Skip to main content Accessibility help
×
Home

Determining the Significance of Coagulase-Negative Staphylococci Isolated From Blood Cultures at a Community Hospital A Role for Species and Strain Identification

  • Soon-Duck Kim (a1) (a2), L. Clifford McDonald (a1) (a2), William R. Jarvis (a1) (a2), Sigrid K. McAllister (a1) (a2), Robert Jerris (a1) (a2), Loretta A. Carson (a1) (a2) and J. Michael Miller (a1) (a2)...

Abstract

Objectives:

To determine the degree to which species identification or strain relatedness assessment of successive blood culture isolates of coagulase-negative staphylococci (CNS) may improve the clinical diagnosis of bloodstream infection (BSI).

Setting:

400-bed community hospital.

Design:

Prospective laboratory survey during which all CNS blood culture isolates obtained between mid-August 1996 and mid-February 1997 (study period) were saved and later identified to the species level; selected isolates were genotyped using pulsed-field gel electrophoresis at the Centers for Disease Control and Prevention (CDC). Retrospective review of medical records of 37 patients with multiple cultures positive for CNS.

Results:

During the study period, 171 patients had blood cultures positive for CNS; 130 had single positive cultures and 41 had ≥2 positive cultures. Of these 41, 23 (62%) were from patients with signs and symptoms of BSI according to CDC surveillance definitions. Species identification and strain clonality of CNS isolates from patients with ≥2 positives revealed 3 (13%) of the 23 patients did not have a consistent CNS species, and another 3 (13%) did not have a consistent genotype in the ≥2 positive cultures, suggesting that CNS from these patients probably were contaminants. Thus, species identification and strain clonality assessment reduced by 27% the number of patients with BSI diagnosed based on the presence of symptoms and ≥2 positive blood cultures.

Conclusions:

Routine species identification and selected strain genotyping of CNS may reduce the misinterpretation of probable contaminants among patients with ≥2 positive blood cultures.

Copyright

Corresponding author

Hospital Infections Program (HIP), Centers for Disease Control and Prevention, 1600 Clifton Rd, MS E69, Atlanta, GA 30333

