{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,1]],"date-time":"2026-04-01T17:19:28Z","timestamp":1775063968681,"version":"3.50.1"},"reference-count":30,"publisher":"Archives of Pathology and Laboratory Medicine","issue":"8","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2013,8]]},"abstract":"\n Context<\/jats:italic>\n .\u2014Timely initiation of directed antimicrobial therapy for\n Staphylococcus aureus<\/jats:italic>\n bacteremia is dependent on rapid identification of\n S aureus<\/jats:italic>\n to ascertain methicillin-susceptibility status.\n <\/jats:p>\n \n Objectives<\/jats:italic>\n .\u2014To investigate the performance of the rapid KeyPath (MicroPhage, Inc, Longmont, Colorado) methicillin-resistant\n S aureus<\/jats:italic>\n (MRSA) and methicillin-susceptible\n S aureus<\/jats:italic>\n (MSSA) blood culture test (MMBT).\n <\/jats:p>\n \n Design<\/jats:italic>\n .\u2014Positive BacT\/ALERT Pediatric FAN (fastidious antibiotic neutralization) blood culture bottles (bioM\u00e9rieux, Inc, Durham, North Carolina) were tested prospectively using MMBT and routine bacterial identification and antibiotic susceptibility testing procedures as the gold standard. The MMBT uses an\n S aureus\u2013<\/jats:italic>\n specific bacteriophage cocktail that infects bacterial cells and replicates them, resulting in cellular lysis. Bacteriophage-specific antibodies detect the increase in bacteriophage concentration in an immunoassay device. Phage amplification, in both the presence and absence of cefoxitin, indicates the presence of MRSA. The sensitivity, specificity, positive predictive value, and negative predictive value of MMBT in detecting\n S aureus,<\/jats:italic>\n MSSA, and MRSA were calculated.\n <\/jats:p>\n \n Results<\/jats:italic>\n .\u2014Of 188 positive blood cultures tested, 199 (63%) had Gram-positive cocci in clusters, 46 (24%) grew\n S aureus<\/jats:italic>\n (26 MSSA [57%], 20 MRSA [43%]) with the MMBT detecting 40 of 46 (87%). The sensitivity, specificity, positive predictive value, and negative predictive value among blood cultures with Gram-positive cocci in clusters were 87%, 100%, 100%, and 92% for\n S aureus<\/jats:italic>\n ; 81%, 100%, 100%, and 95% for MSSA; and 95%, 100%, 100%, and 99% for MRSA. All blood cultures without growth of\n S aureus<\/jats:italic>\n tested negative by MMBT.\n <\/jats:p>\n \n Conclusions<\/jats:italic>\n .\u2014The MMBT detected MSSA and MRSA directly from positive BacT\/ALERT PF bottles with positive predictive values of 100%, suggesting that positive results could be reported immediately, but the sensitivity of this assay limited immediate reporting of negative results.\n <\/jats:p>","DOI":"10.5858\/arpa.2012-0422-oa","type":"journal-article","created":{"date-parts":[[2013,7,30]],"date-time":"2013-07-30T16:10:06Z","timestamp":1375200606000},"page":"1103-1105","source":"Crossref","is-referenced-by-count":18,"title":["Rapid Detection of Methicillin-Resistant Staphylococcus aureus (MRSA) and Methicillin-Susceptible Staphylococcus aureus (MSSA) Using the KeyPath MRSA\/MSSA Blood Culture Test and the BacT\/ALERT System in a Pediatric Population"],"prefix":"10.5858","volume":"137","author":[{"given":"Kaede V.","family":"Sullivan","sequence":"first","affiliation":[{"name":"From the Department of Pathology and Laboratory Medicine, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania (Dr Sullivan, Ms Turner, and Mr Roundtree); and the Perelman School of Medicine, University of Pennsylvania, Philadelphia (Drs Sullivan and McGowan)."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nicole N.","family":"Turner","sequence":"additional","affiliation":[{"name":"From the Department of Pathology and Laboratory Medicine, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania (Dr Sullivan, Ms Turner, and Mr Roundtree); and the Perelman School of Medicine, University of Pennsylvania, Philadelphia (Drs Sullivan and McGowan)."