Rapid Diagnosis of Bacteremia

Early appropriate treatment of bacteremia is important in minimizing morbidity and mortality. Standard blood culture methods are not optimal since several days are often required for recovery and identification of organisms which may be present in the blood. The use of a membrane filter technique allows one to grow any organisms present in blood much more rapidly than by broth or pour plate culture. Furthermore, growth is in the form of typical colonies on the surface of solid media, and a series of rapid diagnostic tests may be used to provide speedy identification. Use of membrane filters also facilitates removal by washing of normal antibacterial factors and antimicrobial drugs which may be present in blood. Although the filter technique yielded the most rapid growth, broth culture and whole blood pour plates yielded more positive cultures and use of all three systems was necessary for maximal recovery of organisms in blood cultures. Data on quantitative aspects of bacteremia in the antimicrobial era are also presented. The number of low level bacteremias (10 colonies/ml or less) is surprisingly high. This is particularly true for gram-negative bacilli; antimicrobial therapy at the time of culture undoubtedly influenced these results greatly. Finally, suggestions are given for a much simpler and more efficient membrance filter blood culture technique.     

Etiology of Bacteremia

Blood-culture results for a 15-year period from a large southern hospital were tabulated and analyzed for alterations in the bacterial species associated with bacteremia. From 15,543 cultures, 2,410 positive cultures (15.6%) were obtained. These results were grouped into 5-year periods, and an alteration in the incidence of the agents was demonstrated. In the past 5 years, gram-negative bacilli have replaced gram-positive cocci as the most common agents of bacteremia, and several species not formerly associated with septicemia were found to be involved in a large number of cases. The importance of the clinical laboratory monitoring blood culture results was demonstrated as was the need for constant collaboration between the clinician and microbiologist.     

Etiology of Bacteremia

Blood-culture results for a 15-year period from a large southern hospital were tabulated and analyzed for alterations in the bacterial species associated with bacteremia. From 15,543 cultures, 2,410 positive cultures (15.6%) were obtained. These results were grouped into 5-year periods, and an alteration in the incidence of the agents was demonstrated. In the past 5 years, gram-negative bacilli have replaced gram-positive cocci as the most common agents of bacteremia, and several species not formerly associated with septicemia were found to be involved in a large number of cases. The importance of the clinical laboratory monitoring blood culture results was demonstrated as was the need for constant collaboration between the clinician and microbiologist.     

New Rapid Methods for Tissue Diagnosis

Two new methods applicable to the staining of fixed and fresh frozen tissue sections are presented herein. In addition certain improvements are suggested for the technic reported by Geschickter, Walker, Hjort and Moulton (1931). In brief the procedures are as follows:

The thionin eosinate method of Geschickter et al (1931). This procedure has been modified as follows:

A mixture of diethylene glycol, 40 parts, ethylene glycol, 40 parts, and grain alcohol, 20 parts is superior to ethylene glycol, 80 parts, and ethyl alcohol, 20 parts, as a solvent for the compound stain in that the staining is intensified.

Ethylene glycol monobutyl ether supplants diethylene glycol monobutyl ether because of its lower viscosity.

Ethyl phthalate replaces butyl phthalate on account of a more satisfactory viscosity.

The methyl green eosinate procedure is the same as the modified thionin eosinate method except for the following variations:

The staining time is increased to one minute.

Decolorization and washing are reduced to about 15 seconds.

The hematoxylin-eosin method. After cutting, the tissue sections are carried thru the following steps:

Unfold in water; transfer to formalin (4 to 40%) for at least 30 seconds; stain in hematoxylin (Harris) for 30 to 60 seconds; wash in water, 5 seconds; decolorize in 0.1% HC1 or saturated aqueous picric acid, 5 seconds; wash in water, S seconds; float in 0.5% ammonia, 5 to 10 seconds; wash in water, 5 seconds; stain in 5% aqueous eosin, 15 seconds¹; wash in water, 5 to 10 seconds; dehydrate in a mixture of diethylene glycol, 30 parts, and ethyl alcohol, 70 parts, 5 to 10 seconds; dehydrate in ethylene glycol monobutyl ether, 5 to 10 seconds; clear in ethyl phthalate, 5 to 10 seconds; float on a glass slide, blot with photographic lintless blotter, place a drop of neutral gum damar on the section, and cover with glass cover slip.     

