- Germs, ironically nicknamed “bugs” continue to be our concern, for they are a real threat. But when it comes for “bad bugs”, what are we going to do?
Adrian Man et al studied the etiology of bacteriemic syndromes and bacterial susceptibility of blood culture isolates in a Romanian county hospital, namely, the County Emergency Clinical hospital of Tîrgu Mureș, Romania. They analyzed for three years all the blood cuture isolates [1].
For any speciality besides microbiology, the process of understanding the general picture of microbiological results is painful. Denominations change, fresh insights into the bugs’ metabolism are paramount, bacteria seem to be more inteligent than predicted. Thus a whole arsenal has to be used to defeat bugs, strategies were developed, even the media and the patients are very sensitive to “killer bugs”.
The workload to come up in time with reliable results seems to be considerable. Useful results mean for me: a result you can trust discriminating contamination from infection and information received within short time (better in less then 6 hours from admission). This could make a difference in outcome.
When looking at the reported results, we learn that:
1.The rate of blood culture positivity is 8%, which is quite low compared to other reports [1].
2.For blood cultures, discrimination between contamination and etiological involvement is “still a problem” [1].
For the severe septic patient, lack of reliable results as decribed is a real challenge. While contamination needs not to be treated with antibiotics, infection on the contary, requires target oriented medication. Only that the target is blurred. One can see it in 8% of the blood cultures, and less than this figure has an evidence-based suppport. Thus roughly >90% of the septic patients are exposed to empiric antimicrobials based on suspicions or on previously described local epidemiologic patterns.
At the end of the day we can get a delayed bacterial result that cannot explain the critical condition of the patient. The identified germ may be a “bad bug”, still an epiphenomenon to a patient with multiple system organ failure of onother origin then septic.
Bacterial results from blood culture imply a disproportionate workload for maginal benefits. Should we give up then to attempt bug identification, or should we reconsider our practcie? I have no doubts that strict adherence to sampling and handling blood protocols is mandatory. Otherwise, we will continue to escalate misunderstandings between microbiologists and clinicians. These snapshots of blood culture results will continue to be of limited use, a genuine waste of means. And yes, please handle everything with clean hands!
Mirror, Mirror on the Ward
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