Characteristics and outcomes of bacteremia among ICU-admitted patients with severe sepsis

Komori, Akira; Abe, Toshikazu; Kushimoto, Shigeki; Ogura, Hiroshi; Shiraishi, Atsushi; Saitoh, Daizoh; Fujishima, Seitaro; Mayumi, Toshihiko; Naito, Toshio; Hifumi, Toru; Shiino, Yasukazu; Nakada, Taka‐aki; Tarui, Takehiko; Otomo, Yasuhiro; Okamoto, Kohji; Umemura, Yutaka; Kotani, Joji; Sakamoto, Yuichiro; Sasaki, Junichi; Shiraishi, Shin‐ichiro; Takuma, Kiyotsugu; Tsuruta, Ryosuke; Hagiwara, Akiyoshi; Yamakawa, Kazuma; Masuno, Tomohiko; Takeyama, Naoshi; Yamashita, Norio; Ikeda, Hiroto; Ueyama, Masashi; Fujimi, Satoshi; Gando, Satoshi

doi:10.1038/s41598-020-59830-6

Cited by 26 publications

(34 citation statements)

References 24 publications

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“…Previous studies have demonstrated bacteremia being associated with both higher and lower mortality and to not affect mortality 6 , 17 – 22 . In a retrospective analysis of a prospective cohort by Komori et al, bacteremia was not associated with higher mortality when they adjusted for SOFA score 22 . We did not include scores for severity of disease in the primary analysis, as we see it as an intermediate in sepsis progression rather than a confounder.…”

Section: Discussionmentioning

confidence: 93%

“…One can falsely assume that it is well known that bacteremia is associated with higher mortality. Only a handful of studies specifically focus on the comparison of culture-negative and culture-positive sepsis and have resulted in evidence both for and against bacteremia being associated with higher mortality 6 , 17 – 22 . In a large, prospective study by Phua et al mortality was not higher among culture-positive patients in a multivariate analysis and Gupta et al found higher mortality in culture-negatives, however antibiotic therapy preceding culture sampling was not included in the models 2 , 9 .…”

Section: Introductionmentioning

confidence: 99%

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Bacteremic sepsis leads to higher mortality when adjusting for confounders with propensity score matching

Mellhammar

Kahn

Whitlow

et al. 2021

Sci Rep

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One can falsely assume that it is well known that bacteremia is associated with higher mortality in sepsis. Only a handful of studies specifically focus on the comparison of culture-negative and culture-positive sepsis with different conclusions depending on study design. The aim of this study was to describe outcome for critically ill patients with either culture-positive or -negative sepsis in a clinical review. We also aimed to identify subphenotypes of sepsis with culture status included as candidate clinical variables. Out of 784 patients treated in intensive care with a sepsis diagnosis, blood cultures were missing in 140 excluded patients and 95 excluded patients did not fulfill a sepsis diagnosis. Of 549 included patients, 295 (54%) had bacteremia, 90 (16%) were non-bacteremic but with relevant pathogens detected and in 164 (30%) no relevant pathogen was detected. After adjusting for confounders, 90-day mortality was higher in bacteremic patients, 47%, than in non-bacteremic patients, 36%, p = 0.04. We identified 8 subphenotypes, with different mortality rates, where pathogen detection in microbial samples were important for subphenotype distinction and outcome. In conclusion, bacteremic patients had higher mortality than their non-bacteremic counter-parts and bacteremia is more common in sepsis when studied in a clinical review. For reducing population heterogeneity and improve the outcome of trials and treatment for sepsis, distinction of subphenotypes might be useful and pathogen detection an important factor.

