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B Rudensky

Publications and source records attributed to B Rudensky.

At least 37 records · Page 2Linked to original sources
PubMed2002

[Combination of heterozygote blood coagulation factor V Leiden carriage with erythrocytosis as a cause of the hip deep vein thrombosis].

AIM: To reject one of the variants of inherited thrombophylia in a 64-year-old patient with deep thrombosis of leg veins and high hemoglobin and red cell levels. MATERIAL AND METHODS: The study was made of antithrombin III and protein C, protein S levels; resistance to activated protein C; molecular structure of DNA coding factor 5; methylenetetrahydrofolate reductase. RESULTS: The patient was diagnosed to have heterozygote factor V Leiden mutation. The replacement of arginine by glutamine in position 506 of factor V molecule raises the risk of thrombosis. This risk was aggravated by high hemoglobin, red cells, hematocrit, low volume of circulating plasma, smoking. The patient had normal levels of leukocytes and platelets, normal spleen size, slightly lowered level of erythropoietin. CONCLUSION: The presence of thrombosis in patients with erythremia or erythrocytosis rejects one of the thrombophilia forms.

Factor V↗
PubMed2001

Diagnostic value of the D-dimer test in deep vein thrombosis: improved results by a new assay method and by using discriminate levels.

Previous studies have suggested that D-dimer testing reliably selects patients for whom duplex sonography should be performed for diagnosis of deep vein thrombosis (DVT). However, the interassay correlation is poor. Therefore, we tested four D-dimer methods for their ability to rule out DVT, including the Miniquant test, a new D-dimer assay method. Sensitivity, specificity, negative predictive value (NPV) and positive predictive value (PPV) were calculated vs. duplex sonography. Twenty-nine of 108 (27%) patients with suspected DVT were diagnosed as having DVT by sonography. The Vidas enzyme-linked immunoabsorbent assay (ELISA) test, the Miniquant turbidimetric test and the latex agglutination test for D-dimer all provided discriminate values for achieving 100% sensitivity and 100% NPV. D-dimer results demonstrated higher specificity and PPV in the outpatient vs. the inpatient group. This probably reflects the higher proportion of inpatients with comorbid conditions, such as malignancy and postsurgery status, in whom D-dimer results show very poor specificity and PPV. The new Miniquant turbidimetric assay performed as well as the more established ELISA method. We conclude that the D-dimer tests were shown to possess the necessary sensitivity and NPV to be useful in screening patients with suspected DVT. A negative D-dimer test in selected patients could be helpful in reducing the number of sonograms performed for diagnosis of DVT.

Adult↗
PubMed2001

Adult patients with occult bacteremia discharged from the emergency department: epidemiological and clinical characteristics.

To determine the epidemiological and clinical characteristics of patients who were discharged from the emergency department (ED) and subsequently proved to have bacteremia, we prospectively assessed all patients examined in the ED during an 18-month period from whose blood cultures a significant organism was isolated. Discharged patients were contacted and reevaluated. Two case-control studies were conducted, in which each study patient was matched with a total of 4 control patients. During the study period, 46,336 patients were examined in the ED; 78% were adults and 22% were children. Blood cultures were performed for 25% of the adult patients and for 44% of the children. Although the occurrence of occult bacteremia in patients who were discharged from the ED is 3.7 times more common in children than in adults, the absolute numbers of discharged adults and children with occult bacteremia are similar. Careful clinical assessment will not prevent discharge of some of these patients; however, these patients in general do well and can be safely recalled for reevaluation and complementation of therapy.

Adolescent↗
PubMed2001

Longitudinal surveillance of antibiotic use in the hospital.

