Hostname: page-component-586b7cd67f-t7fkt Total loading time: 0 Render date: 2024-11-28T15:23:04.976Z Has data issue: false hasContentIssue false
  • English
  • Français

Epidemiology and Clinical Significance of Blood Cultures Positive for Coagulase-Negative Staphylococcus

Published online by Cambridge University Press:  02 January 2015

Louis V. Kirchhoff  and
John N. Sheagren
Louis V. Kirchhoff
Affiliation:
Division of Infectious Diseases, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, Michigan
John N. Sheagren*
Affiliation:
Division of Infectious Diseases, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, Michigan
*
Room 7329, Med. Sci. Bldg. I, University of Michigan Medical School, Ann Arbor, MI 48109
Get access Rights & Permissions [Opens in a new window]

Abstract

Coagulase-negative staphylococci are frequently isolated from blood cultures. As these organisms may occasionally cause serious disease, differentiating bacteremia from contamination is very important but often difficult. Over a 26-month period, of 29,542 blood cultures processed at the University of Michigan Medical Center, 2,875 (9.7%) were positive, and of those, 694 (from 527 patients) grew coagulase-negative staphylococci. Isolates from the 439 patients with only one blood culture positive for coagulase-negative staphy-lococci and those from the 18 patients with two positive cultures 10 days or more apart were deemed contaminants. Review of the records of the remaining 70 patients with multiple isolates indicated that 33 had had an episode of true bacteremia, 29 (87.9%) of which were associated with intravascular catheters or prosthetic valves. Overall, 85% of all coagulase-negative staphylococci isolated during the study period were judged to be contaminants. Seventy-one percent of the blood cultures drawn during the episodes of bacteremia were positive for coagulase-negative staphylococci as opposed to only 34% in the patients with contaminated cultures (p < 0.01). Moreover, coagulase-negative staphylococci grew in both aerobic and anaerobic bottles in 85% of blood culture sets drawn during episodes of bacteremia, but in only 30% of the cultures thought to be contaminated (p < 0.001). Growth of coagulase-negative staphylococci in less than 48 hours was also significantly associated with bacteremia (p < 0.01). Antibiotic sensitivity patterns were not useful in differentiating bacteremia from contamination. Thus, clinicians should consider coagulase-negative staphylococci as true blood pathogens in patients with intravascular devices who have a high proportion of blood cultures positive for this organism over a short period of time, and whose cultures became positive in less than 48 hours, with a high percent positive in both bottles. Microbiology laboratories can conserve considerable resources by limiting sensitivity studies to isolates from such patients.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 6 , Issue 12 , December 1985 , pp. 479 - 486
Copyright
Copyright © The Society for Healthcare Epidemiology of America 1985

