Comparison of contamination rates of catheter-drawn and peripheral blood cultures

The aim of this study was to assess the sensitivity and specificity of catheter-drawn and peripheral blood cultures. Paired blood culture samples collected over a 44-month period from a 280 bed Brisbane metropolitan hospital were analysed, using standard clinical and microbiological criteria, to determine whether blood culture isolates represented true bacteraemias or contamination. Catheter-collected cultures had a specificity of 85% compared with 97% for peripheral cultures. In only two instances (0.2%) was the diagnosis of clinically significant bacteraemia made on the basis of catheter culture alone. This study concluded that catheter-collected samples are not a good test for true bacteraemia, and that peripheral. cultures are more reliable when the results of the paired cultures are discordant. (c) 2004 The Hospital Infection Society. Published by Elsevier Ltd. All rights reserved.

Misleading high tobramycin plasma concentrations can be caused by skin contamination of fingerprick blood following inhalation of nebulized tobramycin (TOBI (R)) - A short report

We observed unexpected high plasma concentrations of tobrarriycin (48.5 and 28.1 mg/L) in fingerprick blood samples after the nebulization of tobramycin solution for inhalation (tobramycin 300 mg/5 mL, TOBI(R)) by 2 young children aged 3 years. To investigate whether dermal contamination could be the source of error, 3 adult volunteers were present during another nebulization by a third child (age 2 years). The volunteers had exposure to tobramycin by handling the nebulizer or the nebule and also by inhalation from holding the child and being in close proximity while TOBI(R) was being administered. Five blood samples by fingerprick and 2 by venipuncture were collected and assayed for tobramycin concentration. On each occasion the site was swabbed with alcohol wipes to mimic standard patient sampling methods. One site was resampled after cleaning of hands with 2% chlorhexidine gluconate and water. Tobramycin concentrations from venipuncture 1-2 hours after nebulization were all < 0.2 mg/L except for 1 result of 1.2 mg/L. The tobramycin concentrations from fingerpricks before hand washing varied between 6.8 and 172 mg/L, and after hand washing between 0.3 and 17.6 mg/L. Contamination of fingers with tobramycin is likely to have caused the error in the 2 initial cases and did cause misleadingly elevated levels in the adult volunteers. We caution that therapeutic drug monitoring of nebulized tobramycin should not be done by fingerprick sampling, and care should be taken to avoid contamination of the venipuncture site.

Haematological values of young male rusa deer (Cervus timorensis)

Objective To measure haematological values of clinical significance for rusa deer and provide reference data for farmed animals. Design Blood samples were collected regularly from eight male rusa deer from 14 days to 27 months old. Procedure Blood samples, collected by venipuncture, were analysed within 6 hours of collection for red cell count, haemoglobin, packed cell volume, plasma glucose, white cell count and differentials. Results Haemoglobin concentrations appeared to increase with age and ranged from 6.0 to 20.9 g/dL. Packed cell volume and plasma glucose concentration did not appear to vary with age. White cell counts ranged from 6.3 to 7.0 x 10(9)/L and differential counts indicated neutrophils > lymphocytes > monocytes > eosinophils > basophils. In general, the values for packed cell volume, red cell count, mean cell volumes and mean cell haemoglobin concentrations were within ranges previously reported for captive or sedated rusa deer. Conclusions Physical restraint and resultant stress was sufficient to generate some of the effects previously reported for physically immobilised or agitated deer. The values reported here do not differ greatly from those previously reported for rusa deer and can be used as reference values for clinically healthy young farmed male rusa deer.