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TheGermDoctor
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Category: Medical
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Experience:  17 years as a physician, Board Certified in both Internal Medicine and Infectious Diseases
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I have included 3 Blood Cultures. The first two are from Oct.

Customer Question

I have included 3 Blood Cultures. The first two are from Oct. 6, 2010. I was in the emergency room for my middle chest and upper left chest hurting and appendix area. They ended up taking my appendix out, it was gangrene. The third blood culture was from Dec. 19, 2010. After the third they finally figured out Bacterial Endocarditis, 8 days in hospital, and now my Aortic Valve has to be replaced tomorrow. I am not suing, just would like your opinion on where things went wrong? It appears to me, someone did not properly follow up the Oct. 6th blood cultures....where did things fail?

Wed, 10/06/2010 08:27
Peripheral BldCul
Collection Time: 6 Oct 10 0827
Specimen: Bld Cult
Gram Stain: Blood culture positive for gram positive cocci in pairs and chains at 30 hours old, Thu, 7 Oct 2010 1345. Report called to T /LPN SW, Thu, 7 Oct 2010 1522 and read back.
Growth: growth
Final ID: Quantity: Organism: diphtheroids
Comment: Please note: Review of original gram stain shows diphtheroid-like gram positive rods. Report paged to Dr. W (on call for Dr. X ) with no response and faxed to Dr. X 10/09/10.
(Note: I was already released from hospital on10/09/10)

Wed, 10/06/2010 09:38
Peripheral BldCul
Collection Time: 6 Oct 10 0938
Specimen: Bld Clt
Gram Stain: Blood Culture positive for gram positive cocci in pairs and chains at 28 hours old, Thu, 7 Oct 2010 1440. Report called to Z /LPN SW, Thu, 7 Oct 2010 1524 and read back.

NO CULTURE TESTS DONE ON THURSDAY AND FRIDAY at the hospital while in for appendix and before being released. No follow up appointment to make sure the blood bacteria is gone.

Urgicare Center
Sun, 12/19/2010 1416
Specimen: Blood Cult – Adult, Peripheral stick
Gram Stain – Blood Culture positive for gram positive cocci in chains at 63 hours old, Wed, 22 Dec 2010 0530. Report called to B / 1 Speciality, Wed, 22 Dec 2010 0659 and read back.
Final ID: Quantity, Organism: Streptoccocus, viridans group
Submitted: 3 years ago.
Category: Medical
Expert:  TheGermDoctor replied 3 years ago.

Hello-

 

Do you have the FINAL culture result from the second specimen from 10/6 ?

( The first came out final as a diphtheroid, the second is only the interim result showing gram positive cocci in chains- this is not a diphtheroid and is a different organism).

 

Do you know if your aortic endocarditis is thought to be from the viridans strep?

Expert:  TheGermDoctor replied 3 years ago.

Also, as an infectious diseases physician, I would not be content with a culture result just stating "viridans strep"- that is actually not an identification of a bacteria- it is just a description of a whole group of bacteria-

 

Did they actually give a final identification ( genus and species) to the bacteria you had in Oct - assuming the second culture was the same- and the third on Dec 19 ? -

By this I mean- Strep mitis, or mutans, etc etc etc...

Customer: replied 3 years ago.

I think I understand what you are asking. The 1st you see is actually the older of the two cultures. As you look at them:

 

1. Wed, 10/06/2010 08:27 - Collection Time: 6 Oct 10 0827 -

Final ID: Quantity: Organism: diphtheroids

 

2. Wed, 10/06/2010 09:38 - Collection Time: 6 Oct 10 0938 - Wow...no Final ID, I have my actual records....but they did notify an LPN of the gram positive cocci in pairs and chains at 28 hours old.

 

Is that where the booboo occurred. Someone should have requested Final ID? I promise it is no where on the page?

