Author:
- ABSTRACT.
- INTRODUCTION
- MATERIALS AND METHODS
- Selection of study sites.
- Quality assessment of blood culture systems.
- Assessment 1: Aggregated quality indicators.
- Assessment 2: Sampling and transportation indicators.
- Assessment 3: Clinical survey on missed opportunities for blood culture utilization.
- Survey content.
- Survey validation.
- Survey implementation.
- Assessment 4: Local guidelines and practices.
- DATA MANAGEMENT AND ANALYSIS
- ETHICAL CONSIDERATIONS
- RESULTS
- DISCUSSION
- CONCLUSION
- ACKNOWLEDGMENTS
- REFERENCES
ProCite
RefWorks
Reference Manager
BibTeX
Zotero
EndNote
-
1.
Kim PW , Perl TM , Keelaghan EF , Langenberg P , Perencevich EN , Harris AD , Song X , Roghmann MC , 2005. Risk of mortality with a bloodstream infection is higher in the less severely ill at admission. Am J Respir Crit Care Med 171: 616–620.
-
2.
Goto M , Al-Hasan MN , 2013. Overall burden of bloodstream infection and nosocomial bloodstream infection in North America and Europe. Clin Microbiol Infect 19: 501–509.
-
3.
Wang YC , Shih SM , Chen YT , Hsiung CA , Kuo SC , 2020. Clinical and economic impact of intensive care unit-acquired bloodstream infections in Taiwan: a nationwide population-based retrospective cohort study. BMJ Open 10: e037484.
-
4.
Rhodes A et al.2017. Surviving sepsis campaign: International guidelines for management of sepsis and septic shock: 2016. Intensive Care Med 43: 304–377.
-
5.
Seymour CW , Gesten F , Prescott HC , Friedrich ME , Iwashyna TJ , Phillips GS , Lemeshow S , Osborn T , Terry KM , Levy MM , 2017. Time to treatment and mortality during mandated emergency care for sepsis. N Engl J Med 376: 2235–2244.
-
6.
Lamy B , Sundqvist M , Idelevich EA , ESCMID Study Group for Bloodstream Infections, Endocarditis and Sepsis (ESGBIES), 2020. Bloodstream infections—standard and progress in pathogen diagnostics. Clin Microbiol Infect 26: 142–150.
-
7.
Ombelet S , Barbe B , Affolabi D , Ronat JB , Lompo P , Lunguya O , Jacobs J , Hardy L , 2019. Best practices of blood cultures in low- and middle-income countries. Front Med (Lausanne) 6: 131.
-
8.
CLSI , 2007. Principles and Procedures for Blood Cultures; Approved Guideline. CLSI document M47-A. Wayne, PA: Clinical and Laboratory Standards Institute.
-
9.
Leber AL , 2016. Clinical Microbiology Procedures Handbook. Washington, DC: ASM Press.
-
10.
World Health Organization , 2015. Global Antimicrobial Resistance Surveillance System: Manual for Early Implementation. Geneva, Switzerland: World Health Organization.
-
11.
Ombelet S , Ronat JB , Walsh T , Yansouni CP , Cox J , Vlieghe E , Martiny D , Semret M , Vandenberg O , Jacobs J , Bacteriology in Low Resource Settings Working Group , 2018. Clinical bacteriology in low-resource settings: today’s solutions. Lancet Infect Dis 18: e248–e258.
-
12.
Jacobs J , Hardy L , Semret M , Lunguya O , Phe T , Affolabi D , Yansouni C , Vandenberg O , 2019. Diagnostic bacteriology in district hospitals in sub-Saharan Africa: at the forefront of the containment of antimicrobial resistance. Front Med (Lausanne) 6: 205.
-
13.
Willems E , Smismans A , Cartuyvels R , Coppens G , Van Vaerenbergh K , Van den Abeele AM , Frans J , Bilulu Study Group , 2012. The preanalytical optimization of blood cultures: a review and the clinical importance of benchmarking in 5 Belgian hospitals. Diagn Microbiol Infect Dis 73: 1–8.
-
14.
Fabre V , Sharara SL , Salinas AB , Carroll KC , Desai S , Cosgrove SE , 2020. Does this patient need blood cultures? A scoping review of indications for blood cultures in adult nonneutropenic inpatients. Clin Infect Dis 71: 1339–1347.