We evaluated antimicrobial use in our hospital by department, including indications for use, source of infections, use of the microbiology laboratory, and appropriateness of prescribing, in a prospective, comparative, non-interventional study of all patients receiving antimicrobial agents. We excluded departments where antimicrobial use was negligible. The other 19 departments were followed for 3 (n=4) or 4 (n=15) months, including 2 consecutive months in the spring-summer and either 1 or 2 in the autumn-winter. Antimicrobial therapy was followed from initiation, through possible adaptations, and possible change from intravenous to oral therapy, until discontinuation of treatment. Overall, 6376 antibiotics were given to 2306 patients. Of the surveyed hospitalized patients, 62%+/-22% received antibiotics, with a range of 4-100% per department. Antibiotics were prescribed for infections acquired in the community (3037 instances, 47%), in the hospital (2182, 34%), in a nursing home (575, 9%), and for prophylaxis continued post-operatively (582, 9%). The most common indications for antimicrobial use were: respiratory tract infection (1729, 27%), urinary tract infection (955, 15%), sepsis (701, 11%), intra-abdominal infections (663, 10%), prophylaxis 582 (9%), soft-tissue infection (572, 9%), and surgical site infection (319, 5%). Univariate indicators for appropriateness of treatment were: age, department, site of infection, source of infection, antimicrobial drug and serum creatinine (all p<0.001). Forty-nine antimicrobials were prescribed in 279 combinations, 58% as single agent and 42% as drug combinations. Half of all antimicrobial use consisted of four agents: cefuroxime (19.1%), metronidazole (11.3%), gentamicin (10.6%) and ampicillin (10.2%), which together accounted for 20% of expenditure on antibiotics. Although use of as many as 53% of antimicrobials (26/49) surveyed was restricted, use in this category accounted for only 29% of all antimicrobial courses. Of 6376 antibiotic courses, 4101 (64%) were given intravenously and 2275 (36%) orally. Appropriateness of use of restricted drugs was lower (70%) than of unrestricted ones (84%, p<0.001). Of 24571 defined daily doses (DDD) given orally, 4587 (19%) were restricted, compared to 7264 (34%) of 21602 DDDs given intravenously (p<0.001). Antibiotic treatment in our hospital appears to be substantial and increasing, justifying efforts to improve appropriateness of therapy and improve clinical and financial results.

Administration, Oral↗
PubMed2001

Incidence of immunoglobulin G antibodies to Chlamydia pneumoniae in acute myocardial infarction patients.

BACKGROUND: Recent studies have suggested a possible association between Chlamydia pneumoniae infection and coronary heart disease. OBJECTIVES: To determine titers of antibodies to C. pneumoniae in patients with acute myocardial infarction compared with titers in several control groups. METHODS: This prospective case-control study investigated 209 individuals. We assessed the serum IgG antibody titers to C. pneumoniae in 57 consecutive patients admitted with AMI to our intensive coronary care unit during a 4 month period. A serum sample was drawn upon admission and after 6 weeks. Results were compared with those of four control groups: a) patients admitted with community-acquired pneumonia (n = 18), b) patients with community-acquired urinary tract infection (n = 42), c) patients with angiographically normal coronary artery disease (n = 44), and d) patients with stable coronary artery disease (n = 48). Serum immunoglobulin G antibody titers to C. pneumoniae were determined using standard micro-immunofluorescence technology. RESULTS: Of 57 patients with AMI, 32 (56%) had a high IgG titer to C. pneumoniae (> or = 1:256) on the initial test, which remained unchanged (62%) after 6 weeks. The percentage of patients with high titers was significantly lower in the control groups: 5 of 18 patients (28%) in the pneumonia group (P < 0.01), 11 of 42 (26%) in the urinary tract infection group (P < 0.01), 11 of 44 (25%) with normal coronary arteries (P < 0.01), and 17 of 48 (35%) with stable chronic ischemic heart disease (P < 0.05). CONCLUSION: The detection of high titers of IgG antibodies to C. pneumonia in many patients with AMI, compared to control groups, suggests that chronic Chlamydia pneumoniae infection plays a role in the pathogenesis of atherosclerosis and acute ischemic events.

Antibodies↗
PubMed2000

The use of the arterial line as a source for blood cultures.

