bactitech
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Topics: 25
Posts: 481
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Yes, C. However, if the organism is coagulase negative staph, then you have a further dilemma. CNS CAN cause problems in blood cultures, particularly in patients with indwelling catheters and shunts. The way our lab works it is: if the CNS shows up in multiple specimens, we do a sensitivity on each isolate and then the doctor can compare sensitivity patterns. If it is only one positive bottle out of two or three specimens drawn (the other remaining negative) we do not do a sensitivity and put a disclaimer on the culture result to the effect that a single positive BC growing CNS, diphtheroids, or Micrococcus sp. is probably a skin contaminant.
The problem is compounded by emergency room nurses/docs, who draw two or three blood cultures with one draw, then shoot the blood into three sets of bottles. If all three go positive, it can give a picture of sepsis when it is really contamination. This costs your patient/Medicare/insurance/the hospital LOTS of money (around $4,000+ more per admission!!!), and your buds on internal medicine a lot more grief because they're juggling the side effects of the antibiotic their patient didn't need.
DO NOT DRAW MORE THAN ONE BLOOD CULTURE AT THE SAME TIME!! THIS IS A NO-NO!!! The lab will do its job but you'll never know whether you have a true pathogen or contaminant. [Yeah yeah, I know it's easier - you have 8 other patients to see in the ER, the patient has lousy veins, the family is a pain in the butt, your chief resident is screaming at you, etc. etc. However, what if your patient has a reaction to Vancomycin, that was started because they were supposedly septic, then ends up with C. difficile in their stool due to pseudomembranous colitis from antibiotic dosing, or a reaction to OD on Vanco, etc. etc. This happens ALL the time].
So, do the right thing. Draw blood culture sets one at a time. In the olden days pre-HIV, you were supposed to change needles before injecting the blood into the bottles. Nowadays, this is a HUGE Bozo-no-no so you have to rely in prescrubbing technique to cut down on contamination. They have newer skin preps out that work really well - they have a sponge involved [sorry I don't know the name]. Hospitals track blood culture contamination rates and some even track who drew the blood culture in case contamination centers upon one individual. Infection control committees get nervous when contamination rate hovers above 5% (it may be lower - I'm not sure). Our local medical schools' rate is higher than our community hospitals - wonder why????
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Clinical Microbiology since 1974
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