-
15.
Chen AI , Bilker WB , Hamilton KW , O’Donnell JA , Nachamkin I , 2018. Blood culture utilization at an academic hospital: addressing a gap in benchmarking. Infect Control Hosp Epidemiol 39: 1353–1359.
-
16.
Fabre V et al.2020. A diagnostic stewardship intervention to improve blood culture use among adult nonneutropenic inpatients: the DISTRIBUTE study . J Clin Microbiol 58: e01053-20.
-
17.
World Health Organization , 2014. Antimicrobial Resistance Global Report on Surveillance. Geneva, Switzerland: World Health Organization.
-
18.
MINSA/INS , 2016. Plan Nacional para enfrentar la resistencia a los antimicrobianos 2017–2021: Grupo de Coordinación sobre la Resistencia Antimicrobiana en Peru.
-
19.
World Health Organization , 2015. Global Action Plan on Antimicrobial Resistance. Geneva, Switzerland: World Health Organization.
-
20.
Alcalde-Rabanal JE , Lazo-González O , Nigenda G , 2011. The health system of Peru. Salud Publica Mex 53: S243–S254.
-
21.
Van Slyke D , Phillips RA , Dole VP , Hamilton PB , Archibald RM , 1950. Calculation of hemoglobin from blood specific gravities. Journal of BioIogical Chemistry 183: 349–360.
-
22.
Maldonado N , et al., 2018. Caracterización de los procedimientos para la realización de hemocultivos en pacientes adultos, en instituciones hospitalarias del Área Metropolitana del Valle de Aburrá. Infectio 22: 19–25.
-
23.
Archibald LK , Pallangyo K , Kazembe P , Reller LB , 2006. Blood culture contamination in Tanzania, Malawi, and the United States: a microbiological tale of three cities. J Clin Microbiol 44: 4425–4429.
-
24.
Peeters M et al.2019. Slow growth of Burkholderia pseudomallei compared to other pathogens in an adapted blood culture system in Phnom Penh, Cambodia. J Med Microbiol 68: 1159–1166.
-
25.
Lee A , Mirrett S , Reller LB , Weinstein MP , 2007. Detection of bloodstream infections in adults: how many blood cultures are needed? J Clin Microbiol 45: 3546–3548.
-
26.
MINSA/INS , 2013. Manual de Procedimientos de laboratorio: manual: laboratorios locales II. Lima, Peru: Ministerio de Salud, Instituto Nacional de Salud.
-
27.
MINSA/INS , 2005. Manual de procedimientos bacteriológicos en infecciones intrahospitalarias. Lima, Peru: Ministerio de Salud, Instituto Nacional de Salud.
-
28.
Cheng MP et al.2019. Blood culture results before and after antimicrobial administration in patients with severe manifestations of sepsis: a diagnostic study. Ann Intern Med 171: 547–554.
-
29.
Alahmadi YM et al.2011. Clinical and economic impact of contaminated blood cultures within the hospital setting. J Hosp Infect 77: 233–236.
-
30.
Bates DW , Goldman L , Lee TH , 1991. Contaminant blood cultures and resource utilization. The true consequences of false-positive results. JAMA 265: 365–369.
-
31.
Chukwuemeka IK , Samuel Y , 2014. Quality assurance in blood culture: a retrospective study of blood culture contamination rate in a tertiary hospital in Nigeria. Niger Med J 55: 201–203.
-
32.
Altindis M et al.2016. A multicenter evaluation of blood culture practices, contamination rates, and the distribution of causative bacteria. Jundishapur J Microbiol 9: e29766.
-
33.
Guzman AM , Sanchez T , de la Barra R , 2012. Análisis de la monitorización de cinco indicadores de calidad del hemocultivo en un hospital universitario en Chile 2009–2011. Rev Chilena Infectol 29: 406–411.
-
34.
Weinstein MP , Towns ML , Quartey SM , Mirrett S , Reimer LG , Parmigiani G , Reller LB , 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.
-
35.
