Sending repeat cultures: is there a role in the management of bacteremic episodes? (SCRIBE study)

被引:75
作者
Wiggers, J. Brad [1 ]
Xiong, Wei [2 ]
Daneman, Nick [1 ,3 ,4 ,5 ]
机构
[1] Univ Toronto, Dept Med, Toronto, ON, Canada
[2] Sunnybrook Hlth Sci Ctr, Sunnybrook Res Inst, Toronto, ON M4N 3M5, Canada
[3] Sunnybrook Hlth Sci Ctr, Dept Med, Div Infect Dis, Toronto, ON M4N 3M5, Canada
[4] Inst Clin Evaluat Sci, Toronto, ON, Canada
[5] Univ Toronto, Sunnybrook Hlth Sci Ctr, Inst Clin Evaluat Sci, Div Infect Dis & Clin Epidemiol, 2075 Bayview Ave,G Wing Room 106, Toronto, ON M4N 3M5, Canada
基金
加拿大健康研究院;
关键词
Bacteremia; Bloodstream infection; Epidemiology; Blood cultures; Gram-positive bacteria; Gram-negative bacteria; COMMUNITY-ACQUIRED PNEUMONIA; BLOOD CULTURES; HOSPITALIZED-PATIENTS; ANTIBIOTIC-THERAPY; ADULT PATIENTS; FEVER; PYELONEPHRITIS; INFECTIONS; CELLULITIS; WOMEN;
D O I
10.1186/s12879-016-1622-z
中图分类号
R51 [传染病];
学科分类号
100401 ;
摘要
Background: In the management of bacteremia, positive repeat blood cultures (persistent bacteremia) are associated with increased mortality. However, blood cultures are costly and it is likely unnecessary to repeat them for many patients. We assessed predictors of persistent bacteremia that should prompt repeat blood cultures. Methods: We conducted a retrospective cohort study of bacteremias at an academic hospital from April 2010 to June 2014. We examined variables associated with patients undergoing repeat blood cultures, and with repeat cultures being positive. A nested case control analysis was performed on a subset of patients with repeat cultures. Results: Among 1801 index bacteremias, repeat cultures were drawn for 701 patients (38.9 %), and 118 persistent bacteremias (6.6 %) were detected. Endovascular source (adjusted odds ratio [aOR], 7.66; 95 % confidence interval [CI], 2.30-25.48), epidural source (aOR, 26.99; 95 % CI, 1.91-391.08), and Staphylococcus aureus bacteremia (aOR, 4.49; 95 % CI, 1.88-10.73) were independently associated with persistent bacteremia. Escherichia coli (5.1 %, P = 0.006), viridans group (1.7 %, P = 0.035) and beta-hemolytic streptococci (0 %, P = 0.028) were associated with a lower likelihood of persistent bacteremia. Patients with persistent bacteremia were less likely to have achieved source control within 48 h of the index event (29.7 % vs 52.5 %, P < .001), but after variable reduction, source control was not retained in the final multivariable model. Conclusions: Patients with S. aureus bacteremia or endovascular infection are at risk of persistent bacteremia. Achieving source control within 48 h of the index bacteremia may help clear the infection. Repeat cultures after 48 h are low yield for most Gram-negative and streptococcal bacteremias.
引用
收藏
页数:10
相关论文
共 23 条
[1]   Blood Cultures for Community-Acquired Pneumonia: Are They Worthy of Two Quality Measures? A Systematic Review [J].
Afshar, Nima ;
Tabas, Jeffrey ;
Afshar, Kia ;
Silbergleit, Robert .
JOURNAL OF HOSPITAL MEDICINE, 2009, 4 (02) :112-123
[2]   The contribution of blood cultures to the clinical management of adult patients admitted to the hospital with community-acquired pneumonia - A prospective observational study [J].
Campbell, SG ;
Marrie, TJ ;
Anstey, R ;
Dickinson, G ;
Ackroyd-Stolarz, S .
CHEST, 2003, 123 (04) :1142-1150
[3]   Multiple Comparison Procedures [J].
Cao, Jing ;
Zhang, Song .
JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION, 2014, 312 (05) :543-544
[4]   CLINICAL ISSUES OF BLOOD CULTURES [J].
CHANDRASEKAR, PH ;
BROWN, WJ .
ARCHIVES OF INTERNAL MEDICINE, 1994, 154 (08) :841-849
[5]   Are blood cultures necessary in the management of women with complicated pyelonephritis? [J].
Chen, Yael ;
Nitzan, Orna ;
Saliba, Walid ;
Chazan, Bibiana ;
Colodner, Raul ;
Raz, Raul .
JOURNAL OF INFECTION, 2006, 53 (04) :235-240
[6]  
Clinical Laboratory Standards Institute, 2007, M47A CLSI
[7]   Does This Adult Patient With Suspected Bacteremia Require Blood Cultures? [J].
Coburn, Bryan ;
Morris, Andrew M. ;
Tomlinson, George ;
Detsky, Allan S. .
JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION, 2012, 308 (05) :502-511
[8]   Duration of Hospital Admission and the Need for Empirical Antipseudomonal Therapy [J].
Daneman, N. ;
Elligsen, M. ;
Walker, S. A. N. ;
Simor, A. .
JOURNAL OF CLINICAL MICROBIOLOGY, 2012, 50 (08) :2695-2701
[9]   Clinical characterization of breakthrough bacteraemia: a survey of 392 episodes [J].
Dupla, ML ;
Martinez, JA ;
Vidal, F ;
Almela, M ;
Lopez, J ;
Marco, F ;
Soriano, A ;
Richart, C ;
Mensa, J .
JOURNAL OF INTERNAL MEDICINE, 2005, 258 (02) :172-180
[10]  
Elligsen Marion, 2012, Can J Hosp Pharm, V65, P31