M Giannella1, R Pascale2, L Pancaldi1, C Monari3, S Ianniruberto1, P Malosso1, L Bussini1, M Bartoletti1, S Tedeschi1, S Ambretti4, R Lewis1, P Viale1. 1. Infectious Diseases Unit, Department of Medical and Surgical Sciences, Policlinico Sant'Orsola Malpighi, University of Bologna, Bologna, Italy. 2. Infectious Diseases Unit, Department of Medical and Surgical Sciences, Policlinico Sant'Orsola Malpighi, University of Bologna, Bologna, Italy. Electronic address: renpa@hotmail.it. 3. Infectious Diseases Unit, Università degli Studi della Campania L. Vanvitelli, Naples, Italy. 4. Operative Unit of Clinical Microbiology, Policlinico Sant'Orsola Malpighi, University of Bologna, Bologna, Italy.
Abstract
OBJECTIVES: We examined factors associated with follow-up blood cultures (FUBCs) in patients with monomicrobial Gram-negative (GN) bloodstream infection (BSI) and investigated the impact of FUBCs on therapeutic management and patient outcome. METHODS: A retrospective cohort analysis was conducted of adult patients diagnosed with GN-BSI at a tertiary-care university hospital during 2013-2016. FUBCs performed between 24 hours and 7 days after index BCs was the exposure variable. Risk factors for 30-day mortality were analysed by multivariate Cox analysis on the overall cohort, including FUBCs as a time-varying covariate and on 1:1 matched patients according to Sequential Organ Failure Assessment (SOFA) score and time to FUBC. RESULTS: In 278 (17.6%) of 1576 patients, FUBCs were performed within a median of 3 and 2 days after index BCs and active antibiotic therapy initiation. Persistent BSI was found in 107 (38.5%) of 278 patients. FUBCs were performed in more severely ill patients, with nonurinary sources, difficult-to-treat pathogens and receipt of initial inappropriate therapy. Source control and infectious disease consultation rates were higher among patients with preceding FUBCs and was associated with longer treatment duration. Thirty-day mortality was 10.4%. Independent risk factors for mortality were Charlson comorbidity index (hazard ratio (HR) 1.12) SOFA (HR 1.11), septic shock (HR 2.64), urinary source (HR 0.60), central venous catheter source (HR 2.30), complicated BSI (HR 2.10), carbapenem resistance (HR 2.34), active empiric therapy (HR 0.68), source control (HR 0.34) and FUBCs (HR 0.48). Association between FUBCs and lower mortality was confirmed in the 274 matched pairs. CONCLUSIONS: FUBCs were performed in more severe GN-BSIs, yielding a high rate of persistent BSI. In this context, FUBCs were associated with lower mortality.
OBJECTIVES: We examined factors associated with follow-up blood cultures (FUBCs) in patients with monomicrobial Gram-negative (GN) bloodstream infection (BSI) and investigated the impact of FUBCs on therapeutic management and patient outcome. METHODS: A retrospective cohort analysis was conducted of adult patients diagnosed with GN-BSI at a tertiary-care university hospital during 2013-2016. FUBCs performed between 24 hours and 7 days after index BCs was the exposure variable. Risk factors for 30-day mortality were analysed by multivariate Cox analysis on the overall cohort, including FUBCs as a time-varying covariate and on 1:1 matched patients according to Sequential Organ Failure Assessment (SOFA) score and time to FUBC. RESULTS: In 278 (17.6%) of 1576 patients, FUBCs were performed within a median of 3 and 2 days after index BCs and active antibiotic therapy initiation. Persistent BSI was found in 107 (38.5%) of 278 patients. FUBCs were performed in more severely ill patients, with nonurinary sources, difficult-to-treat pathogens and receipt of initial inappropriate therapy. Source control and infectious disease consultation rates were higher among patients with preceding FUBCs and was associated with longer treatment duration. Thirty-day mortality was 10.4%. Independent risk factors for mortality were Charlson comorbidity index (hazard ratio (HR) 1.12) SOFA (HR 1.11), septic shock (HR 2.64), urinary source (HR 0.60), central venous catheter source (HR 2.30), complicated BSI (HR 2.10), carbapenem resistance (HR 2.34), active empiric therapy (HR 0.68), source control (HR 0.34) and FUBCs (HR 0.48). Association between FUBCs and lower mortality was confirmed in the 274 matched pairs. CONCLUSIONS: FUBCs were performed in more severe GN-BSIs, yielding a high rate of persistent BSI. In this context, FUBCs were associated with lower mortality.
Authors: Lauren Groft Buzzalino; James Mease; Ciera L Bernhardi; Jacqueline T Bork; J Kristie Johnson; Kimberly C Claeys Journal: Open Forum Infect Dis Date: 2022-04-15 Impact factor: 4.423
Authors: Jongtak Jung; Kyoung-Ho Song; Kang Il Jun; Chang Kyoung Kang; Nak-Hyun Kim; Pyoeng Gyun Choe; Wan Beom Park; Ji Hwan Bang; Eu Suk Kim; Sang-Won Park; Nam Joong Kim; Myoung-Don Oh; Hong Bin Kim Journal: BMC Infect Dis Date: 2020-09-17 Impact factor: 3.090
Authors: Rajiv Amipara; Hana Rac Winders; Julie Ann Justo; P Brandon Bookstaver; Joseph Kohn; Majdi N Al-Hasan Journal: EClinicalMedicine Date: 2021-03-30
Authors: Daniela Dambroso-Altafini; Thatiany C Menegucci; Bruno B Costa; Rafael R B Moreira; Sheila A B Nishiyama; Josmar Mazucheli; Maria C B Tognim Journal: Sci Rep Date: 2022-09-14 Impact factor: 4.996
Authors: Alexis L Green; Yuanyuan Liang; Lyndsay M O'Hara; Lisa Pineles; Scott Sorongon; Anthony D Harris; Jonathan D Baghdadi Journal: Antimicrob Steward Healthc Epidemiol Date: 2021-08-27
Authors: Joshua T Thaden; Sarah Cantrell; Michael Dagher; Yazhong Tao; Felicia Ruffin; Stacey A Maskarinec; Stacy Goins; Matthew Sinclair; Joshua B Parsons; Emily Eichenberger; Vance G Fowler Journal: JAMA Netw Open Date: 2022-09-01