Herwaldt LA , Geiss M , Kao C , Pfaller MA , 1996. The positive predictive value of isolating coagulase-negative staphylococci from blood cultures. Clin Infect Dis 22: 14–20.
| Past two years | Past Year | Past 30 Days | |
|---|---|---|---|
| Abstract Views | 2382 | 413 | 28 |
| Full Text Views | 140 | 88 | 6 |
| PDF Downloads | 121 | 58 | 2 |
Underutilization and Quality Gaps in Blood Culture Processing in Public Hospitals of Peru
Fiorella Krapp
Fiorella Krapp
Universidad Peruana Cayetano Heredia, Lima, Peru;
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Claudia Rondon
Claudia Rondon
Universidad Peruana Cayetano Heredia, Lima, Peru;
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Catherine Amaro
Catherine Amaro
Hospital Cayetano Heredia, Lima, Peru;
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Evelyn Barco-Yaipén
Evelyn Barco-Yaipén
Hospital Regional II-2 José Alfredo Mendoza Olavarría, Tumbes, Peru;
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María Valera-Krumdieck
María Valera-Krumdieck
Hospital María Auxiliadora, Lima, Peru;
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Rubén Vásquez
Rubén Vásquez
Hospital María Auxiliadora, Lima, Peru;
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Alexander Briones
Alexander Briones
Hospital Regional de Loreto Felipe Santiago Arriola Iglesias Loreto, Peru;
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Martin Casapia
Martin Casapia
Hospital Regional de Loreto Felipe Santiago Arriola Iglesias Loreto, Peru;
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Antonio Burgos
Antonio Burgos
Hospital Regional de Pucallpa, Pucallpa, Peru;
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Favio Sarmiento López
Favio Sarmiento López
Hospital Regional de Pucallpa, Pucallpa, Peru;
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Pierina Vilcapoma
Pierina Vilcapoma
Hospital Regional Daniel Alcides Carrión, Huancayo, Peru;
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Roberto Díaz Sipión
Roberto Díaz Sipión
Hospital Regional Lambayeque, Chiclayo, Peru;
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Miguel Villegas-Chiroque
Miguel Villegas-Chiroque
Hospital Regional Lambayeque, Chiclayo, Peru;
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Kelly Castillo
Kelly Castillo
Hospital Belén de Trujillo, La Libertad, Peru;
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Jimena Pino-Dueñas
Jimena Pino-Dueñas
Hospita Antonio Lorena Cusco, Cusco, Peru;
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Edwin Cuaresma Cuadros
Edwin Cuaresma Cuadros
Hospital III-Daniel Alcides Carrión Essalud-Tacna, Tacna, Peru;
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Hugo Alpaca-Salvador
Hugo Alpaca-Salvador
Hospital III Essalud-Chimbote, Ancash, Peru;
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René Campana
René Campana
Hospital Goyeneche, Arequipa, Peru;
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Teresa Peralta Córdova
Teresa Peralta Córdova
Hospital Base Víctor Lazarte Echegaray de EsSalud La Libertad, La Libertad, Peru;
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Elizett Sierra Chavez
Elizett Sierra Chavez
Hospital Nacional Hipólito Unanue, Lima Peru;
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Carla Aguado Ventura
Carla Aguado Ventura
Hospital Regional de Ica, Ica, Peru;
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Marjan Peeters
Marjan Peeters
Institute of Tropical Medicine Antwerp, Belgium;
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Jan Jacobs
Jan Jacobs
Institute of Tropical Medicine Antwerp, Belgium;
Department of Microbiology, Immunology and Transplantation, KU Leuven, Belgium
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Department of Microbiology, Immunology and Transplantation, KU Leuven, Belgium
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Coralith Garcia
Coralith Garcia
Universidad Peruana Cayetano Heredia, Lima, Peru;
Hospital Cayetano Heredia, Lima, Peru;
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Hospital Cayetano Heredia, Lima, Peru;
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ABSTRACT.