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sylvester S.","family":"Roundtree","sequence":"additional","affiliation":[{"name":"From the Department of Pathology and Laboratory Medicine, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania (Dr Sullivan, Ms Turner, and Mr Roundtree); and the Perelman School of Medicine, University of Pennsylvania, Philadelphia (Drs Sullivan and McGowan)."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Karin L.","family":"McGowan","sequence":"additional","affiliation":[{"name":"From the Department of Pathology and Laboratory Medicine, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania (Dr Sullivan, Ms Turner, and Mr Roundtree); and the Perelman School of Medicine, University of Pennsylvania, Philadelphia (Drs Sullivan and McGowan)."}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"3906","reference":[{"issue":"3","key":"i1543-2165-137-8-1103-b01","series-title":"J Clin Microbiol","first-page":"894","article-title":"Clinical characteristics, outcomes, and microbiologic features associated with methicillin-resistant Staphylococcus aureus bacteremia in pediatric patients treated with vancomycin","volume":"48","author":"Welsh\n KJ,","year":"2010","unstructured":"Welsh\n KJ, \n \n Abbott\n AN, \n \n Lewis\n EM, \n et al\n . Clinical characteristics, outcomes, and microbiologic features associated with methicillin-resistant Staphylococcus aureus bacteremia in pediatric patients treated with vancomycin. J Clin Microbiol. 2010;48(3):894\u2013899."},{"issue":"5","key":"i1543-2165-137-8-1103-b02","series-title":"Pediatr Infect Dis J","first-page":"410","article-title":"Clinical and molecular epidemiology of Staphylococcus aureus catheter-related bacteremia in children","volume":"29","author":"Carillo-Marquez\n MA,","year":"2010","unstructured":"Carillo-Marquez\n MA, \n \n Hulten\n KG, \n \n Mason\n EO, \n \n Kaplan\n SL. \n \n Clinical and molecular epidemiology of Staphylococcus aureus catheter-related bacteremia in children. Pediatr Infect Dis J. 2010;29(5):410\u2013414."},{"issue":"5","key":"i1543-2165-137-8-1103-b03","series-title":"Clin Infect Dis","first-page":"695","article-title":"Risk factors for hematogenous complications of intravascular catheter-associated Staphylococcus aureus bacteremia","volume":"40","author":"Fowler\n VG\n Jr,","year":"2005","unstructured":"Fowler\n VG\n Jr, \n \n Justice\n A, \n \n Moore\n C, \n et al\n . Risk factors for hematogenous complications of intravascular catheter-associated Staphylococcus aureus bacteremia. Clin Infect Dis. 2005;40(5):695\u2013703."},{"issue":"11","key":"i1543-2165-137-8-1103-b04","series-title":"Clin Infect Dis","first-page":"1418","article-title":"Outcomes analysis of delayed antibiotic treatment for hospital-acquired Staphylococcus aureus bacteremia","volume":"36","author":"Lodise\n TP,","year":"2003","unstructured":"Lodise\n TP, \n \n McKinnon\n PS, \n \n Swiderski\n L, \n \n Rybak\n MJ. \n \n Outcomes analysis of delayed antibiotic treatment for hospital-acquired Staphylococcus aureus bacteremia. Clin Infect Dis. 2003;36(11):1418\u20131423."},{"issue":"5","key":"i1543-2165-137-8-1103-b05","series-title":"Medicine (Baltimore)","first-page":"333","article-title":"Staphylococcus aureus bacteremia: recurrence and the impact of antibiotic treatment in a prospective multicenter study","volume":"82","author":"Chang\n FY,","year":"2003","unstructured":"Chang\n FY, \n \n Peacock\n JE\n Jr, \n \n Musher\n DM, \n et al\n . Staphylococcus aureus bacteremia: recurrence and the impact of antibiotic treatment in a prospective multicenter study. Medicine (Baltimore). 