Objective To investigate clinical diagnosis，timing of surgery and perioperative therapeutic strategies for blood culture-negative infective endocarditis （IE）. Methods Clinical data of 240 IE patients who were admitted tWuhan Asia Heart Hospital between July 2008 and July 2012 were retrospectively analyzed. According to their blood cultureresults，all the patients were divided into blood culture-negative group and blood culture-positive group. In the blood culture-negative group，there were 158 patients including 88 male and 70 female patients with their age of 51.3±10.1 years. In the blood culture-positive group，there were 82 patients including 45 male and 37 female patients with their age of 48.9±9.8 years. All the patients underwent surgical treatment，and the surgical procedures included complete vegetations excision，debridement of infected valves，removal of necrotic tissue around the annulus，and concomitant heart valve replacement or intracardiac repair. Postoperatively，all the patients received routine monitoring in ICU，cardiac glycosides，diuretics，other symptomatic treatment and adequate dosages of antibiotics for 4-6 weeks. Results Four patients died postoperatively in this study including 1 patient for low cardiac output syndrome and 3 patients for multiple organ dysfunction syndrome，1 patient in the blood culture-positive group and 3 patients in the blood culture-negative group respectively. There was no statistical difference in surgical mortality between the 2 groups （χ2=0.15，P=0.70）. All the other patients were discharged successfully and followed up for 6 to 36 months with the median follow-up time of 22 months. During follow-up, 2 patients died including 1 patient for cerebral infarction 2 years after surgery and another patient for cerebral hemorrhage 3 yearsafter surgery. Conclusion Patients with blood culture-negative IE should receive adequate dosage and duration of broad-spectrum antibiotics to control the infection rapidly, and aggressive surgical therapy to decrease in-hospital mortality and improve their quality of life and prognosis.
ObjectiveTo investigate the distribution of bacteria detected from blood culture of pediatric patients and to observe the blood culture contamination rate. MethodsA total of 6 530 blood samples, collected from January 2011 to December 2012 were detected by BacT/Alert 3D automated blood culture system. We found out the contamination bacteria according to clinical data, laboratory data and microbiology knowledge. ResultsA total of 314 bacteria strains were isolated from 6 530 blood samples, and the positive rate was 4.8%, 228 of which were gram-positive bacteria. The isolates were mainly coagulase-negative staphylococci (43.9%), followed by Staphylococcus aureus (2.9%). In addition, 86 cases were gram-negative bacteria, the majority of which were Escherichia coli (9.6%), followed by Klebsiella pneumonia (8.3%). The overall blood culture contamination rate was 49.7% (156 bacteria were identified). The top two were coagulase-negative staphylococci (31.2%), followed by Bacillus sp. (6.4%). ConclusionThe contamination rate is high in children's blood culture, and coagulase-negative staphylococci are the main bacteria. It's necessary to use clinical data and laboratory data to determine its clinical significance, and avoid unnecessary use of antibiotics.
ObjectiveTo improve the knowledge of pulmonary actinomycosis. MethodsOne case of pulmonary actinomycosis with positive blood culture diagnosed on December 2013 in North Huashan Hospital was analyzed,and related literature from CNKI and Medline after 1990 were reviewed. ResultsA 57-year-old male had recurrent fever for 24 days.Chest CT showed pneumonia in the right middle lobe.Actinomyce culture was twice positive by anaerobic blood culture.The patient's temperature was normal after large doses of penicillin and doxycycline therapy.Literature review revealed that the incidence of pulmonary actinomycesis is common in males.Poor oral hygiene is the main predisposing factors.The common clinical presentations include cough,sputum production,chest pain and hemoptysis.The peripherally progressive enhancement on CT has a certain diagnostic value for pulmonary actinomycosis.Pulmonary actinomycosis can increase FDG uptake on 18F-FDG PET scan and can mimic lung cancer.Accurate diagnosis is generally made by histopathological examination of lung biopsy or surgical samples.High-dose intravenous penicillin therapy is preferred for pulmonary actinomycosis followed by prolonged oral antibiotics for 6 to 12 months.Surgical intervention may be necessary for refractory hemoptysis or patients who do not respond to antibiotic therapy. ConclusionPulmonary actinomycosis is a rare disease.Symptoms of pulmonary actinomycosis are atypical.This patient is the first reported case of actinomyces with positive blood cultures.
