Clinical Case StudyPaenibacillus macerans pseudobacteremia resulting from contaminated blood culture bottles in a neonatal intensive care unit*
Section snippets
Background and investigation
Northwestern Memorial Hospital is a 708-bed academic medical center with a level III neonatal intensive care unit (NICU). The NICU is geographically separate from the remainder of the medical center and consists of a central nurses’ station surrounded by 5 distinct nurseries. Between June 24 and June 30, 1999, 8 neonates had positive blood cultures for P macerans (Table 1).Patient No. Date of collection Nursery Bottle type No. positive/No. cultured 1 6/24/99 B
Results
During the pseudobacteremia period, all blood isolates from 8 patients were identified as P macerans. None of the neonates was infected with this organism as determined by lack of fever or leukocytosis. However, because of their very low birth weights and the report of a positive blood culture, all were empirically started on antimicrobial therapy.
The results of environmental cultures are detailed in Table 2.Sample Empty Cell
Discussion
Bacillus species may be associated with invasive bloodstream infections, especially in neonates or patients with impaired host defenses.1 Therefore, it is necessary to distinguish true bacteremia from pseudobacteremia particularly in these high-risk patients. The prompt recognition of pseudobacteremia is critical to avoid the unnecessary use of antimicrobial agents and to prevent a delay in the diagnostic evaluation of the patient’s clinical syndrome.9 Empiric antimicrobial therapy is often
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Reprint requests: Gary A. Noskin, MD, Division of Infectious Diseases, Northwestern University Medical School, 215 E Huron—Feinberg 16-704, Chicago, IL 60611.