poltconstruction.blogg.se - Gram negative rods in csf

#GRAM NEGATIVE RODS IN CSF HOW TO#
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There are numerous reasons why blood cultures are contaminated so frequently. In recent years, it has also become apparent that contaminated (i.e., the presence of a pathogen from outside the blood stream) blood cultures are common, leading to falsely positive test results.( 1,2) Contaminated blood cultures constitute as many as half or more of all positive blood cultures in some centers, are very costly to patients and the health care system,( 3) and are confusing for clinicians.( 4,5)

Physicians and clinical microbiologists have long appreciated that blood cultures are perhaps the most important laboratory tests to diagnose serious infections.

Failure of the primary and covering physicians to communicate effectively, ultimately resulting in delayed diagnosis and increased patient morbidity.Īlthough each needs to be appropriately addressed to prevent similar errors, this commentary will focus primarily on the interpretation and potential misinterpretation of positive blood cultures.

Misinterpretation of the clinical significance of the positive blood culture result.

Isolation of a microorganism from blood cultures that in most circumstances would represent contamination but, in this instance, represented a clinically important pathogen that caused a potentially life-threatening infection.

A patient with multiple underlying medical problems that predispose to infection.

The case history that forms the basis for this commentary illustrates several of the important complexities and inefficiencies of modern medicine, some of which resulted in medical errors.

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Diagnosed with subacute bacterial endocarditis and treated with IV vancomycin, the patient made a full recovery. (the final speciation was never determined). A transesophageal echocardiogram (TEE) revealed a tricuspid vegetation and blood cultures again showed Corynebacterium spp. Three weeks later, the patient was readmitted after being shocked by his defibrillator (AICD).

#GRAM NEGATIVE RODS IN CSF SKIN#

The physician assumed that the blood cultures were contaminated from the skin and took no action. That evening, the results were reported to a covering physician who was unfamiliar with the patient or previous culture results. Two days later, 2 out of 2 blood cultures drawn at that ED visit started growing Corynebacterium spp. His symptoms improved with IV fluids, and he was discharged after an 18-hour stay. His physical examination and laboratory test results were unremarkable. One month later, the patient presented to the emergency department (ED) with nausea and vomiting. The physicians assumed that the Corynebacterium was a contaminant from the skin. The patient was clinically stable, so the antibiotics were stopped and the patient was discharged to home. Repeat blood cultures (drawn before antibiotics were begun) remained negative. The patient's subsequent evaluation revealed no evidence of infection, including an unremarkable abdominal CT scan and a normal transthoracic echocardiogram (TTE). The patient was hospitalized, seen by a different infectious disease specialist, and started on IV antibiotics.

#GRAM NEGATIVE RODS IN CSF HOW TO#

Uncertain of how to interpret the result (as this bacteria may represent contaminated blood cultures rather than a true cause of disease), the PCP contacted an infectious disease specialist, who recommended hospitalization. However, 5 days later, the PCP was notified that both sets of blood cultures were growing Corynebacterium spp. The routine laboratory tests done that day revealed only a normocytic anemia. The physician ordered routine blood tests and 2 peripheral blood cultures, diagnosed the patient with a nonspecific viral syndrome, and sent him home. The physical examination was unremarkable except for the presence of chronic peripheral neuropathy. A 62-year-old man with type 2 diabetes mellitus, chronic kidney disease, and a history of ventricular tachycardia with an automated implantable cardiac defibrillator (AICD) came to his primary care physician (PCP) with symptoms of shaking, weakness, and vomiting.