Resistance profiles of coagulase-negative staphylococci contaminating blood cultures predict pathogen resistance and patient mortality
Blood culture isolates are the cornerstone of adequate antibiotic treatment. However, many blood cultures are contaminated with bacteria residing on the skin, the most common contaminants being coagulase-negative staphylococci (CoNS). Such contaminated cultures are mostly disregarded. In this retros...
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| Veröffentlicht in: | Journal of antimicrobial chemotherapy 2014-09, Vol.69 (9), p.2541-2546 |
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| creator | Obolski, Uri Alon, Danny Hadany, Lilach Stein, Gideon Y |
| description | Blood culture isolates are the cornerstone of adequate antibiotic treatment. However, many blood cultures are contaminated with bacteria residing on the skin, the most common contaminants being coagulase-negative staphylococci (CoNS). Such contaminated cultures are mostly disregarded. In this retrospective study, we show that contaminated cultures contain diagnostic information. We tested the association between resistance profiles of CoNS contaminants and those of the actual infecting bacteria isolated subsequently from the same patient, as well as their association with short-term mortality.
We identified all patients in Rabin Medical Center, Israel, with positive blood cultures during 2009-12. Data included patient demographics, hospitalization records, comorbidities, blood culture results and date of death.
Our cohort consists of 2518 patients with 5290 blood cultures, where 1124 patients had 1664 blood cultures with CoNS contaminants. High overall CoNS resistance predicted high overall resistance of the subsequent bacterial isolates (P |
| doi_str_mv | 10.1093/jac/dku156 |
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We identified all patients in Rabin Medical Center, Israel, with positive blood cultures during 2009-12. Data included patient demographics, hospitalization records, comorbidities, blood culture results and date of death.
Our cohort consists of 2518 patients with 5290 blood cultures, where 1124 patients had 1664 blood cultures with CoNS contaminants. High overall CoNS resistance predicted high overall resistance of the subsequent bacterial isolates (P<0.004 and P<0.0006, for Gram-positive and -negative bacteria, respectively). Moreover, the resistance of CoNS contaminants to a specific antibiotic predicted the resistance of the subsequent bacterial isolates to that antibiotic (OR=5.55, 95% CI=3.54-8.66, P<10(-15) and OR=2.47, 95% CI=1.61-3.78, P<3 ×10(-5), for Gram-positive and -negative bacteria, respectively). Finally, highly resistant CoNS isolates were associated with higher short-term mortality (hazard ratio=1.71, 95% CI=1.4-2.11, P<10(-6)).
Resistance patterns of CoNS contaminants predict specific and overall resistance of subsequent blood culture isolates and short-term mortality. These results may help predict patient mortality and correct empirical antibiotic therapy if blood cultures yield contaminant bacteria and imply that skin commensals may serve as an additional, non-invasive, diagnostic tool.</description><identifier>ISSN: 0305-7453</identifier><identifier>EISSN: 1460-2091</identifier><identifier>DOI: 10.1093/jac/dku156</identifier><identifier>PMID: 24855122</identifier><language>eng</language><publisher>England: Oxford Publishing Limited (England)</publisher><subject>Aged ; Aged, 80 and over ; Anti-Bacterial Agents - pharmacology ; Anti-Bacterial Agents - therapeutic use ; Bacteremia - microbiology ; Bacteremia - mortality ; Blood ; Blood - microbiology ; Coagulase - secretion ; Drug resistance ; Drug Resistance, Bacterial ; Female ; Gram-positive bacteria ; Humans ; Israel ; Male ; Microbial Sensitivity Tests ; Middle Aged ; Mortality ; Pathogens ; Patients ; Retrospective Studies ; Staphylococcus - drug effects ; Staphylococcus - enzymology ; Staphylococcus - isolation & purification ; Survival Analysis</subject><ispartof>Journal of antimicrobial chemotherapy, 2014-09, Vol.69 (9), p.2541-2546</ispartof><rights>The Author 2014. Published by Oxford University Press on behalf of the British Society for Antimicrobial Chemotherapy. All rights reserved. For Permissions, please e-mail: journals.permissions@oup.com.</rights><rights>Copyright Oxford Publishing Limited(England) Sep 2014</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c351t-e55d785d1db40f5194c0554e4f18974709ccfe760c4169c280f39449582def963</citedby><cites>FETCH-LOGICAL-c351t-e55d785d1db40f5194c0554e4f18974709ccfe760c4169c280f39449582def963</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,780,784,27923,27924</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/24855122$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Obolski, Uri</creatorcontrib><creatorcontrib>Alon, Danny</creatorcontrib><creatorcontrib>Hadany, Lilach</creatorcontrib><creatorcontrib>Stein, Gideon Y</creatorcontrib><title>Resistance profiles of coagulase-negative staphylococci contaminating blood cultures predict pathogen resistance and patient mortality</title><title>Journal of antimicrobial chemotherapy</title><addtitle>J Antimicrob Chemother</addtitle><description>Blood culture isolates are the cornerstone of adequate antibiotic treatment. However, many blood cultures are contaminated with bacteria residing on the skin, the most common contaminants being coagulase-negative staphylococci (CoNS). Such contaminated cultures are mostly disregarded. In this retrospective study, we show that contaminated cultures contain diagnostic information. We tested the association between resistance profiles of CoNS contaminants and those of the actual infecting bacteria isolated subsequently from the same patient, as well as their association with short-term mortality.
