{
  "id": "medical/blood-culture-contamination-misinterpretation",
  "signature": "AI misinterprets a single positive blood culture for coagulase-negative staphylococci as true bacteremia, leading to unnecessary vancomycin therapy",
  "signature_zh": "AI将凝固酶阴性葡萄球菌的单个阳性血培养误判为真性菌血症，导致不必要的万古霉素治疗",
  "regex": "(?:blood culture|BC)\\s*(?:positive|grew|isolated)\\s*(?:CoNS|coagulase[\\s-]?negative|staph epi|staphylococcus)",
  "domain": "medical",
  "category": "data_error",
  "subcategory": null,
  "root_cause": "Coagulase-negative staphylococci (CoNS) are common skin contaminants; true bacteremia requires at least two positive cultures from separate venipunctures or one positive from a sterile site. A single positive bottle has a 70-80% probability of contamination, but AI treats it as definitive infection.",
  "root_cause_type": "generic",
  "root_cause_zh": "凝固酶阴性葡萄球菌是常见的皮肤污染物；真性菌血症需要至少两次来自不同静脉穿刺的阳性培养或一次来自无菌部位的阳性培养。单个阳性瓶有70-80%的概率为污染，但AI将其视为确定性感染。",
  "versions": [
    {
      "version": "BD BACTEC FX v5.0",
      "introduced": null,
      "deprecated": null,
      "removed": null,
      "behavior_change": null,
      "status": "active"
    },
    {
      "version": "bioMerieux VITEK MS v3.2",
      "introduced": null,
      "deprecated": null,
      "removed": null,
      "behavior_change": null,
      "status": "active"
    },
    {
      "version": "Thermo Fisher VersaTREK v2.1",
      "introduced": null,
      "deprecated": null,
      "removed": null,
      "behavior_change": null,
      "status": "active"
    }
  ],
  "os_specific": {},
  "dead_ends": [
    {
      "action": "",
      "why_fails": "Vancomycin is nephrotoxic and promotes resistance; if contamination, patient receives unnecessary antibiotics with risk of AKI",
      "fail_rate": 0.7,
      "condition": "",
      "sources": []
    },
    {
      "action": "",
      "why_fails": "Repeating from the same IV line may yield same contaminant; need separate venipuncture from another site to rule out contamination",
      "fail_rate": 0.6,
      "condition": "",
      "sources": []
    },
    {
      "action": "",
      "why_fails": "Guidelines require two positive sets for CoNS; AI may not check number of sets drawn or time to positivity",
      "fail_rate": 0.55,
      "condition": "",
      "sources": []
    }
  ],
  "workarounds": [
    {
      "action": "Implement a rule-based alert: if only one of two sets is positive for CoNS, flag as 'probable contaminant' and recommend repeat culture from two separate sites before starting antibiotics",
      "success_rate": 0.88,
      "how": "Implement a rule-based alert: if only one of two sets is positive for CoNS, flag as 'probable contaminant' and recommend repeat culture from two separate sites before starting antibiotics",
      "condition": "",
      "sources": []
    },
    {
      "action": "Use time-to-positivity (TTP) analysis: CoNS contaminants typically grow >24 hours; true bacteremia grows <16 hours; if TTP >24h, defer antibiotics and repeat",
      "success_rate": 0.85,
      "how": "Use time-to-positivity (TTP) analysis: CoNS contaminants typically grow >24 hours; true bacteremia grows <16 hours; if TTP >24h, defer antibiotics and repeat",
      "condition": "",
      "sources": []
    },
    {
      "action": "Integrate with electronic health record (EHR) to check for clinical signs of sepsis (fever, WBC, CRP) before acting on single positive CoNS; if no signs, observe and repeat",
      "success_rate": 0.9,
      "how": "Integrate with electronic health record (EHR) to check for clinical signs of sepsis (fever, WBC, CRP) before acting on single positive CoNS; if no signs, observe and repeat",
      "condition": "",
      "sources": []
    }
  ],
  "workarounds_zh": [
    "Implement a rule-based alert: if only one of two sets is positive for CoNS, flag as 'probable contaminant' and recommend repeat culture from two separate sites before starting antibiotics",
    "Use time-to-positivity (TTP) analysis: CoNS contaminants typically grow >24 hours; true bacteremia grows <16 hours; if TTP >24h, defer antibiotics and repeat",
    "Integrate with electronic health record (EHR) to check for clinical signs of sepsis (fever, WBC, CRP) before acting on single positive CoNS; if no signs, observe and repeat"
  ],
  "transition_graph": {
    "leads_to": [],
    "preceded_by": [],
    "frequently_confused_with": []
  },
  "official_doc_url": "https://www.idsociety.org/practice-guideline/clinical-practice-guideline-for-the-diagnosis-and-management-of-staphylococcus-aureus-bacteremia/",
  "official_doc_section": null,
  "error_code": "BC-CONS-FALSE-POS",
  "verification_tier": "ai_generated",
  "confidence": 0.87,
  "fix_success_rate": 0.88,
  "resolvable": "true",
  "first_seen": "2024-02-28",
  "last_confirmed": "2024-06-01",
  "last_updated": "2024-06-01",
  "evidence_count": 1,
  "tags": [],
  "locale": "en",
  "aliases": []
}