New Rapid Methods for Tissue Diagnosis

Two new methods applicable to the staining of fixed and fresh frozen tissue sections are presented herein. In addition certain improvements are suggested for the technic reported by Geschickter, Walker, Hjort and Moulton (1931). In brief the procedures are as follows:

1. The thionin eosinate method of Geschickter et al (1931). This procedure has been modified as follows:
   1. A mixture of diethylene glycol, 40 parts, ethylene glycol, 40 parts, and grain alcohol, 20 parts is superior to ethylene glycol, 80 parts, and ethyl alcohol, 20 parts, as a solvent for the compound stain in that the staining is intensified.
   2. Ethylene glycol monobutyl ether supplants diethylene glycol monobutyl ether because of its lower viscosity.
   3. Ethyl phthalate replaces butyl phthalate on account of a more satisfactory viscosity.
2. The methyl green eosinate procedure is the same as the modified thionin eosinate method except for the following variations:
   1. The staining time is increased to one minute.
   2. Decolorization and washing are reduced to about 15 seconds.
3. The hematoxylin-eosin method. After cutting, the tissue sections are carried thru the following steps:

Unfold in water; transfer to formalin (4 to 40%) for at least 30 seconds; stain in hematoxylin (Harris) for 30 to 60 seconds; wash in water, 5 seconds; decolorize in 0.1% HC1 or saturated aqueous picric acid, 5 seconds; wash in water, S seconds; float in 0.5% ammonia, 5 to 10 seconds; wash in water, 5 seconds; stain in 5% aqueous eosin, 15 seconds¹; wash in water, 5 to 10 seconds; dehydrate in a mixture of diethylene glycol, 30 parts, and ethyl alcohol, 70 parts, 5 to 10 seconds; dehydrate in ethylene glycol monobutyl ether, 5 to 10 seconds; clear in ethyl phthalate, 5 to 10 seconds; float on a glass slide, blot with photographic lintless blotter, place a drop of neutral gum damar on the section, and cover with glass cover slip.     

Rapid Laboratory Diagnosis of an Outbreak of Influenza

The specific diagnosis of an outbreak of acute febrile disease in a sanatorium ward was made rapidly by examining sera from the nine patients for antibodies to a series of likely viruses. All eight convalescent cases had high antibody levels to Influenza A2 (Asian) virus and the case at the acute stage had none. This serological diagnosis provided the first information that influenza was present in the area. Later, Influenza virus Type A2 was grown from the acute case.     

山羊传染性胸膜肺炎病原快速诊断方法的建立

为准确快速鉴定临床疑似山羊传染性胸膜肺炎(CCPP)病原,针对丝状支原体山羊亚种(Mmc)与绵羊肺炎支原体(Mo)16S rRNA基因设计两对特异性引物Ps/Pa、Ms/Ma,通过优化反应条件及体系,建立检测CCPP两种主要致病支原体的双重PCR方法,并检测了所建方法特异性、敏感性及临床应用。当引物、Mg2+及dNTP浓度分别为0.8 pmol/μL、1.5 nmol/μL、0.2 nmol/μL,Ps/Pa与Ms/Mo比例为1 1时,于54℃退火40 s,可最小检出Mmc与Mo核酸量分别为0.1 ng、0.01 ng,敏感性良好。通过特异性与临床疑似病例检测,证明所建方法具较好特异性,可初步应用于临床诊断。     

Microbiological Study of Streptococcal Bacteremia

During a 2.5-year study, streptococci were isolated from 280 patients (19% of those with bacteremia). Of this number, 54 had group D streptococci (45 were enterococci), 218 had α- or γ-hemolytic nongroup D streptococci, and 49 had β-hemolytic streptococci.     

Radiometric Method for Detection of Bacteremia

A study was performed with simulated blood cultures to evaluate the production of (14)CO(2) as an index of bacterial growth. With a range of inoculum sizes from 4 to 4,250 colony-forming units, it was not possible to detect (14)CO(2) within 6 hr after inoculation in 59 separate experiments. In a limited trial with patients' blood cultures, the radiometric method failed to provide any earlier evidence of bacteremia than did routine broth cultures.     