References

Hide All
1.Banerjee, SN, Emori, TG, Culver, DH, Gaynes, RP, Jarvis, WR, Horan, T, et al. Secular trends in nosocomial primary bloodstream infections in the United States, 1980-1989. National Nosocomial Infections Surveillance System. Am J Med 1991;91(3B):86S–89S.
2.Weinstein, MP, Reller, LB, Murphy, JR, Lichtenstein, KA. The clinical significance of positive blood cultures: a comprehensive analysis of 500 episodes of bacteremia and fungemia in adults, I: laboratory and epidemiologic observations. Rev Infect Dis 1983;5:3553.
3.Viagappan, M, Kelsey, MC. The origin of coagulase-negative staphylococci isolated from blood cultures. J Hosp Infect 1995;30:217223.
4.Centers for Disease Control and Prevention. Recommendations for preventing the spread of vancomycin resistance. Recommendations of the Hospital Infection Control Practices Advisory Committee (HICPAC). MMWR 1995;44:113.
5.Bates, DW, Goldman, L, Lee, TH. Contaminant blood cultures and resource utilization. The true consequences of false-positive results. JAMA 1991;265:365369.
6.Souvenir, D, Anderson, DEJ, Palpant, S, Mroch, H, Askin, S, Anderson, J, et al. Blood cultures positive for coagulase-negative staphylococci: antisepsis, pseudobacteremia, and therapy of patients. J Clin Microbiol 1998;36:19231926.
7.Surdulescu, S, Utamsingh, D, Shekar, R. Phlebotomy teams reduce blood-culture contamination rate and save money. Clinical Performance and Quality Healthcare 1998;6:6062.
8.Kirchhoff, LV, Sheagren, JN. Epidemiology and clinical significance of blood cultures positive for coagulase-negative Staphylococcus. Infect Control 1985;6:479486.
9.Baltimore, RS. Is it real or is it a contaminant? A guide to the interpretation of blood culture results. Am J Dis Child 1998;141:241242.
10.Archer, GL. Coagulase-negative staphylococci in blood cultures: the clinician’s dilemma. Infect Control 1985;6:477478.
11.Bates, DW, Lee, TH. Rapid classification of positive blood cultures. Prospective validation of a multivariate algorithm. JAMA 1992;267:19621966.
12.Herwaldt, LA, Geiss, M, Kao, C, Pfaller, MA. The positive predictive value of isolating coagulase-negative staphylococci from blood cultures. Clin Infect Dis 1996;22:1420.
13.Khatib, R, Riederer, KM, Clark, JA, Khatib, S, Briski, LE, Wilson, FM. Coagulase-negative staphylococci in multiple blood cultures: strain relatedness and determinants of same-strain bacteremia. J Clin Microbiol 1995;33:816820.
14.Garner, JS, Jarvis, WR, Emori, TG, Horan, TC, Hughes, JM. CDC definitions for nosocomial infections, 1988. Am J Infect Control 1988;16:128140.
15.Kloos, WE, Lambe, DW. Simplified scheme for routine identification of human Staphylococcus species. J Clin Microbiol 1975;1:8287.
16.Kloos, WE, Bannerman, TL. Staphylococcus and Micrococcus. In: Murray, PR, Baron, EJ, Pfaller, MA, Tenover, FC, Yolken, RH, eds. Manual of Clinical Microbiology. 6th ed. Washington, DC: American Society for Microbiology; 1995:282298.
17.Smith, C, Cantor, C. Purification, specific fragmentation, and separation of large DNA molecules. In: Wu, R, ed. Methods in Enzymology. San Diego, CA: Academic Press; 1987:449467.
18.Tenover, FC, Arbeit, RD, Goering, RV, Mickelsen, PA, Murray, BE, Persing, DH, et al. Interpreting chromosomal DNA restriction patterns produced by pulsed-field gel electrophoresis: criteria for bacterial strain typing. J Clin Microbiol 1995;33:22332239.
19. Centers for Disease Control and Prevention. Update: Staphylococcus aureus with reduced susceptibility to vancomycin—United States, 1997. MMWR 1997;46:813815.
20.Khatib, R. Lack of predictive value of isolating coagulase-negative staphylococci from blood cultures. Clin Infect Dis 1996;23:412.
21.Johnson, JR. Defining true bacteremia due to coagulase-negative staphylococci. Clin Infect Dis 1996;23:413414.
22.Van Wijngaerden, E, Peetermans, WE, Van Lierde, S, Van Eldere, J. Polyclonal Staphylococcus endocarditis. Clin Infect Dis 1997;25:6971.
23.Archer, GL, Karchmer, AW, Vishniavsky, N, Johnston, JL. Plasmid-pattern analysis for the differentiation of infecting from noninfecting Staphylococcus epidermidis. J Infect Dis 1984;149:913920.
24.Tan, TQ, Musser, JM, Shulman, RJ, Mason, EOJ, Mahoney, DHJ, Kaplan, SL. Molecular epidemiology of coagulase-negative Staphylococcus blood isolates from neonates with persistent bacteremia and children with central venous catheter infections. J Infect Dis 1994;169:13931397.
25.Archer, GL, Vishniavsky, N, Stiver, HG. Plasmid pattern analysis of Staphylococcal epidermidis isolates from patients with prosthetic valve endocarditis. Infect Immun 1982;35:627632.
26.Boyce, JM, Potter-Bynoe, G, Opal, SM, Dziobek, L, Medeiros, AA. A common-source outbreak of Staphylococcus epidermidis infections among patients undergoing cardiac surgery. J Infect Dis 1990;161:493499.
27.van Belkum, A, Kluijtmans, J, van Leeuwn, W, Goessens, W, ter Averst, E, Verbrugh, H. Investigation into the repeated recovery of coagulase-negative staphylococci from blood taken at the end of cardiopulmonary by-pass. J Hosp Infect 1995;31:285293.
28.Dominguez, MA, Linares, J, Pulido, A, Perez, JL, de Lencastre, H. Molecular tracking of coagulase-negative staphylococcal isolates from catheter-related infections. Microb Drug Resist 1996;2:423429.
29.Martin, DM, Vindel, A, Offez-Nieto, JA. Epidemiological typing of clinically significant strains of coagulase-negative staphylococci. J Hosp Infect 1995;29:3543.
30.Bares, I, Paszti, J, Czirok, E. Typing of coagulase-negative staphylococci isolated from immunocompromised patients. Acta Microbiologica et Immunologica Hungarica 1994;41:163172.
31.Zaidi, AK, Harrell, LJ, Rost, JR, Reller, LB. Assessment of similarity among coagulase-negative staphylococci from sequential blood cultures of neonates and children by pulsed-field gel electrophoresis. J Infect Dis 1996;174:10101014.
32.Toldos, CM, Yague, G, Ortiz, G, Segovia, M. Assessment of multiple coagulase-negative staphylococci isolated in blood cultures using pulsed-field gel electrophoresis. Eur J Clin Microbiol Infect Dis 1997;16:581586.
33.Koneman, EW, Allen, SD, Janda, WM, Schreckenberger, PC, Winn, SC. Color Atlas and Textbook of Diagnostic Microbiology. 5th ed. Philadelphia, PA: Lippincott-Raven; 1997:539566.
34.Weinbaum, FI, Lavie, S, Danek, M, Sixsmith, D, Heinrich, GF, Mills, SS. Doing it right the first time: quality improvement and the contaminant blood culture. J Clin Microbiol 1997;35:563565.

Metrics

Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed