Araştırma Makalesi
BibTex RIS Kaynak Göster

Can Blood Culture Contamination Cloud Fungal Positivity?

Yıl 2023, Cilt: 12 Sayı: 1, 61 - 65, 15.03.2023

Ali Korhan Sığ Gülhadiye Avcu Basak Yildiz Atikan Mustafa Güney

https://doi.org/10.53424/balikesirsbd.1201884

Öz

ABSTRACT
Objective: Blood culture (BC) is gold standard for diagnosis of fungemia. Contamination of BC is a major problem worldwide, since it may delay actual diagnosis. The aim of this study was to evaluate “contaminant” vials with a prolonged incubation (max 30 days) with antimicrobial supplemented media to observe any mycological growth. Materials and Methods: Routine BCs obtained patients of Balıkesir Atatürk City Hospital for a year period were included. Render BC System BC12-8 (Render Biotech Co. Ltd., Shenzhen, China) were used. Contaminated vials were re-incubated and conventionally inoculated weekly for four weeks total. In case of any growth, identifications were done by PhoenixTM 100 system (Becton Dickinson, MA, USA) with cornmeal tween 80 agar (RTA Laboratories, Kocaeli, Türkiye). Antifungal susceptibility testing was applied with CLSI disk diffusion method. Results: 3.9% (235 sets and additional 138 vials) of total 6047 BC sets (23.06% positive) were contaminated. Only one vial from central venous catheter showed fungal growth within the first week of conventional inoculation (>8th day of total incubation). The isolate was identified as Candida guilliermondii complex and susceptible to caspofungin. Latter set of this patient were positive for the same fungi in the 3rd day of incubation. Conclusion: International guidelines recommend <3% contamination rate. In this study, our single strain was isolated from catheter vial with prolonged incubation and following set was routinely positive for the same fungi. For optimal isolation at least 2 following sets were required and thus, prolonged incubation was not beneficial. It was found that strict following of the rule of “2 following sets" was enough for optimal isolation of fungemia agent.

Anahtar Kelimeler

invasive fungal infections bloodstream infectons fungi Candida invazif fungal enfeksiyonlar kan dolaşımı enfeksiyonları kontaminasyon

Teşekkür

The authors wish to declare special thanks to Muradiye YARAR, M.D., İlkay BOZDAĞ, M.D., Onur IRMAK, M.D., Alev ÇETİN-DURAN, M.D. and Osman KILINÇ, M.D. (Atatürk City Hospital, Department of Medical Microbiology, Balikesir, Turkey) for their precious support.

Kaynakça

  • REFERENCES Arikan-Akdagli, S., Gülmez, D., Doğan, Ö., Çerikçioğlu, N., Dereli, M. D., Birinci, A., & et al. (2019). First multicentre report of in vitro resistance rates in candidaemia isolates in turkey. Journal of Global Antimicrobial Resistance, 18, 230-234. https://doi.org/10.1016/j.jgar.2019.04.003.
  • Baron, E. J., Scott, J. D., & Tompkins, L. S. (2005). Prolonged incubation and extensive subculturing do not increase recovery of clinically significant microorganisms from standard automated blood cultures. Clinical Infectious Diseases, 41(11), 1677-1680. https://doi.org/10.1086/497595.
  • Bourassa, L., Kates, O., & Liu, C. (2019). Limited diagnostic utility of extended aerobic blood culture incubation for fungal pathogen detection. Open Forum Infectious Diseases, 6(Suppl 2): S140.
  • Butta, H., Sardana, R., Mendiratta, L., Sibal, A., Gupta, V., Chawla, R., & Jafri, A. A. (2019). Time to detection of yeast isolates in pediatric and adult patients with fungemia and its relevance to clinical profile and outcome. Indian Journal of Critical Care Medicine, 23(1): 27-30. https://doi.org/10.5005/jp-journals-10071-23108.
  • Clinical and Laboratory Standards Institute (CLSI). Method for antifungal disk diffusion susceptibility testing of yeasts, 3rd edition. CLSI Document M44. Wayne, Pennsylvania, USA, 2018.
  • Clinical and Laboratory Standards Institute (CLSI). Performance standards for antifungal susceptibility testing of yeasts, 1st edition. CLSI Supplement M60. Wayne, Pennsylvania, USA, 2017.
  • Cornely, O. A., Bassetti, M., Calandra, T., Garbino, J., Kullberg, B. J., Lortholary, O., & et al. (2012). ESCMID guideline for the diagnosis and management of Candida diseases 2012: non‐neutropenic adult patients. Clinical Microbiology and Infection, 18, 19-37. https://doi.org/10.1111/1469-0691.12039.
  • Cuenca‐Estrella, M., Verweij, P. E., Arendrup, M. C., Arikan‐Akdagli, S., Bille, J., Donnelly, J. P., & et al. (2012). ESCMID guideline for the diagnosis and management of Candida diseases 2012: diagnostic procedures. Clinical Microbiology and Infection, 18, 9-18. https://doi.org/10.1111/1469-0691.12038.
  • De Plato, F., Fontana, C., Gherardi, G., Privitera, G. P., Puro, V., Rigoli, R., & et al. (2019). Collection, transport and storage procedures for blood culture specimens in adult patients: recommendations from a board of italian experts. Clinical Chemistry and Laboratory Medicine (CCLM), 57(11), 1680-1689. https://doi.org/10.1515/cclm-2018-1146.
  • Dudakova, A., Blei, C., Groß, U., & Schulze, M. H. (2022). Impact of routine bedside infectious diseases service on clinical management and prognosis of patients with Candida fungemia–an example for antifungal stewardship at university level in germany. International Journal of Infectious Diseases, 119, 150-159. https://doi.org/10.1016/j.ijid.2022.03.054.
  • Gülmez, D., Sığ, A. K., Akar, N., & Duyan, S. (2021). Changing trends in isolation frequencies and species of clinical fungal strains: what do the 12-years (2008-2019) mycology laboratory data tell about?. Mikrobiyoloji Bulteni, 55(1), 53-66. https://doi.org/10.5578/mb.20156.
  • Hope, W. W., Castagnola, E., Groll, A. H., Roilides, E., Akova, M., Arendrup, M. C., & et al (2012). ESCMID* guideline for the diagnosis and management of Candida diseases 2012: prevention and management of invasive infections in neonates and children caused by Candida spp. Clinical Microbiology and Infection, 18, 38-52. https://doi.org/10.1111/1469-0691.12040.
  • Kotey, F. C., Dayie, N. T., Tetteh-Uarcoo, P. B., & Donkor, E. S. (2021). Candida Bloodstream Infections: changes in epidemiology and increase in drug resistance. Infectious Diseases: Research and Treatment, 14, 11786337211026927. https://doi.org/10.1177/11786337211026927.
  • Lamy, B., Dargère, S., Arendrup, M. C., Parienti, J. J., & Tattevin, P. (2016). How to optimize the use of blood cultures for the diagnosis of bloodstream infections?: a state-of-the art. Frontiers in microbiology, 7, 697. https://doi.org/10.3389/fmicb.2016.00697.
  • La Rocco M. Processing specimens for fungal culture. In: Garcia LS (editor), Clinical Microbiology Procedures Handbook, 3th Edition. ASM press, USA, 2010.
  • Lin, S. Y., Lu, P. L., Tan, B. H., Chakrabarti, A., Wu, U. I., Yang, J. H., & et al. (2019). The epidemiology of non‐Candida yeast isolated from blood: the asia surveillance study. Mycoses, 62(2), 112-120. https://doi.org/10.1111/myc.12852.
  • Marginson, M. J., Daveson, K. L., & Kennedy, K. J. (2014). Clinical impact of reducing routine blood culture incubation time from 7 to 5 days. Pathology, 46(7), 636-639. https://doi.org/10.1097/PAT.0000000000000167.
  • Mataj, V., Guney, M., Sig, A. K., Uskudar-Guclu, A., Albay, A., Bedir, O., & Baysallar, M. (2020). An Investigation into bacterial bloodstream infections and antibiotic resistance profiles in a tertiary hospital for a ten-year period. Clinical Laboratory, 66, 1467-1477. https://doi.org/10.7754/clin.lab.2020.191033.
  • Osaki, S., Kikuchi, K., Moritoki, Y., Motegi, C., Ohyatsu, S., Nariyama, T., & et al. (2020). Distinguishing coagulase-negative Staphylococcus bacteremia from contamination using blood-culture positive bottle detection pattern and time to positivity. Journal of Infection and Chemotherapy, 26(7), 672-675. https://doi.org/10.1016/j.jiac.2020.02.004.
  • Ransom, E. M., Alipour, Z., Wallace, M. A., & Burnham, C. A. D. (2021). Evaluation of optimal blood culture incubation time to maximize clinically relevant results from a contemporary blood culture instrument and media system. Journal of clinical microbiology, 59(3), e02459-20. https://doi.org/10.1128/JCM.02459-20.
  • Seagle, E. E., Williams, S. L., & Chiller, T. M. (2021). Recent trends in the epidemiology of fungal infections. Infectious Disease Clinics, 35(2), 237-260. https://doi.org/10.1016/j.idc.2021.03.001.
  • The European Committee on Antimicrobial Susceptibility Testing. Overview of antifungal ECOFFs and clinical breakpoints for yeasts, moulds and dermatophytes using the EUCAST E.Def 7.3, E.Def 9.4 and E.Def 11.0 procedures. Version 3, 2022. http://www.eucast.org.
  • Ullmann, A. J., Akova, M., Herbrecht, R., Viscoli, C., Arendrup, M. C., Arikan‐Akdagli, S., & et al. (2012). ESCMID guideline for the diagnosis and management of Candida diseases 2012: adults with haematological malignancies and after haematopoietic stem cell transplantation (HCT). Clinical Microbiology and Infection, 18, 53-67. https://doi.org/10.1111/1469-0691.12041.

Kontamine Kan Kültürleri Fungal Pozitifliği Gölgeleyebilir Mi?

Yıl 2023, Cilt: 12 Sayı: 1, 61 - 65, 15.03.2023

Ali Korhan Sığ Gülhadiye Avcu Basak Yildiz Atikan Mustafa Güney

https://doi.org/10.53424/balikesirsbd.1201884

Öz

Amaç: Kan kültürü kontaminasyonu dünyada ciddi bir sorundur ve kan dolaşımı enfeksiyonu tanısını geciktirebilmektedir. Bu çalışmanın amacı, kontamine şişelerin uzatılmış inkübasyonu ile mikolojik üreme elde edilip edilemeyeceğinin araştırılmasıdır. Gereç ve Yöntem: Balıkesir Atatürk Şehir Hastanesi’nde bir yıl boyunca erişkin hastaların kan kültürleri Render BC128 Sistemiyle (Render Biotech Co. Ltd., Çin) çalışmaya alındı. Kontamine kan kültürü şişelerinin inkübasyonu geleneksel yöntemlerle haftalık ekilerek 30 güne tamamlandı. Üremelere PhoenixTM 100 sistemi (Becton Dickinson, ABD) ve mısır unu tween 80 agar (RTA Laboratories, Türkiye) ile tanımlama, CLSI disk difüzyon ile antifungal duyarlılık yapıldı. Bulgular: Toplam yıllık 6047 kan kültürü seti (%23.06 pozitif) işlendi ve bunların %3.9’u (235 set ve ek 138 şişe) kontamineydi. Sadece santral venöz kateterden alınan bir şişede anlamlı fungal üreme oldu (toplam inkübasyonun 8. Gününden sonra). Kaspofungine duyarlı Candida guilliermondii kompleks olarak tespit edildi. Bu hastanın takip eden ikinci seti 3’üncü gün pozitif sinyal verdi. Sonuç: Uluslararası rehberler, kontaminasyonu <%3 olarak önermektedir. Bu çalışmada, kateterden alınan kan kültürü şişesinde uzatılmış inkübasyonla fungal üreme oldu ve takip eden set aynı mikroorganizma için rutin inkübasyonda pozitifti. Optimal izolasyon için en az 2 takip eden set alınması gerektiğinden, kontaminasyon tanıyı geciktirmedi ve kontamine şişelerin uzatılmış inkübasyonu fayda sağlamadı. “2 takip eden set” kuralına uyum ile optimal düzeyde fungemi etkeninin izole edilebileceği sonucuna varıldı.