We identified all patients in Rabin Medical Center, Israel, with positive blood cultures during 2009-12. Data included patient demographics, hospitalization records, comorbidities, blood culture results and date of death.
Our cohort consists of 2518 patients with 5290 blood cultures, where 1124 patients had 1664 blood cultures with CoNS contaminants. High overall CoNS resistance predicted high overall resistance of the subsequent bacterial isolates (P<0.004 and P<0.0006, for Gram-positive and -negative bacteria, respectively). Moreover, the resistance of CoNS contaminants to a specific antibiotic predicted the resistance of the subsequent bacterial isolates to that antibiotic (OR=5.55, 95% CI=3.54-8.66, P<10(-15) and OR=2.47, 95% CI=1.61-3.78, P<3 ×10(-5), for Gram-positive and -negative bacteria, respectively). Finally, highly resistant CoNS isolates were associated with higher short-term mortality (hazard ratio=1.71, 95% CI=1.4-2.11, P<10(-6)).
Resistance patterns of CoNS contaminants predict specific and overall resistance of subsequent blood culture isolates and short-term mortality. These results may help predict patient mortality and correct empirical antibiotic therapy if blood cultures yield contaminant bacteria and imply that skin commensals may serve as an additional, non-invasive, diagnostic tool.</description><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Anti-Bacterial Agents - pharmacology</subject><subject>Anti-Bacterial Agents - therapeutic use</subject><subject>Bacteremia - microbiology</subject><subject>Bacteremia - mortality</subject><subject>Blood</subject><subject>Blood - microbiology</subject><subject>Coagulase - secretion</subject><subject>Drug resistance</subject><subject>Drug Resistance, Bacterial</subject><subject>Female</subject><subject>Gram-positive bacteria</subject><subject>Humans</subject><subject>Israel</subject><subject>Male</subject><subject>Microbial Sensitivity Tests</subject><subject>Middle Aged</subject><subject>Mortality</subject><subject>Pathogens</subject><subject>Patients</subject><subject>Retrospective Studies</subject><subject>Staphylococcus - drug effects</subject><subject>Staphylococcus - enzymology</subject><subject>Staphylococcus - isolation & purification</subject><subject>Survival Analysis</subject><issn>0305-7453</issn><issn>1460-2091</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2014</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNpdkVFrFDEQx4Mo9lp98QNIwBcR1iabzO7mUYpaoVAo9XnJJZNrzt1kTbLCfQE_tzmuKvRpYObHf2b4EfKGs4-cKXG51-bS_lg5dM_IhsuONS1T_DnZMMGg6SWIM3Ke854x1kE3vCRnrRwAeNtuyO87zD4XHQzSJUXnJ8w0Omqi3q2TztgE3OnifyGt1PJwmKKJxvgKhKJnH-os7Oh2itFSs05lTTVgSWi9KXTR5SHuMND0f4sO9tj3GAqdYyp68uXwirxwesr4-rFekO9fPt9fXTc3t1-_XX26aYwAXhoEsP0AltutZA64koYBSJSOD6qXPVPGOOw7ZiTvlGkH5oSSUsHQWnSqExfk_Sm3_vpzxVzG2WeD06QDxjWPHECIlnMGFX33BN3HNYV63ZGSILteHAM_nCiTYs4J3bgkP-t0GDkbj3bGamc82anw28fIdTuj_Yf-1SH-AOmXjiE</recordid><startdate>20140901</startdate><enddate>20140901</enddate><creator>Obolski, Uri</creator><creator>Alon, Danny</creator><creator>Hadany, Lilach</creator><creator>Stein, Gideon Y</creator><general>Oxford Publishing Limited (England)</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7QL</scope><scope>7QO</scope><scope>7T7</scope><scope>7U7</scope><scope>7U9</scope><scope>8FD</scope><scope>C1K</scope><scope>FR3</scope><scope>H94</scope><scope>K9.</scope><scope>M7N</scope><scope>NAPCQ</scope><scope>P64</scope><scope>7X8</scope></search><sort><creationdate>20140901</creationdate><title>Resistance profiles of coagulase-negative staphylococci contaminating blood cultures predict pathogen resistance and patient mortality</title><author>Obolski, Uri ; Alon, Danny ; Hadany, Lilach ; Stein, Gideon Y</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c351t-e55d785d1db40f5194c0554e4f18974709ccfe760c4169c280f39449582def963</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2014</creationdate><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Anti-Bacterial Agents - pharmacology</topic><topic>Anti-Bacterial Agents - therapeutic use</topic><topic>Bacteremia - microbiology</topic><topic>Bacteremia - mortality</topic><topic>Blood</topic><topic>Blood - microbiology</topic><topic>Coagulase - secretion</topic><topic>Drug resistance</topic><topic>Drug Resistance, Bacterial</topic><topic>Female</topic><topic>Gram-positive bacteria</topic><topic>Humans</topic><topic>Israel</topic><topic>Male</topic><topic>Microbial Sensitivity Tests</topic><topic>Middle Aged</topic><topic>Mortality</topic><topic>Pathogens</topic><topic>Patients</topic><topic>Retrospective Studies</topic><topic>Staphylococcus - drug effects</topic><topic>Staphylococcus - enzymology</topic><topic>Staphylococcus - isolation & purification</topic><topic>Survival