 

 

Customer: replied 3 years ago.
The day they were checking me out of the hospital, the nurse said, you have a Staph infection. I had heard those are not good. I said, "What is it? Where is it? Where did I get it?" She replied, "I don't know" No one else did either....
Customer: replied 3 years ago.
Yes, sir...strep Viridians...
Expert:  TheGermDoctor replied 3 years ago.

OK- First thing.

Unless you have other cultures that you did not include, the nurse may have just misspoken in saying you had a "Staph" infections. ( This is a very common bacteria, and she may have just assumed it - doesn't mean she is right).

 

Second- that second culture- I would need to clarify with the microbiology lab.

Yes, I would insist on a final culture result which you have not included here.

The lab may have meant to include a note that it was the same as the first one- ie a diphtheroid. I can almost guarantee you that the lab did identify it- just your report , as you wrote here is incomplete. That doesn't mean that is a problem- just incomplete.

 

Now- as far as endocarditis- if you have a normal native valve, then the strep would be a more common cause of endocarditis than the diphtheroid- that diphtheroid may in fact be unrelated- it could have been from a central line, or even your appendix, and does not necessarily have anything to do with your subsequent strep infection. I just cannot be entirely sure without knowing for sure what that second culture was. ( If that second culture in fact was a strep as well... then I would be more suspicious).

 

Always ask if you need clarification/more information.


POSITIVE feedback & a BONUS are warmly appreciated.
Please note that answers are for information only, do not take the place of an assessment by your doctor,
and does not establish a patient-physician relationship.

 

 

Expert:  TheGermDoctor replied 3 years ago.

Again, in a top level lab, especially when endocarditis is considered and it is not thought to be a contaminant, "strep viridans" is an incomplete identification.

this is not a bacterial identification, it is a description of the appearance of the bacteria.

The bacteria would need more specific identification in Dec ( and as well in Oct if that second culture was the same)- to be able to know more clearly if this was the same infection from Oct.

 

Always ask if you need clarification/more information.


POSITIVE feedback & a BONUS are warmly appreciated.
Please note that answers are for information only, do not take the place of an assessment by your doctor,
and does not establish a patient-physician relationship.

Customer: replied 3 years ago.

Thank you...Would the fact that they had me on Zosyn during the 3 days, and then Cipro and I think Cephalexin(sorry for spelling) when I got out tell you anything?

 

I had a hive reaction on my back and chest within 2 days of getting out....they thought it was from the Cipro so they had me stop it. Turns out it was the Zosyn I was allergic to.

 

But based on the Anti-Biotics and the Power Level....does that tell you anything?

Expert:  TheGermDoctor replied 3 years ago.

Those antibiotics I assume were for your appendicitis.

It doesn't tell me much about your problem now.

 

I would add, however, that I always do follow up blood cultures in those who are positive- so if you had positive cultures in Oct, I would repeat them again- after you were off antibiotics, to assure clearance ( and not 2 months later in Dec.).

 

Good luck.

 

Always ask if you need clarification/more information.


POSITIVE feedback & a BONUS are warmly appreciated.
Please note that answers are for information only, do not take the place of an assessment by your doctor,
and does not establish a patient-physician relationship.

TheGermDoctor, Doctor
Category: Medical
Satisfied Customers: 1549
Experience: 17 years as a physician, Board Certified in both Internal Medicine and Infectious Diseases
TheGermDoctor and 7 other Medical Specialists are ready to help you
Customer: replied 3 years ago.

Bingo....you are awesome. I do feel better.....my gut was telling me, please...why didn't they just follow up just to make sure after the positive blood cultures on the appendix and knowing I had pain in my middle and upper left chest area. They would have caught the Endocarditis and killed it before it killed my Aortic Valve.

 

Thank you...

Expert:  TheGermDoctor replied 3 years ago.

It is always hard to know the sequence and results.

 

As I noted there are some missing pieces of information not included, so I cannot say for sure about the relationship to the Oct cultures and if it had anything to do with Dec., or if your endocarditis could have been prevented.

 

I did not say that, and could not be sure of that, without the missing information provided.

 

Good luck with your surgery.

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