OBJECTIVE: To determine the reliability of blood cultures obtained through indwelling arterial lines as compared to that of blood cultures obtained by venipuncture. DESIGN: A prospective observational study. SETTING: Six-bed mixed medical surgical intensive care unit (ICU) of a 550-bed university-affiliated medical center. MEASUREMENTS: During a 3-month period blood culture sets, when clinically indicated, were drawn in parallel from indwelling arterial catheters and one-time venipuncture and the results compared. Each blood sample consisted of 15 ml and was distributed equally between three blood culture bottles: aerobic, anaerobic and one aerobic resin-containing bottle. Blood culture results from the two sources were compared according to preset definitions. MAIN RESULTS: During the study period 90 parallel blood culture sets (540 bottles) were obtained from 36 patients. Forty-three (16%) venipuncture bottles were positive versus 88 (32%) arterial line culture bottles (p < 0.001). Of the parallel sets, 83% yielded equivalent results - either both sterile or both growing the same organism. Amongst the discordant sets, the arterial line cultures grew 37 gram-positive and 18 gram-negative isolates not found in venipuncture sets (i.e. 50% of 109 arterial line isolates), while only two gram-positive isolates were solely grown in venipuncture cultures (4% of all 55 venipuncture isolates, p < 0.001). On clinical correlation, all the gram-positive organisms in the discordant cultures were found not to reflect bacteremia, while five of the 18 gram-negative isolates (28%) grown only in arterial line cultures probably did reflect ongoing bacteremia. CONCLUSION: The results of blood cultures taken from the arterial line are frequently equivalent to those taken from venipuncture. When discordant, the growth of gram-positive bacteria almost certainly reflects contamination or arterial line colonization, whereas the growth of gram-negative bacteria may have to be considered as reflecting bacteremia.

Bacteremia↗
PubMed2000

Prospective surveillance of vancomycin-resistant enterococci in a neonatal intensive care unit.

A point-prevalence study of vancomycin-resistant enterococci colonization of the gastrointestinal tract in an Israeli hospital revealed that 14.7% of the 320 inpatients were colonized. Vancomycin-resistant enterococci colonization was detected in most departments except the neonatal intensive care unit. Hence, a prospective longitudinal study of the prevalence of vancomycin-resistant enterococci colonization in the neonatal intensive care unit was conducted. A rectal swab was obtained from every newborn on admission to the neonatal intensive care unit and once weekly thereafter until the patient was discharged. Enterococci were isolated and tested for susceptibility to vancomycin. A total of 84 neonates were enrolled and monitored on average for 3 weeks (SD +/- 3.9, range 1-20 weeks). Mean gestational age was 35.7 weeks (SD +/- 3.9, range 25-42 weeks), and mean birth weight was 2.4 kg (SD +/- 0.9, range 0.45-4.1 kg). Most patients had one or more of the known risk factors associated with colonization with vancomycin-resistant enterococci. Eighty percent of the patients received antibiotics during the study, and 14.3% received vancomycin. The median duration of vancomycin treatment was 12.5 days (SD +/- 16.8, range 5-55 days). Fifty-one of 84 (61%) patients acquired enterococci sensitive to vancomycin during the study period, but no newborn had vancomycin-resistant enterococci. Possible explanations for this finding may be physical isolation of the neonatal intensive care unit from the rest of the hospital, intrinsic differences in the bowel milieu of this age group and the lack of exposure to food and other environmental sources of vancomycin-resistant enterococci from the community.

Adolescent↗
PubMed2000

Lipopolysaccharides of a Campylobacter coli isolate from a patient with Guillain-Barré syndrome display ganglioside mimicry.

Campylobacter coli was isolated from a patient with severe, axonal type Guillain-Barré syndrome (GBS). The patient's serum was tested by ELISA for glycolipid antibodies and showed a high titer of IgG antibodies to asialo-GM1 (GA1) and GD3. Campylobacter coli lipopolysaccharide (LPS) was extracted and analyzed by ELISA, immunoblot binding and blocking studies, and found to avidly bind cholera toxin and peanut agglutinin. The LPS from the patient's isolate also induced anti-GA1 antibodies in a rat model. These findings suggest that the LPS from this bacterial isolate contains a ganglioside-like epitope, which most likely resembles GA1. Thus, it appears that ganglioside cross-reactivity is not unique to Campylobacter jejuni and seems to occur in all bacterial isolates from GBS cases so far analyzed.

Aged↗
PubMed1999

Ten-year follow-up study of hepatitis B virus infection and vaccination status in hospital employees.