Anahtar Kelimeler

Candida invazif fungal enfeksiyonlar kan dolaşımı enfeksiyonları kontaminasyon

Kaynakça

  • REFERENCES Arikan-Akdagli, S., Gülmez, D., Doğan, Ö., Çerikçioğlu, N., Dereli, M. D., Birinci, A., & et al. (2019). First multicentre report of in vitro resistance rates in candidaemia isolates in turkey. Journal of Global Antimicrobial Resistance, 18, 230-234. https://doi.org/10.1016/j.jgar.2019.04.003.
  • Baron, E. J., Scott, J. D., & Tompkins, L. S. (2005). Prolonged incubation and extensive subculturing do not increase recovery of clinically significant microorganisms from standard automated blood cultures. Clinical Infectious Diseases, 41(11), 1677-1680. https://doi.org/10.1086/497595.
  • Bourassa, L., Kates, O., & Liu, C. (2019). Limited diagnostic utility of extended aerobic blood culture incubation for fungal pathogen detection. Open Forum Infectious Diseases, 6(Suppl 2): S140.
  • Butta, H., Sardana, R., Mendiratta, L., Sibal, A., Gupta, V., Chawla, R., & Jafri, A. A. (2019). Time to detection of yeast isolates in pediatric and adult patients with fungemia and its relevance to clinical profile and outcome. Indian Journal of Critical Care Medicine, 23(1): 27-30. https://doi.org/10.5005/jp-journals-10071-23108.
  • Clinical and Laboratory Standards Institute (CLSI). Method for antifungal disk diffusion susceptibility testing of yeasts, 3rd edition. CLSI Document M44. Wayne, Pennsylvania, USA, 2018.
  • Clinical and Laboratory Standards Institute (CLSI). Performance standards for antifungal susceptibility testing of yeasts, 1st edition. CLSI Supplement M60. Wayne, Pennsylvania, USA, 2017.
  • Cornely, O. A., Bassetti, M., Calandra, T., Garbino, J., Kullberg, B. J., Lortholary, O., & et al. (2012). ESCMID guideline for the diagnosis and management of Candida diseases 2012: non‐neutropenic adult patients. Clinical Microbiology and Infection, 18, 19-37. https://doi.org/10.1111/1469-0691.12039.
  • Cuenca‐Estrella, M., Verweij, P. E., Arendrup, M. C., Arikan‐Akdagli, S., Bille, J., Donnelly, J. P., & et al. (2012). ESCMID guideline for the diagnosis and management of Candida diseases 2012: diagnostic procedures. Clinical Microbiology and Infection, 18, 9-18. https://doi.org/10.1111/1469-0691.12038.
  • De Plato, F., Fontana, C., Gherardi, G., Privitera, G. P., Puro, V., Rigoli, R., & et al. (2019). Collection, transport and storage procedures for blood culture specimens in adult patients: recommendations from a board of italian experts. Clinical Chemistry and Laboratory Medicine (CCLM), 57(11), 1680-1689. https://doi.org/10.1515/cclm-2018-1146.
  • Dudakova, A., Blei, C., Groß, U., & Schulze, M. H. (2022). Impact of routine bedside infectious diseases service on clinical management and prognosis of patients with Candida fungemia–an example for antifungal stewardship at university level in germany. International Journal of Infectious Diseases, 119, 150-159. https://doi.org/10.1016/j.ijid.2022.03.054.
  • Gülmez, D., Sığ, A. K., Akar, N., & Duyan, S. (2021). Changing trends in isolation frequencies and species of clinical fungal strains: what do the 12-years (2008-2019) mycology laboratory data tell about?. Mikrobiyoloji Bulteni, 55(1), 53-66. https://doi.org/10.5578/mb.20156.
  • Hope, W. W., Castagnola, E., Groll, A. H., Roilides, E., Akova, M., Arendrup, M. C., & et al (2012). ESCMID* guideline for the diagnosis and management of Candida diseases 2012: prevention and management of invasive infections in neonates and children caused by Candida spp. Clinical Microbiology and Infection, 18, 38-52. https://doi.org/10.1111/1469-0691.12040.
  • Kotey, F. C., Dayie, N. T., Tetteh-Uarcoo, P. B., & Donkor, E. S. (2021). Candida Bloodstream Infections: changes in epidemiology and increase in drug resistance. Infectious Diseases: Research and Treatment, 14, 11786337211026927. https://doi.org/10.1177/11786337211026927.
  • Lamy, B., Dargère, S., Arendrup, M. C., Parienti, J. J., & Tattevin, P. (2016). How to optimize the use of blood cultures for the diagnosis of bloodstream infections?: a state-of-the art. Frontiers in microbiology, 7, 697. https://doi.org/10.3389/fmicb.2016.00697.
  • La Rocco M. Processing specimens for fungal culture. In: Garcia LS (editor), Clinical Microbiology Procedures Handbook, 3th Edition. ASM press, USA, 2010.
  • Lin, S. Y., Lu, P. L., Tan, B. H., Chakrabarti, A., Wu, U. I., Yang, J. H., & et al. (2019). The epidemiology of non‐Candida yeast isolated from blood: the asia surveillance study. Mycoses, 62(2), 112-120. https://doi.org/10.1111/myc.12852.
  • Marginson, M. J., Daveson, K. L., & Kennedy, K. J. (2014). Clinical impact of reducing routine blood culture incubation time from 7 to 5 days. Pathology, 46(7), 636-639. https://doi.org/10.1097/PAT.0000000000000167.
  • Mataj, V., Guney, M., Sig, A. K., Uskudar-Guclu, A., Albay, A., Bedir, O., & Baysallar, M. (2020). An Investigation into bacterial bloodstream infections and antibiotic resistance profiles in a tertiary hospital for a ten-year period. Clinical Laboratory, 66, 1467-1477. https://doi.org/10.7754/clin.lab.2020.191033.
  • Osaki, S., Kikuchi, K., Moritoki, Y., Motegi, C., Ohyatsu, S., Nariyama, T., & et al. (2020). Distinguishing coagulase-negative Staphylococcus bacteremia from contamination using blood-culture positive bottle detection pattern and time to positivity. Journal of Infection and Chemotherapy, 26(7), 672-675. https://doi.org/10.1016/j.jiac.2020.02.004.
  • Ransom, E. M., Alipour, Z., Wallace, M. A., & Burnham, C. A. D. (2021). Evaluation of optimal blood culture incubation time to maximize clinically relevant results from a contemporary blood culture instrument and media system. Journal of clinical microbiology, 59(3), e02459-20. https://doi.org/10.1128/JCM.02459-20.
  • Seagle, E. E., Williams, S. L., & Chiller, T. M. (2021). Recent trends in the epidemiology of fungal infections. Infectious Disease Clinics, 35(2), 237-260. https://doi.org/10.1016/j.idc.2021.03.001.
  • The European Committee on Antimicrobial Susceptibility Testing. Overview of antifungal ECOFFs and clinical breakpoints for yeasts, moulds and dermatophytes using the EUCAST E.Def 7.3, E.Def 9.4 and E.Def 11.0 procedures. Version 3, 2022. http://www.eucast.org.
  • Ullmann, A. J., Akova, M., Herbrecht, R., Viscoli, C., Arendrup, M. C., Arikan‐Akdagli, S., & et al. (2012). ESCMID guideline for the diagnosis and management of Candida diseases 2012: adults with haematological malignancies and after haematopoietic stem cell transplantation (HCT). Clinical Microbiology and Infection, 18, 53-67. https://doi.org/10.1111/1469-0691.12041.
Toplam 23 adet kaynakça vardır.