2003;82(5):333\u2013339."},{"issue":"2","key":"i1543-2165-137-8-1103-b06","series-title":"Clin Infect Dis","first-page":"190","article-title":"Use of vancomycin or first-generation cephalosporins for the treatment of hemodialysis dependent patients with methicillin-susceptible Staphylococcus aureus bacteremia","volume":"44","author":"Stryjewski\n ME,","year":"2007","unstructured":"Stryjewski\n ME, \n \n Szczech\n LA, \n \n Benjamin\n DK\n Jr, \n et al\n . Use of vancomycin or first-generation cephalosporins for the treatment of hemodialysis dependent patients with methicillin-susceptible Staphylococcus aureus bacteremia. Clin Infect Dis. 2007;44(2):190\u2013196."},{"key":"i1543-2165-137-8-1103-b07","series-title":"Healthcare Infection Control Practices Advisory Committee. Management of multidrug-resistant organisms in healthcare settings","author":"Siegel\n JD,","year":"2006","unstructured":"Siegel\n JD, \n \n Rhinehart\n E, \n \n Jackson\n M, \n \n Chiarello\n L; \n \n Healthcare Infection Control Practices Advisory Committee. Management of multidrug-resistant organisms in healthcare settings, 2006. http:\/\/www.cdc.gov\/hicpac\/pdf\/MDRO\/MDROGuideline2006.pdf. Accessed June 30, 2012."},{"issue":"9","key":"i1543-2165-137-8-1103-b08","series-title":"J Clin Microbiol","first-page":"S53","article-title":"Conventional and molecular methods for the detection of methicillin-resistant Staphylococcus aureus","volume":"49","author":"Marlowe\n EM,","year":"2011","unstructured":"Marlowe\n EM, \n \n Bankowski\n MJ. \n \n Conventional and molecular methods for the detection of methicillin-resistant Staphylococcus aureus. J Clin Microbiol. 2011;49(9):S53\u2013S56."},{"key":"i1543-2165-137-8-1103-b09","article-title":"Class 3 recall; Cepheid Xpert MRSA\/SA blood culture","year":"2012","unstructured":"US Food and Drug Administration. Class 3 recall; Cepheid Xpert MRSA\/SA blood culture. 2012. http:\/\/www.accessdata.fda.gov\/scripts\/cdrh\/cfdocs\/cfRes\/res.cfm?ID=105528. Accessed June 30, 2012."},{"issue":"11","key":"i1543-2165-137-8-1103-b10","series-title":"J Clin Microbiol","first-page":"3747","article-title":"Failure of the BD GeneOhm StaphSR assay for direct detection of methicillin-resistant and methicillin-susceptible Staphylococcus aureus isolates in positive blood cultures collected in the United States","volume":"47","author":"Snyder\n JL,","year":"2009","unstructured":"Snyder\n JL, \n \n Munier\n GK, \n \n Heckman\n SA, \n \n Camp\n P, \n \n Overman\n TL. \n \n Failure of the BD GeneOhm StaphSR assay for direct detection of methicillin-resistant and methicillin-susceptible Staphylococcus aureus isolates in positive blood cultures collected in the United States. J Clin Microbiol. 2009;47(11):3747\u20134748."},{"issue":"5","key":"i1543-2165-137-8-1103-b11","series-title":"J Clin Microbiol","first-page":"1875","article-title":"New real-time PCR assay for rapid detection of methicillin-resistant Staphylococcus aureus directly from specimens containing a mixture of staphylococci","volume":"42","author":"Huletsky\n A,","year":"2004","unstructured":"Huletsky\n A, \n \n Giroux\n R, \n \n Rossbach\n V, \n et al\n . New real-time PCR assay for rapid detection of methicillin-resistant Staphylococcus aureus directly from specimens containing a mixture of staphylococci. J Clin Microbiol. 2004;42(5):1875\u20131884."