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Journal of Clinical Microbiology, July 1998, p. 1923-1926, Vol. 36, No. 7
Internal Medicine Spokane, Spokane,
Washington 992041;
Laboratory Medicine,
Sacred Heart & Deaconess Medical Centers, Spokane, Washington
992202; and
College of Pharmacy,
Washington State University, Spokane, Washington
992013
Received 26 January 1998/Returned for modification 12 March
1998/Accepted 7 April 1998
A blood culture cohort study investigating issues related to
isolation of coagulase-negative staphylococci (CoNS) and other skin
microflora is reported. Data were collected over 12 weeks to determine
the incidence of significant CoNS bacteremia versus that of
pseudobacteremia (contaminants) and to evaluate drug therapy in
patients with cultures positive for CoNS. In addition, the effectiveness of 0.2% chlorine peroxide as a bactericidal disinfectant was compared to that of 10% providone iodine. A total of 3,276 cultures of blood from 1,433 patients were evaluated in the study. Eighty-nine cultures were positive for skin flora, with 81 of 89 (91%)
involving CoNS. The incidence of significant CoNS bacteremia was 20 of
81 (24.7%), that of indeterminate bacteremia was 10 of 81 (12.3%),
and that of contamination was 59 of 81 (72.8%). The incidence of
significant bacteremia involving CoNS was double the 10 to 12% rate
based on previous estimations at our institutions. In tests with the
two bactericidal disinfectants, 22 of 1,639 cultures (1.3%) in the
chlorine peroxide group versus 37 of 1,637 (2.3%) in the providone
iodine group were considered contaminated (P = 0.065).
Rates of contamination for venipuncture versus catheter collection were
not significantly different (P = 0.46). The overall contamination rate was 59 of 3,276 (1.8%), which is consistent with
the lower end of published quality assurance benchmark standards. The
low rate was believed to be due to the professional phlebotomy staff in
our institutions. There was excellent agreement between retrospective
analysis by reviewers, when formal criteria were used, and the
attending physicians' intuitive clinical impressions in the
classification of significant bloodstream infections (100% agreement)
or contamination (95% agreement). However, physicians still used
antimicrobial agents to treat nearly one-half of the patients with
contaminated blood cultures, with vancomycin being misused in 34% of
patients. In addition, 10% of patients with significant bacteremia
were treated with inappropriate agents. There were no significant
adverse events or prolonged hospital stays due to the unnecessary use
of vancomycin; however, the additional costs of treating patients whose
cultures contained CoNS contaminants was estimated to be $1,000 per
patient. Measures to limit the unnecessary use of vancomycin (and other
agents) are important.
0095-1137/98/$04.00+0
Copyright © 1998, American Society for Microbiology. All rights reserved.
Blood Cultures Positive for Coagulase-Negative
Staphylococci: Antisepsis, Pseudobacteremia, and Therapy of
Patients
*
Corresponding author. Mailing address: Laboratory
Medicine, Sacred Heart Medical Center, 101 West Eighth Ave., P.O. Box
2555, Spokane, WA 99220-2555. Phone: (800) 442-8535. Fax: (509)
455-2052. E-mail: dander{at}wsu.edu.
Prior to the completion of the manuscript Douglas M. Campbell died
of complications associated with an untreatable malignancy. Doug's
role in designing and conducting the study was vital, and he continued
to work on data analysis during his terminal illness. Doug is sorely
missed as both a friend and a colleague.
Journal of Clinical Microbiology, July 1998, p. 1923-1926, Vol. 36, No. 7
0095-1137/98/$04.00+0
Copyright © 1998, American Society for Microbiology. All rights reserved.
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