Correct processing of blood cultures may impact individual patient management, antibiotic stewardship, and scaling up of antimicrobial resistance surveillance. To assess the quality of blood culture processing, we conducted four assessments at 16 public hospitals across different regions of Peru. We assessed the following standardized quality indicators: 1) positivity and contamination rates, 2) compliance with recommended number of bottles/sets and volume of blood sampled, 3) blood culture utilization, and 4) possible barriers for compliance with recommendations. Suboptimal performance was found, with a median contamination rate of 4.2% (range 0–15.1%), with only one third of the participating hospitals meeting the target value of < 3%; and a median positivity rate of 4.9% (range 1–8.1%), with only 6 out of the 15 surveilled hospitals meeting the target of 6–12%. None of the assessed hospitals met both targets. The median frequency of solitary blood cultures was 71.9% and only 8.9% (N = 59) of the surveyed adult bottles met the target blood volume of 8 – 12 mL, whereas 90.5% (N = 602) were underfilled. A high frequency of missed opportunities for ordering blood cultures was found (69.9%, 221/316) among patients with clinical indications for blood culture sampling. This multicenter study demonstrates important shortcomings in the quality of blood culture processing in public hospitals of Peru. It provides a national benchmark of blood culture utilization and quality indicators that can be used to monitor future quality improvement studies and diagnostic stewardship policies.
- Supplemental Materials (PDF 414 KB)
Author Notes
Financial support: This work was funded by the Belgian Directorate of Development Cooperation (DGD) through the Framework Agreement between the Belgian DGD and the Institute of Tropical Medicine, Belgium. F. K. holds a PhD scholarship of the Belgian DGD.
Authors’ addresses: Fiorella Krapp and Claudia Rondon, Universidad Peruana Cayetano Heredia, Lima, Peru, E-mails: fiorella.krapp@upch.pe and claudia.rondon.p@upch.pe. Catherine Amaro, Hospital Cayetano Heredia, Lima, Peru, E-mail: catherineamaro2007@hotmail.com. Evelyn Barco-Yaipén, Hospital Regional II-2 José Alfredo Mendoza Olavarría, Tumbes, Peru, E-mail: evelynbarco@gmail.com. María Valera-Krumdieck and Rubén Vásquez, Hospital María Auxiliadora, Lima, Peru, E-mails: mvalerak@gmail.com and ruben_dariovb@yahoo.es. Alexander Briones and Martin Casapia, Hospital Regional de Loreto Felipe Santiago Arriola Iglesias Loreto, Peru, E-mails: alexander.brionesalejos@gmail.com and mcasapia@acsaperu.org. Antonio Burgos and Favio Sarmiento López, Hospital Regional de Pucallpa, Pucallpa, Peru, E-mails: segundo67lab@hotmail.com and faviosar@yahoo.com. Pierina Vilcapoma, Hospital Regional Daniel Alcides Carrión, Huancayo, Peru, E-mail: pierina222@hotmail.com. Roberto Díaz Sipión and Miguel Villegas-Chiroque, Hospital Regional Lambayeque, Chiclayo, Peru, E-mails: betosipion@hotmail.com and mivichi2003@hotmail.com. Kelly Castillo, Hospital Belén de Trujillo, La Libertad, Peru, E-mail: kmcastillod@yahoo.es. Jimena Pino-Dueñas, Hospita Antonio Lorena Cusco, Cusco, Peru, E-mail: jimenaedith@hotmail.com. Edwin Cuaresma Cuadros, Hospital III Daniel Alcides Carrión Essalud-Tacna, Tacna, Peru, E-mail: ecuaresma74@hotmail.com. Hugo Alpaca-Salvador, Hospital III Essalud-Chimbote, Ancash, Peru, E-mail: h_anibal24@hotmail.com. René Campana, Hospital Goyeneche, Arequipa, Peru, E-mail: reneefrain@yahoo.es. Teresa Peralta Córdova, Hospital Base Víctor Lazarte Echegaray de EsSalud La Libertad, La Libertad, Peru, E-mail: tdjpc@hotmail.com. Elizett Sierra Chavez, Hospital Nacional Hipólito Unanue, Lima Peru, E-mail: elicett_b@hotmail.com. Carla Aguado Ventura, Hospital Regional de Ica, Ica, Peru, E-mail: carlaguado@hotmail.com. Marjan Peeters, Institute of Tropical Medicine Antwerp, Belgium, E-mail: mpeeters@itg.be. Jan Jacobs, Institute of Tropical Medicine Antwerp, Belgium and Department of Microbiology, Immunology and Transplantation, KU Leuven, Belgium, E-mail: jjacobs@itg.be. Coralith Garcia, Universidad Peruana Cayetano Heredia, Lima, Peru and Hospital Cayetano Heredia, Lima, Peru, E-mail: coralith.garcia@upch.
- ABSTRACT.
- INTRODUCTION
- MATERIALS AND METHODS
- Selection of study sites.