Analysis</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Obolski, Uri</creatorcontrib><creatorcontrib>Alon, Danny</creatorcontrib><creatorcontrib>Hadany, Lilach</creatorcontrib><creatorcontrib>Stein, Gideon Y</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Bacteriology Abstracts (Microbiology B)</collection><collection>Biotechnology Research Abstracts</collection><collection>Industrial and Applied Microbiology Abstracts (Microbiology A)</collection><collection>Toxicology Abstracts</collection><collection>Virology and AIDS Abstracts</collection><collection>Technology Research Database</collection><collection>Environmental Sciences and Pollution Management</collection><collection>Engineering Research Database</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Algology Mycology and Protozoology Abstracts (Microbiology C)</collection><collection>Nursing & Allied Health Premium</collection><collection>Biotechnology and BioEngineering Abstracts</collection><collection>MEDLINE - Academic</collection><jtitle>Journal of antimicrobial chemotherapy</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Obolski, Uri</au><au>Alon, Danny</au><au>Hadany, Lilach</au><au>Stein, Gideon Y</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Resistance profiles of coagulase-negative staphylococci contaminating blood cultures predict pathogen resistance and patient mortality</atitle><jtitle>Journal of antimicrobial chemotherapy</jtitle><addtitle>J Antimicrob Chemother</addtitle><date>2014-09-01</date><risdate>2014</risdate><volume>69</volume><issue>9</issue><spage>2541</spage><epage>2546</epage><pages>2541-2546</pages><issn>0305-7453</issn><eissn>1460-2091</eissn><abstract>Blood culture isolates are the cornerstone of adequate antibiotic treatment. However, many blood cultures are contaminated with bacteria residing on the skin, the most common contaminants being coagulase-negative staphylococci (CoNS). Such contaminated cultures are mostly disregarded. In this retrospective study, we show that contaminated cultures contain diagnostic information. We tested the association between resistance profiles of CoNS contaminants and those of the actual infecting bacteria isolated subsequently from the same patient, as well as their association with short-term mortality.
We identified all patients in Rabin Medical Center, Israel, with positive blood cultures during 2009-12. Data included patient demographics, hospitalization records, comorbidities, blood culture results and date of death.
Our cohort consists of 2518 patients with 5290 blood cultures, where 1124 patients had 1664 blood cultures with CoNS contaminants. High overall CoNS resistance predicted high overall resistance of the subsequent bacterial isolates (P<0.004 and P<0.0006, for Gram-positive and -negative bacteria, respectively). Moreover, the resistance of CoNS contaminants to a specific antibiotic predicted the resistance of the subsequent bacterial isolates to that antibiotic (OR=5.55, 95% CI=3.54-8.66, P<10(-15) and OR=2.47, 95% CI=1.61-3.78, P<3 ×10(-5), for Gram-positive and -negative bacteria, respectively). Finally, highly resistant CoNS isolates were associated with higher short-term mortality (hazard ratio=1.71, 95% CI=1.4-2.11, P<10(-6)).
Resistance patterns of CoNS contaminants predict specific and overall resistance of subsequent blood culture isolates and short-term mortality. These results may help predict patient mortality and correct empirical antibiotic therapy if blood cultures yield contaminant bacteria and imply that skin commensals may serve as an additional, non-invasive, diagnostic tool.</abstract><cop>England</cop><pub>Oxford Publishing Limited (England)</pub><pmid>24855122</pmid><doi>10.1093/jac/dku156</doi><tpages>6</tpages><oa>free_for_read</oa></addata></record> |
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| source | MEDLINE; Oxford University Press Journals All Titles (1996-Current); EZB-FREE-00999 freely available EZB journals; Alma/SFX Local Collection; Free Full-Text Journals in Chemistry |
| subjects | Aged Aged, 80 and over Anti-Bacterial Agents - pharmacology Anti-Bacterial Agents - therapeutic use Bacteremia - microbiology Bacteremia - mortality Blood Blood - microbiology Coagulase - secretion Drug resistance Drug Resistance, Bacterial Female Gram-positive bacteria Humans Israel Male Microbial Sensitivity Tests Middle Aged Mortality Pathogens Patients Retrospective Studies Staphylococcus - drug effects Staphylococcus - enzymology Staphylococcus - isolation & purification Survival Analysis |
| title | Resistance profiles of coagulase-negative staphylococci contaminating blood cultures predict pathogen resistance and patient mortality |
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