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Section: Discussionmentioning

confidence: 93%

Section: Introductionmentioning

confidence: 99%

Bacteremic sepsis leads to higher mortality when adjusting for confounders with propensity score matching

Mellhammar

Kahn

Whitlow

et al. 2021

Sci Rep

View full text Add to dashboard Cite

show abstract

“…Previous studies have resulted in evidence both for and against bacteremia being associated with higher mortality (6,17,(23)(24)(25)(26)(27). In a retrospective analysis of a prospective cohort by Komori et al, bacteremia was not associated with higher mortality when they adjusted for SOFA score (17). We did not include scores for severity of disease in the primary analysis, as we see it as an intermediate in sepsis progression rather than a confounder.…”

Section: Discussionmentioning

confidence: 98%

“…Few studies speci cally focus on the comparison of culture-negative and culture-positive sepsis or include culture status in identi cation of subphenotypes (2,6,(9)(10)(11)(12)(13)(14)(15)(16)(17).…”

Section: Introductionmentioning

confidence: 99%

Higher mortality in bacteremic sepsis - A propensity score matched study

Mellhammar

Kahn

Whitlow

et al. 2020

Preprint

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The aim of this study was to describe outcome for critically ill patients with either culture-positive or -negative sepsis.In a clinical chart review of patients with a sepsis diagnosis treated in an intensive Care Unit (ICU), those who fulfilled sepsis-3 criteria and at had least one blood culture sampled ±48h from ICU admission were included. In a propensity score analysis bacteremic and non-bacteremic patients were matched with regard to age, comorbidities, site of infection and antimicrobial therapy prior to blood cultures.Out of 784 patients treated in the ICU with a sepsis diagnosis, blood cultures were missing in 140 excluded patients and additionally 95 excluded patients did not fulfill a sepsis diagnosis. In total 549 patients were included, 295 (54%) with bacteremia, 90 (16%) were non-bacteremic but had relevant pathogens detected from another body location and in 164 (30%) no relevant pathogen was detected in microbial samples. After the propensity score analysis, 90-day mortality was higher in bacteremic patients, 47%, than in non-bacteremic patients, 36%, p =0.04. In conclusion, bacteremic patients had higher mortality than their non-bacteremic counter-parts and bacteremia is more common in sepsis when studied in a clinical review.

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“…Morbidity and mortality of biofilm infections including catheter-related candidemia and bacteremia remain unacceptably high with current antimicrobial agents 2 , 15 – 17 . In addition, multidrug-resistance and polymicrobial infection often make treatment difficult 8 , 9 , 18 , 19 .…”

Section: Discussionmentioning

confidence: 99%

Novel and potent antimicrobial effects of caspofungin on drug-resistant Candida and bacteria

Sumiyoshi

Miyazaki

Makau

et al. 2020

Sci Rep

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Echinocandins, including caspofungin, micafungin, and anidulafungin, are first-line antifungal agents for the treatment of invasive candidiasis. They exhibit fungicidal activity by inhibiting the synthesis of β-1,3-d-glucan, an essential component of the fungal cell wall. However, they are active only against proliferating fungal cells and unable to completely eradicate fungal cells even after a 24 h drug exposure in standard time-kill assays. Surprisingly, we found that caspofungin, when dissolved in low ionic solutions, had rapid and potent antimicrobial activities against multidrug-resistant (MDR) Candida and bacteria cells even in non-growth conditions. This effect was not observed in 0.9% NaCl or other ion-containing solutions and was not exerted by other echinocandins. Furthermore, caspofungin dissolved in low ionic solutions drastically reduced mature biofilm cells of MDR Candida auris in only 5 min, as well as Candida-bacterial polymicrobial biofilms in a catheter-lock therapy model. Caspofungin displayed ion concentration-dependent conformational changes and intracellular accumulation with increased reactive oxygen species production, indicating a novel mechanism of action in low ionic conditions. Importantly, caspofungin dissolved in 5% glucose water did not exhibit increased toxicity to human cells. This study facilitates the development of new therapeutic strategies in the management of catheter-related biofilm infections.

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Characteristics and outcomes of bacteremia among ICU-admitted patients with severe sepsis

Cited by 26 publications

References 24 publications

Bacteremic sepsis leads to higher mortality when adjusting for confounders with propensity score matching

Bacteremic sepsis leads to higher mortality when adjusting for confounders with propensity score matching

Higher mortality in bacteremic sepsis - A propensity score matched study

Novel and potent antimicrobial effects of caspofungin on drug-resistant Candida and bacteria

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