Journal of clinical microbiology
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J. Clin. Microbiol. · Apr 2009
Impact of blood cultures drawn by phlebotomy on contamination rates and health care costs in a hospital emergency department.
We conducted a prospective comparison of blood culture contamination rates associated with dedicated phlebotomists and nonphlebotomy staff in the emergency department (ED) at Parkland Memorial Hospital in Dallas, TX. In addition, hospital charges and lengths of stay were determined for patients with negative, false-positive, and true-positive blood culture results. A total of 5,432 blood culture collections from two ED areas, the western wing of the ED (ED west) and the nonwestern wing of the ED (ED nonwest), were evaluated over a 13-month period. ⋯ Similar results were observed when rates between phlebotomists in ED west and nonphlebotomy staff in ED nonwest were compared (62/2,012 [3.1%] versus 100/1,770 [5.6%]; P < 0.001). Comparison of median patient charges between negative and false-positive episodes ($18,752 versus $27,472) showed $8,720 in additional charges per contamination event while the median length of stay increased marginally from 4 to 5 days. By utilizing phlebotomists to collect blood cultures in the ED, contamination rates were lowered to recommended levels, with projected reductions in patient charges of approximately $4.1 million per year.
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J. Clin. Microbiol. · Mar 2009
Comparative StudyComparison of viral isolation and multiplex real-time reverse transcription-PCR for confirmation of respiratory syncytial virus and influenza virus detection by antigen immunoassays.
We evaluated the Prodesse ProFlu-1 real-time reverse transcription-PCR multiplex assay with the SmartCycler instrument for the detection of human respiratory syncytial virus (RSV) and influenza A and B viruses in comparison to conventional cell culture and antigen immunoassays with the BD Directigen A+B and Binax NOW RSV assays over two successive respiratory virus seasons. Ninety-two percent of the 361 specimens tested were nasopharyngeal aspirates obtained from individual patients, of which 119 were positive for RSV and 59 were positive for influenza virus. ⋯ The specificity of all of the methods tested was >or=99%, and the individual sensitivities of NOW RSV, RSV culture, Directigen A+B, influenza virus culture, and the Proflu-1 PCR for influenza/RSV were 82% (95% confidence interval [CI], 73 to 88), 57% (95% CI, 44 to 69), 59% (95% CI, 44 to 72), 54% (95% CI, 38 to 69), and 98% (95% CI, 93 to 100)/95% (95% CI, 85 to 99), respectively. In a clinical setting where viral isolation is performed to confirm rapid antigen immunoassay results for these common respiratory viruses, one-step real-time reverse transcriptase PCR testing can be a more sensitive and timely confirmatory method.
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J. Clin. Microbiol. · Jan 2009
Case ReportsGardnerella vaginalis acute hip arthritis in a renal transplant recipient.
We report the case of an acute hip septic arthritis caused by Gardnerella vaginalis in a 48-year-old woman under immunosuppressive therapy for kidney transplantation. After surgical resection of the hip and 6 weeks of combination antibiotic therapy, a total hip prosthesis was successfully implanted with no recurrence after 4 years.
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J. Clin. Microbiol. · Jan 2009
Single-nucleotide polymorphisms in Rv2629 are specific for Mycobacterium tuberculosis genotypes Beijing and Ghana but not associated with rifampin resistance.
Sequence analysis of 58 multidrug-resistant Mycobacterium tuberculosis complex strains from Germany and 55 susceptible strains from a reference collection comprising major phylogenetic lineages confirmed that variations in Rv2629, 191A/C and 965C/T, are specific for genotypes Beijing and Ghana, respectively, but not involved in the development of rifampin (rifampicin) resistance.