Radiometric Detection of Bacteremia in Neonates

The predicted prevalence of false positive blood cultures due to hyperactive neonatal blood cells in a radiometric detection system was confirmed. Suppression of this blood background radioactivity in the system was achieved by using a hypertonic medium containing 10% sucrose. The radiometric system produced accurate results as fast as the conventional blood culturing method, saved labor and minimized the recovery of extraneous contaminants.     

Evaluation of Rapid IgG4 Test for Diagnosis of Gnathostomiasis

Human gnathostomiasis is a parasitic disease caused by Gnathostoma nematode infection. A rapid, reliable, and practical immunoassay, named dot immuno-gold filtration assay (DIGFA), was developed to supporting clinical diagnosis of gnathostomiasis. The practical tool detected anti-Gnathostoma-specific IgG4 in human serum using crude extract of third-stage larvae as antigen. The result of the test was shown by anti-human IgG4 monoclonal antibody conjugated colloidal gold. The sensitivity and specificity of the test were both 100% for detection in human sera from patients with gnathostomiasis (13/13) and from healthy negative controls (50/50), respectively. Cross-reactivity with heterogonous serum samples from patients with other helminthiases ranged from 0 (trichinosis, paragonimiasis, clonorchiasis, schistosomiasis, and cysticercosis) to 25.0% (sparganosis), with an average of 6.3% (7/112). Moreover, specific IgG4 antibodies diminished at 6 months after treatment. This study showed that DIGFA for the detection of specific IgG4 in human sera could be a promising tool for the diagnosis of gnathostomiasis and useful for evaluating therapeutic effects.     

Simple Genetic Transformation Assay for Rapid Diagnosis of Moraxella osloensis

A genetic transformation assay for unequivocal identification of strains of Moraxella osloensis is described. In this assay a stable tryptophan auxotroph is transformed to prototrophy by deoxyribonucleic acid (DNA) samples from other strains of M. osloensis but not by DNA samples from unrelated bacteria. The test is simple to perform and definitive results can be obtained in less than 24 h. The procedure, which is suitable for routine diagnosis in a clinical laboratory, involves a rapid method for preparation of crude transforming DNA from small quantities of bacterial cells and permits simultaneous examination of large numbers of isolated cultures. The assay was shown to correctly identify 27 strains previously classified as M. osloensis. Forty-five other gram-negative, oxidase-positive, nonmotile coccobacilli, which might be confused with M. osloensis unless subject to more extensive testing, were shown to be unrelated genetically to M. osloensis. The transformation assay clearly distinguishes M. osloensis from Acinetobacter. Although most strains of M. osloensis are nonfastidious, being able to grow in a mineral medium supplemented with a single organic carbon source, one of the strains tested was only able to grow on fairly complex media and could not be transformed to grow on simple media. Inability to alkalize Simmons citrate agar was shown not to be characteristic of all strains of M. osloensis.     

Rapid Species Diagnosis for Invasive Candidiasis Using Mass Spectrometry

Background

Matrix-assisted laser desorption ionisation time of flight mass spectrometry (MALDI TOF-MS) allows the identification of most bacteria and an increasing number of fungi. The potential for the highest clinical benefit of such methods would be in severe acute infections that require prompt treatment adapted to the infecting species. Our objective was to determine whether yeasts could be identified directly from a positive blood culture, avoiding the 1–3 days subculture step currently required before any therapeutic adjustments can be made.

Methodology/Principal Findings

Using human blood spiked with Candida albicans to simulate blood cultures, we optimized protocols to obtain MALDI TOF-MS fingerprints where signals from blood proteins are reduced. Simulated cultures elaborated using a set of 12 strains belonging to 6 different species were then tested. Quantifiable spectral differences in the 5000–7400 Da mass range allowed to discriminate between these species and to build a reference database. The validation of the method and the statistical approach to spectral analysis were conducted using individual simulated blood cultures of 36 additional strains (six for each species). Correct identification of the species of these strains was obtained.

Conclusions/Significance

Direct MALDI TOF-MS analysis of aliquots from positive blood cultures allowed rapid and accurate identification of the main Candida species, thus obviating the need for sub-culturing on specific media. Subsequent to this proof-of-principle demonstration, the method can be extended to other clinically relevant yeast species, and applied to an adequate number of clinical samples in order to establish its potential to improve antimicrobial management of patients with fungemia.