},{"issue":"4","key":"i1543-2165-137-8-1103-b12","series-title":"J Clin Microbiol","first-page":"1240","article-title":"Genotypic and phenotypic characterization of methicillin-susceptible Staphylococcus aureus isolates misidentified as methicillin-resistant Staphylococcus aureus by the BD GeneOhm MRSA Assay","volume":"49","author":"Stamper\n PD,","year":"2011","unstructured":"Stamper\n PD, \n \n Louie\n L, \n \n Wong\n H, \n \n Simor\n AE, \n \n Farley\n JE, \n \n Carroll\n KC. \n \n Genotypic and phenotypic characterization of methicillin-susceptible Staphylococcus aureus isolates misidentified as methicillin-resistant Staphylococcus aureus by the BD GeneOhm MRSA Assay. J Clin Microbiol. 2011;49(4):1240\u20131244."},{"issue":"11","key":"i1543-2165-137-8-1103-b13","series-title":"Clin Microbiol Infect","first-page":"1631","article-title":"Matrix-assisted laser desorption ionization time-of-flight mass spectrometry identifies 90% of bacteria directly from blood culture vials","volume":"16","author":"Moussaoui\n W,","year":"2010","unstructured":"Moussaoui\n W, \n \n Jaulhac\n B, \n \n Hoffmann\n AM, \n et al\n . Matrix-assisted laser desorption ionization time-of-flight mass spectrometry identifies 90% of bacteria directly from blood culture vials. Clin Microbiol Infect. 2010;16(11):1631\u20131638."},{"key":"i1543-2165-137-8-1103-b14","series-title":"Proceedings from the 110th General Meeting of the American Society for Microbiology","article-title":"A novel phage technology for the detection of S aureus and differentiation of MSSA and MRSA in positive blood culture bottles","author":"Kingery\n JD,","year":"2010","unstructured":"Kingery\n JD, \n \n Stamper\n PD, \n \n Peterson\n LR, \n et al\n . A novel phage technology for the detection of S aureus and differentiation of MSSA and MRSA in positive blood culture bottles. In: Proceedings from the 110th General Meeting of the American Society for Microbiology; May 23\u201327, 2010; San Diego, CA. Abstract C-153."},{"issue":"9","key":"i1543-2165-137-8-1103-b15","series-title":"Clin Infect Dis","first-page":"1074","article-title":"An antimicrobial stewardship program's impact with rapid polymerase chain reaction methicillin-resistant Staphylococcus aureus\/S. aureus blood culture test in patients with S. aureus bacteremia","volume":"51","author":"Bauer\n KA,","year":"2010","unstructured":"Bauer\n KA, \n \n West\n JE, \n \n Balada-Llasat\n JM, \n \n Pancholi\n P, \n \n Stevenson\n KB, \n \n Goff\n DA. \n \n An antimicrobial stewardship program's impact with rapid polymerase chain reaction methicillin-resistant Staphylococcus aureus\/S. aureus blood culture test in patients with S. aureus bacteremia. Clin Infect Dis. 2010;51(9):1074\u20131080."},{"issue":"3","key":"i1543-2165-137-8-1103-b01","series-title":"J Clin Microbiol","first-page":"894","article-title":"Clinical characteristics, outcomes, and microbiologic features associated with methicillin-resistant Staphylococcus aureus bacteremia in pediatric patients treated with vancomycin","volume":"48","author":"Welsh\n KJ,","year":"2010","unstructured":"Welsh\n KJ, \n \n Abbott\n AN, \n \n Lewis\n EM, \n et al\n . Clinical characteristics, outcomes, and microbiologic features associated with methicillin-resistant Staphylococcus aureus bacteremia in pediatric patients treated with vancomycin. J Clin Microbiol. 2010;48(3):894\u2013899."},{"issue":"5","key":"i1543-2165-137-8-1103-b02","series-title":"Pediatr Infect Dis J","first-page":"410","article-title":"Clinical and molecular epidemiology of Staphylococcus aureus catheter-related bacteremia in children","volume":"29","author":"Carillo-Marquez\n MA,","year":"2010","unstructured":"Carillo-Marquez\n MA, \n \n Hulten\n KG, \n \n Mason\n EO, \n \n Kaplan\n SL. \n \n Clinical and molecular epidemiology of Staphylococcus aureus catheter-related bacteremia in children. Pediatr Infect Dis J. 2010;29(5):410\u2013414."