Determining the clinical significance of coagulase-negative staphylococci isolated from blood cultures

Susan E Beekmann; Daniel J Diekema; Gary V Doern

doi:10.1086/502584

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Determining the clinical significance of coagulase-negative staphylococci isolated from blood cultures

Journal article

Peer reviewed

Determining the clinical significance of coagulase-negative staphylococci isolated from blood cultures

Susan E Beekmann, Daniel J Diekema and Gary V Doern

Infection control and hospital epidemiology, Vol.26(6), pp.559-566

06/2005

DOI: 10.1086/502584

PMID: 16018432

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Abstract

Coagulase-negative staphylococci are both an important cause of nosocomial blood-stream infections and the most common contaminants of blood cultures. Judging the clinical significance of coagulase-negative staphylococci is vital but often difficult and can have a profound impact on an institution's bloodstream infection rates. Our objective was to develop an algorithm to assist in determining the clinical significance of coagulase-negative staphylococci. A single experienced reviewer examined the medical records of 960 consecutive patients with positive blood cultures in a tertiary-care referral teaching hospital. Four hundred five of the cultures contained coagulase-negative staphylococci. A determination of clinical significance was made and the performances of various published algorithms that contained readily available clinical and laboratory data were compared. Eighty-nine (22%) of the episodes were considered significant, whereas 316 were contaminants. Patients with bacteremia were significantly more likely to be neutropenic and exhibit signs of sepsis syndrome. The algorithm with the best combined sensitivity (62%) and specificity (91%) for determining the clinical significance of coagulase-negative staphylococci was defined as at least two blood cultures positive for coagulase-negative staphylococci within 5 days, or one positive blood culture plus clinical evidence of infection, which includes abnormal white blood cell count and temperature or blood pressure. Use of this algorithm could potentially reduce misclassification of nosocomial bloodstream infections and inappropriate use of vancomycin for positive blood cultures likely to represent contamination.

Prospective Studies

Fever - microbiology

Humans

Infection Control

Bacterial Typing Techniques - methods

Drug Utilization

Bacteremia - microbiology

Anti-Bacterial Agents - therapeutic use

Likelihood Functions

Sensitivity and Specificity

Hospitals, Teaching

Bacteremia - blood

Leukocyte Count

Staphylococcal Infections - microbiology

Staphylococcal Infections - blood

Staphylococcal Infections - drug therapy

Blood Specimen Collection - standards

Coagulase

Bacteremia - drug therapy

Bacteremia - diagnosis

Bacterial Typing Techniques - standards

Cross Infection - drug therapy

Iowa

Staphylococcal Infections - diagnosis

Algorithms

Analysis of Variance

Staphylococcus - isolation & purification

Vancomycin - therapeutic use

Cross Infection - microbiology

Cross Infection - diagnosis

Decision Trees

Blood Specimen Collection - methods

Cross Infection - blood

Details

Title: Subtitle: Determining the clinical significance of coagulase-negative staphylococci isolated from blood cultures
Creators: Susan E Beekmann - Division of Medical Microbiology, Department of Pathology, University of Iowa College of Medicine, Iowa City, Iowa, USA. susan-beekmann@uiowa.edu
Daniel J Diekema
Gary V Doern
Resource Type: Journal article
Publication Details: Infection control and hospital epidemiology, Vol.26(6), pp.559-566
Publisher: United States
DOI: 10.1086/502584
PMID: 16018432
ISSN: 0899-823X
eISSN: 1559-6834
Language: English
Date published: 06/2005
Academic Unit: Infectious Diseases; Epidemiology; Pathology; Internal Medicine
Record Identifier: 9983986368802771

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126 Times Cited - Web of Science

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