- Email: [email protected]
An unexpected cause of pseudobacteraemia
Letters
266
to the Editor
Elfrink,
J. G. R. & Booij, H. L. (1974). Interactions of chlorhexidine with yeast cells. Biochemical Pharmacology 23, 1413-1419. Russell, A. D., Hammond, S. A. & Morgan, J. R. (1986). Bacterial resistance to antiseptics and disinfectants. Journal of Hospital Injection 7, 213-225. Stickler, D. J. & Thomas, B. (1980). Antiseptic and antibiotic resistance in Gram negative bacteria causing urinary tract infection. Journal of Clinical Pathology 33, 288-296. Walker, E. M. & Lowes, J. A. (1985). An investigation into the in vitro methods for the detection of chlorhexidine resistance. Journal of Hospital Infection 6, 389-397.
Sir,
An unexpected
cause
of pseudobacteraemia
During August and September 1988, some unusual contaminants were detected in blood cultures received from the paediatric wards and special care baby unit at Kettering and District General Hospital. Of 90 blood cultures examined, five contained optochin-resistant alpha-haemolytic streptococci and four contained unusual Gram positive branching bacilli. The Gram positive branching bacilli were all slow-growing anaerobes or micro-aerophiles. Attempts to identify them using API 20A were unsuccessful. Two of the alpha-haemolytic streptococci were identified as Streptococcus mitis using API 20 Strep. Strep. mitis has been described as a cause of septicaemia in neonates (Hellwege et al., 1984), but only two of our five isolates were from neonates and none of these was judged to be clinically significant. The appearances of these contaminants coincided with the arrival of three new paediatric house officers. Their usual technique for taking blood for culture was to cannulate a vein on the dorsum of the hand after disinfecting the skin with isopropyl alcohol-impregnated wipes. However, “Butterfly-21 Int” cannulae intended for administration of intravenous drugs had been supplied to the wards instead of “Butterfly-21”. Both consist of a fine steel cannula attached to a flexible plastic tube which ends in a rigid plastic hub. The “Butterfly-21 Int” has a tightly adherent cap with a diaphragm through which a needle can be inserted. The “Butterfly-21” has an easily removable cap so that a syringe or giving set can be attached. The paediatricians admitted that when they inadvertently used the wrong type of “Butterfly” they had great difficulty removing the cap, and had, on occasions, resorted to using their teeth for this purpose. This may explain the occurrence of organisms associated with the oral flora in the blood cultures.
Rosamond
A. Cox
Department of Pathology, Kettering General Hospital, Northamptonshire NN16 8UZ, UK Reference
Hellwege, H. H., Streptococcus
Ram, mitis.
W., Scherf, H. and Lancet i, 743-744.
Fock,
R. (1984).
Neonatal
meningitis
caused
by
266
to the Editor
Elfrink,
J. G. R. & Booij, H. L. (1974). Interactions of chlorhexidine with yeast cells. Biochemical Pharmacology 23, 1413-1419. Russell, A. D., Hammond, S. A. & Morgan, J. R. (1986). Bacterial resistance to antiseptics and disinfectants. Journal of Hospital Injection 7, 213-225. Stickler, D. J. & Thomas, B. (1980). Antiseptic and antibiotic resistance in Gram negative bacteria causing urinary tract infection. Journal of Clinical Pathology 33, 288-296. Walker, E. M. & Lowes, J. A. (1985). An investigation into the in vitro methods for the detection of chlorhexidine resistance. Journal of Hospital Infection 6, 389-397.
Sir,
An unexpected
cause
of pseudobacteraemia
During August and September 1988, some unusual contaminants were detected in blood cultures received from the paediatric wards and special care baby unit at Kettering and District General Hospital. Of 90 blood cultures examined, five contained optochin-resistant alpha-haemolytic streptococci and four contained unusual Gram positive branching bacilli. The Gram positive branching bacilli were all slow-growing anaerobes or micro-aerophiles. Attempts to identify them using API 20A were unsuccessful. Two of the alpha-haemolytic streptococci were identified as Streptococcus mitis using API 20 Strep. Strep. mitis has been described as a cause of septicaemia in neonates (Hellwege et al., 1984), but only two of our five isolates were from neonates and none of these was judged to be clinically significant. The appearances of these contaminants coincided with the arrival of three new paediatric house officers. Their usual technique for taking blood for culture was to cannulate a vein on the dorsum of the hand after disinfecting the skin with isopropyl alcohol-impregnated wipes. However, “Butterfly-21 Int” cannulae intended for administration of intravenous drugs had been supplied to the wards instead of “Butterfly-21”. Both consist of a fine steel cannula attached to a flexible plastic tube which ends in a rigid plastic hub. The “Butterfly-21 Int” has a tightly adherent cap with a diaphragm through which a needle can be inserted. The “Butterfly-21” has an easily removable cap so that a syringe or giving set can be attached. The paediatricians admitted that when they inadvertently used the wrong type of “Butterfly” they had great difficulty removing the cap, and had, on occasions, resorted to using their teeth for this purpose. This may explain the occurrence of organisms associated with the oral flora in the blood cultures.
Rosamond
A. Cox
Department of Pathology, Kettering General Hospital, Northamptonshire NN16 8UZ, UK Reference
Hellwege, H. H., Streptococcus
Ram, mitis.
W., Scherf, H. and Lancet i, 743-744.
Fock,
R. (1984).
Neonatal
meningitis
caused
by