},{"issue":"5","key":"i1543-2165-137-8-1103-b03","series-title":"Clin Infect Dis","first-page":"695","article-title":"Risk factors for hematogenous complications of intravascular catheter-associated Staphylococcus aureus bacteremia","volume":"40","author":"Fowler\n VG\n Jr,","year":"2005","unstructured":"Fowler\n VG\n Jr, \n \n Justice\n A, \n \n Moore\n C, \n et al\n . Risk factors for hematogenous complications of intravascular catheter-associated Staphylococcus aureus bacteremia. Clin Infect Dis. 2005;40(5):695\u2013703."},{"issue":"11","key":"i1543-2165-137-8-1103-b04","series-title":"Clin Infect Dis","first-page":"1418","article-title":"Outcomes analysis of delayed antibiotic treatment for hospital-acquired Staphylococcus aureus bacteremia","volume":"36","author":"Lodise\n TP,","year":"2003","unstructured":"Lodise\n TP, \n \n McKinnon\n PS, \n \n Swiderski\n L, \n \n Rybak\n MJ. \n \n Outcomes analysis of delayed antibiotic treatment for hospital-acquired Staphylococcus aureus bacteremia. Clin Infect Dis. 2003;36(11):1418\u20131423."},{"issue":"5","key":"i1543-2165-137-8-1103-b05","series-title":"Medicine (Baltimore)","first-page":"333","article-title":"Staphylococcus aureus bacteremia: recurrence and the impact of antibiotic treatment in a prospective multicenter study","volume":"82","author":"Chang\n FY,","year":"2003","unstructured":"Chang\n FY, \n \n Peacock\n JE\n Jr, \n \n Musher\n DM, \n et al\n . Staphylococcus aureus bacteremia: recurrence and the impact of antibiotic treatment in a prospective multicenter study. Medicine (Baltimore). 2003;82(5):333\u2013339."},{"issue":"2","key":"i1543-2165-137-8-1103-b06","series-title":"Clin Infect Dis","first-page":"190","article-title":"Use of vancomycin or first-generation cephalosporins for the treatment of hemodialysis dependent patients with methicillin-susceptible Staphylococcus aureus bacteremia","volume":"44","author":"Stryjewski\n ME,","year":"2007","unstructured":"Stryjewski\n ME, \n \n Szczech\n LA, \n \n Benjamin\n DK\n Jr, \n et al\n . Use of vancomycin or first-generation cephalosporins for the treatment of hemodialysis dependent patients with methicillin-susceptible Staphylococcus aureus bacteremia. Clin Infect Dis. 2007;44(2):190\u2013196."},{"key":"i1543-2165-137-8-1103-b07","series-title":"Healthcare Infection Control Practices Advisory Committee. Management of multidrug-resistant organisms in healthcare settings","author":"Siegel\n JD,","year":"2006","unstructured":"Siegel\n JD, \n \n Rhinehart\n E, \n \n Jackson\n M, \n \n Chiarello\n L; \n \n Healthcare Infection Control Practices Advisory Committee. Management of multidrug-resistant organisms in healthcare settings, 2006. http:\/\/www.cdc.gov\/hicpac\/pdf\/MDRO\/MDROGuideline2006.pdf. Accessed June 30, 2012."},{"issue":"9","key":"i1543-2165-137-8-1103-b08","series-title":"J Clin Microbiol","first-page":"S53","article-title":"Conventional and molecular methods for the detection of methicillin-resistant Staphylococcus aureus","volume":"49","author":"Marlowe\n EM,","year":"2011","unstructured":"Marlowe\n EM, \n \n Bankowski\n MJ. \n \n Conventional and molecular methods for the detection of methicillin-resistant Staphylococcus aureus. J Clin Microbiol. 2011;49(9):S53\u2013S56."},{"key":"i1543-2165-137-8-1103-b09","article-title":"Class 3 recall; Cepheid Xpert MRSA\/SA blood culture","year":"2012","unstructured":"US Food and Drug Administration. Class 3 recall; Cepheid Xpert MRSA\/SA blood culture. 2012. http:\/\/www.accessdata.fda.gov\/scripts\/cdrh\/cfdocs\/cfRes\/res.cfm?ID=105528. Accessed June 30, 2012."