We sought to determine the incidence of infection with hepatitis B virus (HBV) amongst hospital employees over a 10-year period and to assess the extent and efficacy of vaccination against HBV in this population. In 1984 a cohort of 301 hospital employees was tested for hepatitis B surface antibody (anti HBs), hepatitis B core antibody (anti HBc), and hepatitis B surface antigen (HBsAg). Ten years later, 160 (53%) of these workers remained at the hospital and were re-tested. In addition, they were tested for hepatitis C virus antibody (anti HCV). Records of the hospital vaccination program were inspected to determine the rate and effectiveness of vaccination in these workers. Over the ten year period two of the 160 retested workers (1.25%) had sero-converted to anti HBc positive, yielding an incidence density of 0.27 cases per 100 person-years exposed in unvaccinated workers. While the overall seroprevalence of anti HBc did not change significantly between 1984 (81/301, 27%) and 1994 (39/160, 24%), it was much greater than that of the general population (10%). A significantly greater percentage of Jews of Sephardi ancestry (22/65, 34%) were positive for anti HBc than those of Ashkenazi ancestry (15/90, 17%, P < 0.05). In addition, doctors were found to be less likely to be anti HBc positive than nurses (4% vs. 25%, respectively, P < 0.01). Two cases of anti HCV positivity were discovered yielding a prevalence of 1.25% in the 1994 cohort as compared to 0.15% in the population of healthy blood donors. Of the 93 employees of the 1994 cohort eligible for vaccination (i.e., anti HBc-negative and employed in an occupation involving potential exposure to HBV), 53 (57%) had received vaccination and showed protective antibody titers (anti HBs > or = 10 i.u./ml). 17/52 workers with documented vaccinations (33%) did not have detectable antibody levels one to eight years after vaccination. In conclusion, the seroprevalence of anti HBc and anti HCV is significantly higher in this cohort of hospital employees than in the general population. The relatively low vaccination rate among at-risk personnel emphasizes the need for more effective vaccination programs.

Adult↗
PubMed1999

In-vitro activity of cefepime and other broad-spectrum antimicrobials against several groups of gram-negative bacilli and Staphylococcus aureus.

The in vitro activity of cefepime was compared with that of amikacin, ceftazidime, imipenem, ciprofloxacin, and piperacillin-tazobactam by using the E-test against five groups of carefully selected organisms: Klebsiella pneumoniae (68 isololates), Pseudomonas aeruginosa (62), methicillin-susceptible Staphylococcus aureus (MSSA) (60), and two groups of Enterobacteriaceae (60 and 62 isolates, respectively). The bacteria were subdivided according to whether the infection was nosocomial or community-acquired, applying accepted and predefined criteria. These isolates were obtained from patients admitted to our medical center throughout 1998. We retrospectively compared antimicrobial susceptibilities of the study sample with those of the +/- 3000 bacterial strains isolated from blood stream infections since 1990: the study sample appeared to represent adequately the clinical databank. Presence of extended-spectrum beta-lactamase (ESBL) was determined in all groups of Enterobacteriaceae with the ESBL screening E-test strip. Of the 252 Gram-negative bacilli tested, 242 (96%) were susceptible to cefepime, whereas only 168 (67%) were susceptible to ceftazidime, 211 (84%) to amikacin, and 220 (87%) to piperacillin-tazobactam (p < 0.001). Imipenem was slightly superior to cefepime with only seven isolates resistant (3%), six of which were P. aeruginosa. Cefepime was more active against Enterobacteriaceae than ceftazidime (93% vs. 72%, p < 0.001). This superiority was most evident against nosocomial strains of K. pneumoniae, against which cefepime was > three times more active than ceftazidime. The high level of resistance seen in nosocomial isolates of K. pneumoniae is consistent with high rates of ESBL production (69%, compared with 15-26% in other Enterobacteriaceae). The MIC90 of cefepime to methicillin-sensitive S. aureus was 1.5 micrograms/mL, whereas that of ceftazidime was 4 micrograms/mL; the susceptibility rate of both was 100%. In conclusion, cefepime possesses in vitro potencies against MSSA and current clinical strains of Gram-negative bacilli, many of which harbor resistance to other antimicrobial agents. Hence, it seems very suitable for empiric coverage of serious nosocomial infections.

Cefepime↗
PubMed1999

Cost-effectiveness of blood cultures for adult patients with cellulitis.

To assess the cost-effectiveness of blood cultures for patients with cellulitis, a retrospective review was conducted of clinical and microbiological data for all 757 patients admitted to a medical center because of community-acquired cellulitis during a 41-month period. Blood cultures were performed for 553 patients (73%); there were a total of 710 blood samples (i.e., a mean of 1.3 cultures were performed per patient). In only 11 cases (2.0%) was a significant patient-specific microbial strain isolated, mainly beta-hemolytic streptococci (8 patients [73%]). An organism that was considered a contaminant was isolated from an additional 20 culture bottles (3. 6%). The cost of laboratory workup of the 710 culture sets was $36, 050. Isolation of streptococci led to a change from empirical treatment with cefazolin to penicillin therapy for 8 patients. All patients recovered. In conclusion, the yield of blood cultures is very low, has a marginal impact on clinical management, and does not appear to be cost-effective for most patients with cellulitis.