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1.Wilson, TS, Stuart, RD: Staphylococcus albus in wound infection and septicemia. Can Med Assoc J 1965; 93:8–16.Google ScholarPubMed
2.Quinn, EL, Cox, F, Fisher, M: The problem of associating coagulase-negative staphylococci with disease. Ann NY Acad Sci 1965; 128:428–442.Google Scholar
3.Andriole, VT. Lyons, RW: Coagulase-negative staphylococcus. Ann NY Acad Sci 1970; 174:533–544.Google Scholar
4.Keys, TF, Hewitt, WL: Endocarditis due to micrococci and Staphylococcus epidermidis. Arch Intern Med 1973; 132:216–220.Google Scholar
5.Arnett, EN, Roberts, WC: Prosthetic valve endocarditis. Am J Cardiol 1976; 38:281–292.CrossRefGoogle ScholarPubMed
6.Watanakunakorn, C: Prosthetic valve endocarditis. Prog Cardiovasc Dis 1979; 22:181–190.CrossRefGoogle Scholar
7.Karchmer, AW, Archer, GL, Dismukes, WE: Staphylococcus epidermidis causing prosthetic valve endocarditis: Microbiologic and clinical observations as guides to therapy. Ann Intern Med 1983; 98:447–455.Google Scholar
8.Shurtleff, DB, Foltz, EL, Weeks, RD, et al: Therapy of Staphylococcus epidermidis: Infections associated with cerebrospinal fluid shunts. Pediatrics 1974; 53:55–63.Google Scholar
9.Schoenbaum, SC. Gardner, P, Shillito, J: Infections of cerebrospinal fluid shunts: Epidemiology, clinical manifestations, and therapy. J Infect Dis 1975; 131:543–552.Google Scholar
10.Forse, RA. Dixon, C, Bernard, K, et al: Staphylococcus epidermidis: An important pathogen. Surgery 1979; 86:507–514.Google ScholarPubMed
11.Sitges-Serra, A. Puig, P, Jaurrieta, E, et al: Catheter sepsis due to Staphylococcus epidermidis during parenteral nutrition. Surg Gynecol Obstet 1980: 151:481–483.Google Scholar
12.Christensen, GD. Bisno, AL, Parisi, JT, et al: Nosocomial septicemia due to multiply antibiotic-resistant Staphylococcus epidermidis. Ann Intern Med 1982; 96:1–10.Google Scholar
13.Stattler, FR, Foderaro, JB. Aber, RC: Staphylococcus epidermidis bacteremia associated with vascular catheters: An important cause of febrile morbidity in hospitalized patients. Infect Control 1984; 5:279–283.Google Scholar
14.Ponce de Leon, S, Wenzel, RP: Hospital-acquired bloodstream infections with Staphylococcus epidermidis. Am J Med 1984; 77:639–644.CrossRefGoogle ScholarPubMed
15.Lewis, JF, Blake, SR, Anderson, DJ, et al: Urinary tract infections due to coagulase-negative Staphylococcus. Am J Clin Pathol 1982; 77:736–739.CrossRefGoogle ScholarPubMed
16.Parker, MA. Tuazon, CV: Cervical osteomyelitis: Infection due to Staphylococcus epidermidis in hemodialysis patients. JAMA 1978; 240:50–51.Google Scholar
17.Bender, JW. Hughes, WT: Fatal Staphylococcus epidermidis sepsis following bone marrow transplantation. The Johns Hopkins Medical Journal 1980; 146:13–15.Google Scholar
18.Ebright, JR, Rytel, MW: Intra-abdominal abscess caused by Staphylococcus epidermidis. Arch Surg 1980; 115:326.Google Scholar
19.Wade, JC. Schimpff, SC. Newman, KA, et al: Staphylococcus epidermidis: An increasing cause of infection in patients with granulocytopenia. Ann Intern Med 1982: 97:503–508.Google Scholar
20.Winston, DJ, Dudnick, DV, Chapin, M, et al: Coagulase-negative staphylococcal bacteremia in patients receiving immunosuppressive therapy. Arch Intern Med 1983; 143:32–36.CrossRefGoogle ScholarPubMed
21.Friedman, LE. Brown, AE. Miller, DR. et al: Staphylococcus epidermidis septicemia in children with leukemia and lymphoma. Am J Dis Child 1984; 138:715–719.Google Scholar
22.MacLowry, JD: Clinical microbiology of bacteremia: An overview. Am J Med July 28, 1983: 2–6.Google Scholar
23.Weinstein, MP. Reller, BL, Murphy, JR. et al: The clinical significance of positive blood cultures: A comprehensive analysis of 500 episodes of bacteremia and fungemia in adults. I. Laboratory and epidemiologic observations. Rev Infect Dis 1983; 5:35–53.Google Scholar
24.Roberts, FJ: A review of positive blood cultures: Identification and source of microorganisms and patterns of sensitivity to antibiotics. Rev Infect Dis 1980; 3:329–339.Google Scholar
25.Schimpff, SC, Satterlee, W, Young, VM, et al: Empiric therapy with carbenicillin and gentamicin for febrile patients with cancer and granulocytopenia. N Engl J Med 1971; 284:1061–1065.Google Scholar
26.National Committee for Clinical Laboratory Standards: NCCLS Approved Standard: ASM-2. Second Edition. 1980.Google Scholar
27.Finegold, SM, Martin, WJ, Scott, EG: Bailey and Scott's Diagnostic Microbiology. St. Louis, Missouri, C. V. Mosby. 1978. p 125.Google Scholar
28.Dixon, WJ, Massey, FJ Jr: Introduction to Statistical Analysis. New York, McGraw-Hill, 1969, pp 237, 351.Google Scholar
29.Beaman, KD, Kasten, BL, Gavan, TL: Rate of detection of bacteremia: Retrospective evaluation of 23,392 blood cultures. Cleve Clin Q 1977; 44:129–136.Google Scholar
30.Zierdt, CH: Evidence for transient Staphylococcus epidermidis bacteremia in patients and in healthy humans. J Clin Microbiol 1983; 17:628–630.Google Scholar
31.Marples, RR, Hone, R, Notley, CM, et al: Investigation of coagulase-negative staphylococci from infections in surgical patients. Zentralbl Bakteriol [Orig A] 1978;241:140–156.Google Scholar
32.Archer, GL: Antimicrobial susceptibility and selection of resistance among Staphylococcus epidermidis isolates recovered from patients with infections of indwelling foreign devices. Antimicrob Agents Chemother 1978; 14:353–359.Google Scholar
33.Blouse, LE. Lathrop, GD. Kolonel, LW, et al: Epidemiologic features and phage types associated with nosocomial infections caused by Staphylococcus epidermidis. Zentralbl Bakteriol [Orig A] 1978; 241:119–135.Google ScholarPubMed
34.Archer, GL, Tenenbaum, MJ: Antibiotic-resistant Staphylococcus epidermidis in patients undergoing cardiac surgery. Antimicrob Agents Chemother 1980; 17:269–272.Google Scholar