- Quality assessment of blood culture systems.
- Assessment 1: Aggregated quality indicators.
- Assessment 2: Sampling and transportation indicators.
- Assessment 3: Clinical survey on missed opportunities for blood culture utilization.
- Survey content.
- Survey validation.
- Survey implementation.
- Assessment 4: Local guidelines and practices.
- DATA MANAGEMENT AND ANALYSIS
- ETHICAL CONSIDERATIONS
- RESULTS
- DISCUSSION
- CONCLUSION
- ACKNOWLEDGMENTS
- REFERENCES
ProCite
RefWorks
Reference Manager
BibTeX
Zotero
EndNote
-
1.
Kim PW , Perl TM , Keelaghan EF , Langenberg P , Perencevich EN , Harris AD , Song X , Roghmann MC , 2005. Risk of mortality with a bloodstream infection is higher in the less severely ill at admission. Am J Respir Crit Care Med 171: 616–620.
-
2.
Goto M , Al-Hasan MN , 2013. Overall burden of bloodstream infection and nosocomial bloodstream infection in North America and Europe. Clin Microbiol Infect 19: 501–509.
-
3.
Wang YC , Shih SM , Chen YT , Hsiung CA , Kuo SC , 2020. Clinical and economic impact of intensive care unit-acquired bloodstream infections in Taiwan: a nationwide population-based retrospective cohort study. BMJ Open 10: e037484.
-
4.
Rhodes A et al.2017. Surviving sepsis campaign: International guidelines for management of sepsis and septic shock: 2016. Intensive Care Med 43: 304–377.
-
5.
Seymour CW , Gesten F , Prescott HC , Friedrich ME , Iwashyna TJ , Phillips GS , Lemeshow S , Osborn T , Terry KM , Levy MM , 2017. Time to treatment and mortality during mandated emergency care for sepsis. N Engl J Med 376: 2235–2244.
-
6.
Lamy B , Sundqvist M , Idelevich EA , ESCMID Study Group for Bloodstream Infections, Endocarditis and Sepsis (ESGBIES), 2020. Bloodstream infections—standard and progress in pathogen diagnostics. Clin Microbiol Infect 26: 142–150.
-
7.
Ombelet S , Barbe B , Affolabi D , Ronat JB , Lompo P , Lunguya O , Jacobs J , Hardy L , 2019. Best practices of blood cultures in low- and middle-income countries. Front Med (Lausanne) 6: 131.
-
8.
CLSI , 2007. Principles and Procedures for Blood Cultures; Approved Guideline. CLSI document M47-A. Wayne, PA: Clinical and Laboratory Standards Institute.
-
9.
Leber AL , 2016. Clinical Microbiology Procedures Handbook. Washington, DC: ASM Press.
-
10.
World Health Organization , 2015. Global Antimicrobial Resistance Surveillance System: Manual for Early Implementation. Geneva, Switzerland: World Health Organization.
-
11.
Ombelet S , Ronat JB , Walsh T , Yansouni CP , Cox J , Vlieghe E , Martiny D , Semret M , Vandenberg O , Jacobs J , Bacteriology in Low Resource Settings Working Group , 2018. Clinical bacteriology in low-resource settings: today’s solutions. Lancet Infect Dis 18: e248–e258.
-
12.
Jacobs J , Hardy L , Semret M , Lunguya O , Phe T , Affolabi D , Yansouni C , Vandenberg O , 2019. Diagnostic bacteriology in district hospitals in sub-Saharan Africa: at the forefront of the containment of antimicrobial resistance. Front Med (Lausanne) 6: 205.
-
13.
Willems E , Smismans A , Cartuyvels R , Coppens G , Van Vaerenbergh K , Van den Abeele AM , Frans J , Bilulu Study Group , 2012. The preanalytical optimization of blood cultures: a review and the clinical importance of benchmarking in 5 Belgian hospitals. Diagn Microbiol Infect Dis 73: 1–8.
-
14.
Fabre V , Sharara SL , Salinas AB , Carroll KC , Desai S , Cosgrove SE , 2020. Does this patient need blood cultures? A scoping review of indications for blood cultures in adult nonneutropenic inpatients. Clin Infect Dis 71: 1339–1347.
-
15.