ObjectiveTo investigate the diagnostic value of simultaneous culture of central venous catheter (CVC) blood and peripheral blood for catheter-related bloodstream infections (CRBSI). MethodsNon-septic patients who were treated with CVC for 1 to 7 days were enrolled from February 2011 to February 2015 in the First Hospital of Wuhan City. Blood were collected from both peripheral vein and CVC for bacterial culture once a day. The CVCs were removed from patients who got CRBSI from the first to sixth day and who did not by the end of the seventh day for semi-quantitative catheter culture, quantitative catheter culture, CVC culture and catheter exit-site pus culture. The diagnosis of CRBSI were based on 4 methods as follows:A, both peripheral and CVC blood were positive and the time of CVC blood positive were 2 hours earlier than peripheral blood; B, the colonies of semi-quantitative catheter cultures were ≥15 CFU and the microorganisms in both CVC and peripheral blood were the same; C, the colonies ratio of CVC and peripheral blood cultures were ≥5:1; D, the microorganisms in both the peripheral blood and catheter exit-site pus were the same. The diagnostic value of the four methods was compared. ResultsA total of 1 086 patients were finally included. From 1 to 7 days, 64 patients were peripheral blood positive, 79 were CVC blood positive. The patients diagnosed as CRBSI using A, B, C, and D methods were 58, 55, 51, and 36, respectively. Sixty patients were diagnosed as CRBSI based on the clinical and laboratory methods. For the number of patients diagnosed with CRBSI, there was no significant difference between A and B (P>0.05), as well as A and C (P>0.05), however, significant difference was found between A and D (P<0.05). In the diagnostic value of CRBSI, A is similar to B (sensitivity:93.33% vs. 91.67%, specificity:99.81% vs. 100%, Youden index:0.93 vs. 0.92). A, B and C had almost similar specificity (all >99%), however, A had higher sensitivity (93.33% vs. 76.67%, 58.33%) and Youden index (0.93 vs. 0.76, 0.58). ConclusionSimultaneous culture of CVC blood and peripheral blood has a good diagnostic value for CRBSI.
Objective To explore the pathogen distribution and the characteristics of antibiotics use of patients with positive bile culture in order to provide evidence for appropriate antibiotic use. Methods Using a patient-based approach, the clinical and laboratory data of patients with positive bile culture between December 1st 2016 and November 30th 2017 were retrospectively analyzed. The pathogen distribution and antibiotics use of patients with bililary duct infections and colonizations were analyzed. Multidrug-resistant organism infections of patients with bililary duct infections were studied. Results There were 299 submitted bililary samples and in which 158 were culture-positive (52.8%). One hundred and ten strains of pathogens were found in 79 patients with positive bile culture, including 66 strains of Gram-negative (G–) organisms (60.0%), 37 strains of Gram-positive (G+) organisms (33.6%), and 7 strains of fungi (6.4%). The top three G– organisms were Escherichia coli (25 strains, 22.7%), Klebsiella pneumoniae (9 strains, 8.2%), and Acinetobacter baumanii (7 strains, 6.4%). The top three G+ organisms were Enterococcus faecium (10 strains, 9.1%), Enterococcus faecalis (6 strains, 5.5%), and coagulase negativeStaphylococcus (6 strains, 5.5%). The number of patients with bililary duct infections and colonizations were 42 and 37, respectively, with pathogens occupied mainly by G– bacteria. Ten strains of multidrug-resistant organisms were isolated from patients with bililary duct infections. Compared to patients with non-multidrug-resistant organism infections, the length of antibiotics use was longer in patients with multidrug- resistant organism infections (t=2.129, P=0.039). The rate of target therapy for antibiotics in patients with bililary duct infections was 76.2%. The rate of proper antibiotics use was 16.2% before positive bile culture and 78.4% after positive bile culture in patients with bililary duct colonizations. Conclusions Pathogens isolated from bile culture of infection and colonization are predominantly G– organisms. The bile culture and blood culture should be done for patients with suspected bililary duct infection. Infection and colonization should be distinguished for positive bile culture and antibiotic should be chosen according to drug susceptibility test results.