PIAC Case Series
Case 02 - Doris, 65 years old
Doris is a 65 who underwent R hemicolectomy and diverting loop ilestomy for cecal tumor with perforation and peritontitis
She received antibiotics for 5 days; she has not tolerated oral/enteral nutrition and has required TPN; post-op day 6 the patient develops T=38.8 and WBC = 15K
The following day 2 of 2 blood cultures are positive for gm + cocci
1) How is a central-line associated bloodstream infection (CLA-BSI) diagnosed?
2). What organisms in blood culture are possible contaminants? Which organisms should definitely not be considered contaminants?
- Staphylococcus aureus
- Staphylococcus epidermidis (CONS)
- Pseudomonas aeruginosa
- Bacillus species
- Candida albicans
CLA-BSI diagnosed by:
- + blood culture with recognized pathogen (e.g. S. aureus), central line in place and no other evident source
- If blood culture + for pathogen of uncertain significance (e.g. CONS), need 2 positive cultures and sign/symptom (fever, chills, hypotension)
- Organisms likely contaminants = corynebacterium ("diptheroids"), bacillus (non-anthracis), propionibacterium
- Possible contaminants = coagulase-negative staph
- NOT contaminants = Staph aureus, Candida, Pseudomonas
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