Chen AI , Bilker WB , Hamilton KW , O’Donnell JA , Nachamkin I , 2018. Blood culture utilization at an academic hospital: addressing a gap in benchmarking. Infect Control Hosp Epidemiol 39: 1353–1359.
-
16.
Fabre V et al.2020. A diagnostic stewardship intervention to improve blood culture use among adult nonneutropenic inpatients: the DISTRIBUTE study . J Clin Microbiol 58: e01053-20.
-
17.
World Health Organization , 2014. Antimicrobial Resistance Global Report on Surveillance. Geneva, Switzerland: World Health Organization.
-
18.
MINSA/INS , 2016. Plan Nacional para enfrentar la resistencia a los antimicrobianos 2017–2021: Grupo de Coordinación sobre la Resistencia Antimicrobiana en Peru.
-
19.
World Health Organization , 2015. Global Action Plan on Antimicrobial Resistance. Geneva, Switzerland: World Health Organization.
-
20.
Alcalde-Rabanal JE , Lazo-González O , Nigenda G , 2011. The health system of Peru. Salud Publica Mex 53: S243–S254.
-
21.
Van Slyke D , Phillips RA , Dole VP , Hamilton PB , Archibald RM , 1950. Calculation of hemoglobin from blood specific gravities. Journal of BioIogical Chemistry 183: 349–360.
-
22.
Maldonado N , et al., 2018. Caracterización de los procedimientos para la realización de hemocultivos en pacientes adultos, en instituciones hospitalarias del Área Metropolitana del Valle de Aburrá. Infectio 22: 19–25.
-
23.
Archibald LK , Pallangyo K , Kazembe P , Reller LB , 2006. Blood culture contamination in Tanzania, Malawi, and the United States: a microbiological tale of three cities. J Clin Microbiol 44: 4425–4429.
-
24.
Peeters M et al.2019. Slow growth of Burkholderia pseudomallei compared to other pathogens in an adapted blood culture system in Phnom Penh, Cambodia. J Med Microbiol 68: 1159–1166.
-
25.
Lee A , Mirrett S , Reller LB , Weinstein MP , 2007. Detection of bloodstream infections in adults: how many blood cultures are needed? J Clin Microbiol 45: 3546–3548.
-
26.
MINSA/INS , 2013. Manual de Procedimientos de laboratorio: manual: laboratorios locales II. Lima, Peru: Ministerio de Salud, Instituto Nacional de Salud.
-
27.
MINSA/INS , 2005. Manual de procedimientos bacteriológicos en infecciones intrahospitalarias. Lima, Peru: Ministerio de Salud, Instituto Nacional de Salud.
-
28.
Cheng MP et al.2019. Blood culture results before and after antimicrobial administration in patients with severe manifestations of sepsis: a diagnostic study. Ann Intern Med 171: 547–554.
-
29.
Alahmadi YM et al.2011. Clinical and economic impact of contaminated blood cultures within the hospital setting. J Hosp Infect 77: 233–236.
-
30.
Bates DW , Goldman L , Lee TH , 1991. Contaminant blood cultures and resource utilization. The true consequences of false-positive results. JAMA 265: 365–369.
-
31.
Chukwuemeka IK , Samuel Y , 2014. Quality assurance in blood culture: a retrospective study of blood culture contamination rate in a tertiary hospital in Nigeria. Niger Med J 55: 201–203.
-
32.
Altindis M et al.2016. A multicenter evaluation of blood culture practices, contamination rates, and the distribution of causative bacteria. Jundishapur J Microbiol 9: e29766.
-
33.
Guzman AM , Sanchez T , de la Barra R , 2012. Análisis de la monitorización de cinco indicadores de calidad del hemocultivo en un hospital universitario en Chile 2009–2011. Rev Chilena Infectol 29: 406–411.
-
34.
Weinstein MP , Towns ML , Quartey SM , Mirrett S , Reimer LG , Parmigiani G , Reller LB , 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.
-
35.
Herwaldt LA , Geiss M , Kao C , Pfaller MA , 1996. The positive predictive value of isolating coagulase-negative staphylococci from blood cultures. Clin Infect Dis 22: 14–20.
| Past two years | Past Year | Past 30 Days | |
|---|---|---|---|
| Abstract Views | 2382 | 413 | 28 |
| Full Text Views | 140 | 88 | 6 |
| PDF Downloads | 121 | 58 | 2 |