Adolescent↗
PubMed1998

Combination of ABO blood group incompatibility and glucose-6-phosphate dehydrogenase deficiency: effect on hemolysis and neonatal hyperbilirubinemia.

The incidence (%) of hyperbilirubinemia (serum bilirubin > or = 257 micromol/l) was similar in neonates with a combination of ABO incompatibility and glucose-6-phosphate dehydrogenase (G-6-PD) deficiency (45%), with ABO incompatibility (54%) or G-6-PD deficiency (37%), alone (ns). Carboxyhemoglobin values, corrected for inspired CO, were similarly elevated in all three groups (0.87 +/- 0.32%, 0.82 +/- 0.29%, 0.76 +/- 0.18%, respectively, ns), but correlated with bilirubin only in those with ABO incompatibility alone. ABO-incompatible/G-6-PD-deficient neonates, compared with those with either condition alone, are not at increased risk for hemolysis or hyperbilirubinemia.

ABO Blood-Group System↗
PubMed1998

Bilirubin conjugation, reflected by conjugated bilirubin fractions, in glucose-6-phosphate dehydrogenase-deficient neonates: a determining factor in the pathogenesis of hyperbilirubinemia.

BACKGROUND AND OBJECTIVE: Glucose-6-phosphate dehydrogenase (G-6-PD) deficiency is frequently associated with neonatal hyperbilirubinemia, which in severe cases may cause kernicterus and death. Because G-6-PD-deficient individuals frequently undergo acute, trigger-induced hemolytic episodes, increased hemolysis has frequently been implied in the pathogenesis of this neonatal hyperbilirubinemia. However, in Sephardic Jewish G-6-PD-deficient neonates, the rate of hemolysis, reflected by blood carboxyhemoglobin values corrected for inspired carbon monoxide, has been shown to be elevated, not only in those who developed hyperbilirubinemia, but also, to a similar extent, in those who remained only moderately jaundiced. Because at any point, serum total bilirubin values reflect a balance between bilirubin production on the one hand and bilirubin conjugation and elimination on the other, we suspected bilirubin conjugation to be a key factor in the pathogenesis of the hyperbilirubinemia. Physiologically, a fraction of conjugated bilirubin refluxes from the hepatocyte to the serum, and accurate determination of serum conjugated bilirubin fractions can be used to mirror intrahepatocytic bilirubin. Using this principle, we previously demonstrated a decreased diconjugated bilirubin fraction in hyperbilirubinemic G-6-PD-deficient neonates compared with hyperbilirubinemic G-6-PD-normal controls, suggesting diminished bilirubin conjugation. This conjugated bilirubin pattern probably reflects the recently described interaction between G-6-PD deficiency and the variant promoter for the gene encoding the bilirubin conjugating enzyme UDP glucuronosyltransferase, as seen in Gilbert's syndrome. Therefore, we postulated that efficiency of bilirubin conjugation is a crucial factor in the development of hyperbilirubinemia in G-6-PD-deficient neonates. We hypothesized that those G-6-PD-deficient neonates who develop hyperbilirubinemia would have decreased bilirubin conjugation ability, whereas those with a more efficient conjugating system would have a lesser degree of bilirubinemia. METHODS: Term, healthy, male, G-6-PD-deficient neonates with no other obvious predisposing cause for hyperbilirubinemia were selected at random when their serum diazo total bilirubin values ranged from 171 to 254 micromol/L (10-14.9 mg/dL). At this point, simultaneous with the diazo bilirubin determination, serum was collected and frozen for high-performance liquid chromatography (HPLC) measurement of serum bilirubin fractions. The infants were followed clinically and with serum diazo bilirubin determinations until they either did not exceed a serum diazo bilirubin value of 254 micromol/L (14.9 mg/dL) (nonhyperbilirubinemic) or until bilirubin values rose above this level (hyperbilirubinemic), by a process of self-selection. A method of alkaline methanolysis, followed by reverse-phase HPLC, was used to measure unconjugated bilirubin and the mono- and diconjugated fractions of serum conjugated bilirubin. Total HPLC bilirubin and total conjugated bilirubin values were calculated from these measured bilirubin fractions. Patients also were classified according to the serum total conjugated bilirubin value as low bilirubin conjugators (serum total conjugated bilirubin less than median) or as high bilirubin conjugators (serum total conjugated bilirubin greater than median). The data were analyzed by comparing serum conjugated bilirubin fractions between the hyperbilirubinemic and nonhyperbilirubinemic groups and the risk of developing hyperbilirubinemia in the low bilirubin conjugators, relative to that of the high bilirubin conjugators. RESULTS: Neonates were sampled at 53 +/- 12 and 58 +/- 12 hours for the subsequently hyperbilirubinemic and nonhyperbilirubinemic groups, respectively (NS). Initial (ie, at the time of sampling) serum total diazo bilirubin values (mean +/- SD) were almost identical for the subsequently hyperbilirubinemic and nonhyperbilirubinemic groups (214 +/

