2008 245 2 1) 1) 2) 3) 4) 1) 1) 1) 1) 1), 2) 1) 2) 3) / 4) 20 3 24 20 8 18 2001 2 2 2004 2 59.0 2002 1 2004 12 3 2 22.1 1 14.0 (CNS), Bacillus c 2 p 0.01 2 1 31.3 41.9 21.4 1 2 80 CNS 2 1 74.3 2 Key words: cultivation of blood, two-sets blood culture, detection rate of germ ( 173 8610) 30 1 TEL: 03 3972 8111 3985 FAX: 03 3972 8137 E-mail: tanimichi.yumiko@nihon-u.ac.jp 1) 2 2) 3) 2000 1 1 2001 2 2 Vol. 18 No. 4 2008. 25
246 1 2 1 2 2 2000 1 2004 12 5 23,928 3,580 20,348 (BD) BACTEC 9240 9120 7 BD 92F 93F 1 2 2 1 94F (BD) 1 2 1. 2000 2004 5 1 1 1 2. 2 2000 2004 5 2 3. 1 2 2002 1 2004 12 3 1 5,613 2 4,988 1) 1 2 1 1 2 1 2 1 4 1 1 2) 1 2 1 2 4. 2 2002 1 2004 12 3 2 2 1 4 1 A E 5 3 (CNS), Bacillus 6 26 Vol. 18 No. 4 2008.
2 247 2 1. 2000 2004 2 2004 2000 3.0 2.0 2. 2 2000 2004 2 74 492 1,228 1,591 2,167 2 4.0 21.0 34.6 47.1 59.0 3. 1 2 1) 2002 2003 2004 3 1 2 1 3 1 14.0 2 22.1 8.1 2 c 2 p 0.001 2) 2002 2003 2004 3 1 2 9 2 1 2 CNS, Bacillus c 2 p 0.01 4. 2 6 3 1 1 2 2002 2003 2004 1 2,320 1,788 1,505 5,613 306 231 251 788 13.2 12.9 16.7 14.0 2002 2003 2004 2 1,228 1,591 2,169 4,988 243 347 514 1,104 19.8 21.8 23.7 22.1 c 2 1.72123E 27 0.1 1 2 1) 240 Escherichia coli 88 (36.7 ) Klebsiella spp. 75 (31.3 ) Enterobacter spp. 39 (16.3 ), Serratia spp. 20 (8.3 ) 18 (7.5 ) 2 1 A B 31.3 2) 93 Pseudomonas aeruginosa 67 (72.0 ), Acinetobacter spp. 9 (9.7 ), Stenotrophomonas maltophilia 7 (7.5 ), 10 (10.8 ) A, C 2 1 1 A 41.9 Vol. 18 No. 4 2008. 27
248 2 1 2 1 5,613 2 4,988 208 (3.71) 240 (4.80) 55 (0.98) 93 (1.86) 168 (2.99) 171 (3.26) CNS 172 (3.06) 319 (6.38) 72 (1.28) 95 (1.90) 27 (0.77) 35 (1.14) 28 (0.50) 30 (0.60) Bacillus 32 (0.57) 83 (1.66) 34 (0.61) 48 (0.96) 796 (14.18) 1,114 (22.33) Propionibacterium 3 6 3) 173 MRSA 121 (69.9 ), MSSA 52 (30.1 ) MRSA MSSA 4) CNS 319 Staphylococcus epidermidis 209 (65.5 ), S. epidermidis CNS 110 (34.5 ) 2 1 A B 74.3 S. epidermidis CNS 1 A 56.4 62 5) 95 Enterococcus spp. 51 Viridans streptococci 22 Streptococcus pneumoniae 13 9 4 E 50.5 Enterococcus 28 Vol. 18 No. 4 2008.
2 249 spp. 35.3, Viridans streptococci 53.8 S. pneumoniae 68.2 E 6) Bacillus 83 4 1 A 2 16.9 1 2 2 2 2 1 4) 2 1 31.3 41.9 1 1 ml 10 5) 6, 7) 2 CNS Bacillus 2 CNS 80 1) 8) 1) 2 1 CNS 9) CNS Bacillus Bacillus cereus 10), 11) 2 2002 3 212 (11.2 ) 212 105 CNS Bacillus 12) 2 1), 13), 14) 2 Vol. 18 No. 4 2008. 29
250 1) Weinstein M. P., M. L., Towns, S. M. Quartey, et al. 1997. The clinical significance of positive blood cultures in the 1990s: A prospective comprehensive evaluation of the microbiology, epidemiology, and outcome of bacteremia and fungemia in adults. Clin. Infect. Dis. 24: 584 602. 2) BD/ BD 1998. 1 3) 1998. (1). 46: 887 892. 4) 1995. The Current Clinical Technologist 1(1): 7 13. 5) Henny, N. K., et al. 1983. Microbiological and clinical evaluation of the isolator lysis centrifugation blood culture tube. J. Clin. Microbiol. 17: 864 869. 6) 1999. 23: 258 269. 7) 2003. Febrile neutropenia 19(6): 47 53. 8) 1996. 24: 459 462. 9) 2004. coagulase-negative staphylococci 14: 177 182. 10) 1985. 43: 985 987. 11) 2007. Bacillus cereus 1 17: 119 123. 12) 2006. 54: 1059 1065. 13) Washington J. A., 1975. Blood cultures. Principles and techniques. Mayo. Clin. Proc. 50: 91 98. 14) 2004. 53: 1127 1130. Increasing two-sets blood cultures and its e$cacy Yumiko Tanimichi, Michiko Yagoshi, Mitsuru Yanai, Yuki Uehara, Naoto Hosokawa, Kazuo Shimoguchi, Hiroko Yamada, Mutsuko Oosoko, Sachiyo Yamamoto, Kazunari Kumasaka 1) Clinical Laboratory Nihon University Itabashi Hospital 2) Department of Laboratory Medicine, Nihon University School of Medicine 3) Department of Infection Control Science, Faculty of Medicine, Juntendo University 4) Department of Infectious Disease, Kameda General Hospital Importance of multi-sets blood cultures is indicated so as to increase the positivity rate and help clinical judgment. But in Japan, the importance has not been recognized yet because multiple sets of blood cultures are troublesome and induce an increase in costs. In our hospital, we have encouraged to take two sets of blood cultures. As a result, the percentage of two-sets blood cultures increased from 21.0 in 2001 to 59.0 in 2004. The total positivity rate of two-sets blood cultures (22.1 ) was significantly higher than that of one-set blood culture (14.0, p 0.01). Regarding the isolates, only one of two sets showed positive results in 31.3 of the family Enterobacteriaceae, 41.9 of Non-fermentative Gram-negative rods and 21.4 of Staphylococcus aureus, which should be the pathogens of bacteremia when they are isolated in blood cultures. On the other hand, coagulase-negative Staphylococci, which is frequently recognized as 30 Vol. 18 No. 4 2008.
2 251 contamination, 74.8 was positive in only one of two sets. In conclusion, two-sets blood cultures are useful to increase the positivity rate of blood culture significantly. Large percentage of essential pathogens can be detected by only one of two sets, and they also help for the interpretation of positive results of coagulase-negataive Staphylococci usually recognized as contaminant. Vol. 18 No. 4 2008. 31