihai, Miruna Mihaela Micheu
A contaminated blood culture can have an important impact not only at the individual level, but also globally, on the entire health system. False positive blood cultures significantly increase healthcare costs, while efforts in the direction of reducing blood culture contamination by various strategies are being continuously researched, including through hiring dedicated phlebotomists, an approach that could reduce the annual financial burden by almost 5 million dollars31. A high number of unnecessary antibiotics prescriptions are issued due to contaminants, with increment costs of roughly £5000 per subject32. Despite numerous studies looking for distinctive markers to differentiate commensal from pathogenic CoNS strains, there is no single parameter with either sufficient sensitivity or specificity to be used in a clinical setting; several clinical and microbiological characteristics must be considered in conjunction with host’s susceptibility (Figure 1).