Bilirubin↗
PubMed1997

Analysis of 5 years of bacteraemias: importance of stratification of microbial susceptibilities by source of patients.

Many factors need to be considered when selecting empiric antimicrobial treatment for infections; foremost are the principal pathogens causing the diagnosed infection and their antimicrobial susceptibility patterns. These susceptibilities are location specific. This study analyses blood cultures of a 5-year period (1990-94) at a 550 bed community hospital and stratifies antimicrobial susceptibilities by source of patients. Data included: date of culture, patient location, number of positive bottles with the same organism over a period of 2 weeks and results of susceptibility testing. Positive cultures from patients in the Emergency Department were deemed to reflect community-acquired strains: positive cultures from patients in the Intensive Care Unit were considered nosocomial organisms. During the study period 52055 blood cultures were drawn; 5652 (11%) from 2742 patients grew at least one organism, excluding skin contaminants. Organisms cultured most frequently were: Enterobacteriaceae: 1162 patients (42%); Staphylococcus aureus: 442 (16%); Enterococcus; 429 (16%); and Pseudomonas: 196 (7%). Antimicrobial susceptibility percentages of Enterobacteriaceae from Emergency Room patients (n = 370) were significantly greater to all tested antimicrobials than from ICC patients (n = 161) (P < 0.001). Overall, 143 isolates of S. aureus from 442 patients (32%) were methicillin resistant (MR); stratification by department revealed a range of 20/142 (14%) MR in community acquired strains to 49/67 (73%) from ICU patients (P < 0.001). Detailed tables with antimicrobial susceptibilities according to strains, and stratified by source of patients are presented. When selecting empiric antimicrobial therapy for patients with bacterial infections, it is crucially important to physicians to have access to antimicrobial susceptibility percentages, stratified by source of patients.

Anti-Bacterial Agents↗
PubMed1997

Routine surveillance blood cultures: their place in the management of critically ill patients.

The use of surveillance blood cultures has been advocated as a means to allow earlier detection of septic episodes amongst intensive care patients, and therefore earlier institution of appropriate antibiotic therapy. We compared the results of surveillance cultures and clinically indicated blood cultures for bacterial isolates grown and the influence of culture results on patient management. Blood cultures were obtained from all intensive care unit (ICU) patients over the course of 3 months at a set surveillance time (surveillance group) or according to clinical indications (clinical group). Bacteriological results were compared and real-time chart review performed to assess the influence of the surveillance cultures on patient management, with particular reference to antibiotic therapy. Two hundred and forty-nine blood culture sets were collected over 3 months, 99 in the surveillance group and 150 in the clinical group. A total of 256 bacterial isolates were grown, 95 in the surveillance group and 161 in the clinical group. For the surveillance group 36%, 20%, and 44% of the isolates represented bacteraemia, line colonization and culture contamination, respectively. For the clinical group the distibution was 69%, 7%, and 24% respectively (P<0.001, P<0.01, and P<0.0027 for comparisons of percentages within each classification). On only one occasion was antibiotic therapy started based on the result of a surveillance culture, and on only one occasion was a septic episode detected earlier by a surveillance culture; however, this culture result did not lead to a change in patient management. Surveillance blood cultures are expensive and add very little to the management of patients in the intensive care environment.

Adult↗