Nosocomial bloodstream infections: are positive blood cultures misleading?

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Abstract
Sir —We read with great interest the article of Edmond et al. [ 1 ] on nosocomial bloodstream infections and were impressed by the findings and the originality of some of the analyses. However, although the trend for increase in gram-positive pathogens is already well established [ 2 ], the finding of 32% coagulase-negative staphylococci (CNS) in nosocomial bloodstream infections (BSI) far exceeds the findings of previous studies (11% from nation-wide data [ 3 ] and 18% in critically ill patients [ 4 ]). Our concern is that many, if not most, of the CNS isolates included here represent contamination. All of the criteria used in this study could not assure that these isolates represent true bacteremias. The presence of intravascular catheters, the initiation of antimicrobial therapy, and the presence of fever are almost universal characteristics of patients from whom blood cultures are obtained.