Ayrıntılar

Birincil Dil İngilizce
Konular Sağlık Kurumları Yönetimi
Bölüm Makaleler
Yazarlar

Ali Korhan Sığ 0000-0003-2907-257X

Gülhadiye Avcu 0000-0002-0562-3544

Basak Yildiz Atikan 0000-0002-9617-3963

Mustafa Güney 0000-0002-8478-1072

Yayımlanma Tarihi 15 Mart 2023
Gönderilme Tarihi 9 Kasım 2022
Yayımlandığı Sayı Yıl 2023 Cilt: 12 Sayı: 1

Kaynak Göster

APA Sığ, A. K., Avcu, G., Yildiz Atikan, B., Güney, M. (2023). Can Blood Culture Contamination Cloud Fungal Positivity?. Balıkesir Sağlık Bilimleri Dergisi, 12(1), 61-65. https://doi.org/10.53424/balikesirsbd.1201884
 Kapak Resmi İndir

Uluslararası Hakemli Dergi

Dergimiz Açık Erişim Politikasını benimsemiş olup dergimize gönderilen yayınlar için gerek değerlendirme gerekse yayınlama dahil yazarlardan hiçbir ücret talep edilmemektedir. 

Creative Commons License

Bu eser Creative Commons Atıf-GayriTicari 4.0 Uluslararası Lisansı ile lisanslanmıştır.