},{"issue":"11","key":"i1543-2165-137-8-1103-b10","series-title":"J Clin Microbiol","first-page":"3747","article-title":"Failure of the BD GeneOhm StaphSR assay for direct detection of methicillin-resistant and methicillin-susceptible Staphylococcus aureus isolates in positive blood cultures collected in the United States","volume":"47","author":"Snyder\n JL,","year":"2009","unstructured":"Snyder\n JL, \n \n Munier\n GK, \n \n Heckman\n SA, \n \n Camp\n P, \n \n Overman\n TL. \n \n Failure of the BD GeneOhm StaphSR assay for direct detection of methicillin-resistant and methicillin-susceptible Staphylococcus aureus isolates in positive blood cultures collected in the United States. J Clin Microbiol. 2009;47(11):3747\u20134748."},{"issue":"5","key":"i1543-2165-137-8-1103-b11","series-title":"J Clin Microbiol","first-page":"1875","article-title":"New real-time PCR assay for rapid detection of methicillin-resistant Staphylococcus aureus directly from specimens containing a mixture of staphylococci","volume":"42","author":"Huletsky\n A,","year":"2004","unstructured":"Huletsky\n A, \n \n Giroux\n R, \n \n Rossbach\n V, \n et al\n . New real-time PCR assay for rapid detection of methicillin-resistant Staphylococcus aureus directly from specimens containing a mixture of staphylococci. J Clin Microbiol. 2004;42(5):1875\u20131884."},{"issue":"4","key":"i1543-2165-137-8-1103-b12","series-title":"J Clin Microbiol","first-page":"1240","article-title":"Genotypic and phenotypic characterization of methicillin-susceptible Staphylococcus aureus isolates misidentified as methicillin-resistant Staphylococcus aureus by the BD GeneOhm MRSA Assay","volume":"49","author":"Stamper\n PD,","year":"2011","unstructured":"Stamper\n PD, \n \n Louie\n L, \n \n Wong\n H, \n \n Simor\n AE, \n \n Farley\n JE, \n \n Carroll\n KC. \n \n Genotypic and phenotypic characterization of methicillin-susceptible Staphylococcus aureus isolates misidentified as methicillin-resistant Staphylococcus aureus by the BD GeneOhm MRSA Assay. J Clin Microbiol. 2011;49(4):1240\u20131244."},{"issue":"11","key":"i1543-2165-137-8-1103-b13","series-title":"Clin Microbiol Infect","first-page":"1631","article-title":"Matrix-assisted laser desorption ionization time-of-flight mass spectrometry identifies 90% of bacteria directly from blood culture vials","volume":"16","author":"Moussaoui\n W,","year":"2010","unstructured":"Moussaoui\n W, \n \n Jaulhac\n B, \n \n Hoffmann\n AM, \n et al\n . Matrix-assisted laser desorption ionization time-of-flight mass spectrometry identifies 90% of bacteria directly from blood culture vials. Clin Microbiol Infect. 2010;16(11):1631\u20131638."},{"key":"i1543-2165-137-8-1103-b14","series-title":"Proceedings from the 110th General Meeting of the American Society for Microbiology","article-title":"A novel phage technology for the detection of S aureus and differentiation of MSSA and MRSA in positive blood culture bottles","author":"Kingery\n JD,","year":"2010","unstructured":"Kingery\n JD, \n \n Stamper\n PD, \n \n Peterson\n LR, \n et al\n . A novel phage technology for the detection of S aureus and differentiation of MSSA and MRSA in positive blood culture bottles. In: Proceedings from the 110th General Meeting of the American Society for Microbiology; May 23\u201327, 2010; San Diego, CA. Abstract C-153."},{"issue":"9","key":"i1543-2165-137-8-1103-b15","series-title":"Clin Infect Dis","first-page":"1074","article-title":"An antimicrobial stewardship program's impact with rapid polymerase chain reaction methicillin-resistant Staphylococcus aureus\/S. aureus blood culture test in patients with S. aureus bacteremia","volume":"51","author":"Bauer\n KA,","year":"2010","unstructured":"Bauer\n KA, \n \n West\n JE, \n \n Balada-Llasat\n JM, \n \n Pancholi\n P, \n \n Stevenson\n KB, \n \n Goff\n DA. \n \n An antimicrobial stewardship program's impact with rapid polymerase chain reaction methicillin-resistant Staphylococcus aureus\/S. aureus blood culture test in patients with S. aureus bacteremia. 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