Clinical impact of extended blood culture examination: Too much of a good thing.

Blood culture is the most critical examination for diagnosing bacterial infections. The longer the blood culture incubation period, the higher the chances of identifying bacterial strains. However, unnecessary extension of the incubation period can burden the capacity of the instrument and merely result in the detection of contaminant bacteria having no clinical significance. This study aimed to optimize the blood culture incubation period using the currently available continuous-monitoring automated blood culture instrument. This was a 2-year retrospective study performed at Osaka University Hospital (January 1, 2016 to December 31, 2017). The BD BACTEC™ FX blood culture system (Becton Dickinson, Sparks, MD, USA) and BD BACTEC™ Plus series blood culture bottles were used. All blood cultures were incubated for more than 12 consecutive days. We reviewed the clinical data of cases that tested positive between 6 and 12 days of incubation. During the study period, 14,822 sets of blood culture were drawn. Of 1751 sets testing positive, 95.7% (1665 sets) became positive within 5 days of incubation. The overall contamination rate (false positives) after 6 days of incubation was 80.2% (69/86 sets). Based on the positive blood culture results, antimicrobials were changed in 7.0% (6/86) of the sets, and a diagnosis of infectious disease was made in only one case. There was no death associated with the extended blood culture results. In conclusion, the clinical impact of extended blood culture incubation for 6 days or more was limited, and a routine extension of the incubation period might be unnecessary.

Hit pause: Developmental arrest in annual killifishes and their close relatives.

Killifishes survive and persist in extreme environments by exploiting both aquatic and terrestrial habitats for egg deposition, and by adjusting the length of development to match availability of water to support larval growth and maturation. Annual killifishes persist in ephemeral bodies of water through the production of drought-tolerant embryos. Survival of the environmental stresses associated with their highly variable and seasonal habitat is supported by their ability to enter into at least two states of metabolic and developmental dormancy, diapause or quiescence. There are three stages of diapause in annual killifishes, one occurring prior to gastrulation, one about midway through development, and one in late pre-hatching embryos. Quiescence may occur at any developmental stage. In addition, delayed hatching is known to occur in close relatives of the annual killifishes, and may be superficially confused with pre-hatching diapause. These types of developmental delay are induced by different cues and serve different purposes in the life history of the species. Thus, it is likely that the molecular mechanisms that induce dormancy and support survival are unique in each case. It is imperative that we properly define these forms of developmental dormancy in our studies in order to put our results into the proper ecological and evolutionary context. Here the unique characteristics of these distinct categories of developmental delay are reviewed. Developmental Dynamics 246:858-866, 2017. © 2017 The Authors Developmental Dynamics published by Wiley Periodicals, Inc. on behalf of American Association of Anatomists.

Ten-day culture incubation time can accurately detect bacterial infection in periprosthetic infection in shoulder arthroplasty.

BACKGROUND: Cutibacterium acnes is the most commonly isolated organism involved in periprosthetic shoulder infections. C acnes has traditionally been difficult to isolate, and much debate exists over appropriate culture methods. Recently, our institution initiated a 10-day culture method using a Brucella blood agar medium to enhance anaerobic growth specifically for C acnes in shoulder specimens. METHODS: A retrospective review of shoulder cultures from 2014-2017 of patients undergoing workup for possible infected shoulder arthroplasty was performed. Cultures were obtained in patients either preoperatively or intraoperatively at the time of revision. Presence of infection was determined based on at least 1 positive culture and treatment with either prolonged antibiotics, placement of an antibiotic spacer at the time of revision, or repeat surgical débridement. RESULTS: The records of 85 patients with 136 cultures were reviewed. Eighty-two patients had full records with at least 1-year clinical follow-up. Fifty-eight cultures were positive, with C acnes as the most commonly recovered organism (57% of positive cultures). Clinical follow-up of patients with negative cultures found no incidence of missed periprosthetic infection. CONCLUSIONS: Use of a 10-day culture incubation method to enhance anaerobic bacterial growth is able to accurately detect periprosthetic infection in the shoulder including those related to C acnes. Our results suggest that by adopting more uniform culture methods, a shorter culture incubation time may be adequate. Ultimately, prospective studies with rigorous microbiologic methods are needed to best understand the clinical significance of unexpected positive bacterial cultures in shoulder arthroplasty.