Follow-up blood cultures are associated with improved outcome of patients with gram-negative bloodstream infections: retrospective observational cohort study

Giannella, Maddalena; Pascale, Renato; Pancaldi, Livia; Monari, Caterina; Ianniruberto, Stefano; Malosso, Pietro; Bussini, Linda; Bartoletti, Michele; Tedeschi, Sara; Ambretti, Simone; Lewis, R. E.; Viale, Pierluigi

doi:10.1016/j.cmi.2020.01.023

Cited by 38 publications

(75 citation statements)

References 19 publications

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“…Recent studies revealed that when FUBCs were performed in cases of gram-negative bloodstream infection, they were associated with improved clinical outcomes [13,14]. However, the proportion of FUBCs performed was relatively low (17.6-68%) compared to our present study (86.2%).…”

Section: Discussioncontrasting

confidence: 81%

“…Therefore, our findings alone will not be sufficient to change routine practice. As discussed above, recent studies have shown that FUBC was associated with improved outcome of GNB [13,14], but these results couldn't be applied to the uncomplicated GNB. Further investigations such as a prospective randomized control study should be conducted to reveal the exact clinical impact of FUBC in GNB.…”

Section: Discussionmentioning

confidence: 99%

“…However, contamination rates in blood cultures have been reported ranging from 0.9-7.9% [5]. In other studies related to FUBCs, contaminants were identified in 2.0-3.9% of FUBCs [13,14]. Therefore, universal FUBCs of all gram-negative bacteremia may produce contamination, which could lead to increased medical costs and prolonged hospital stays [5].…”

Section: Discussionmentioning

confidence: 99%

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Predictive scoring models for persistent gram-negative bacteremia that reduce the need for follow-up blood cultures: a retrospective observational cohort study

et al. 2020

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Background Although the risk factors for positive follow-up blood cultures (FUBCs) in gram-negative bacteremia (GNB) have not been investigated extensively, FUBC has been routinely carried out in many acute care hospitals. We attempted to identify the risk factors and develop a predictive scoring model for positive FUBC in GNB cases. Methods All adults with GNB in a tertiary care hospital were retrospectively identified during a 2-year period, and GNB cases were assigned to eradicable and non-eradicable groups based on whether removal of the source of infection was possible. We performed multivariate logistic analyses to identify risk factors for positive FUBC and built predictive scoring models accordingly. Results Out of 1473 GNB cases, FUBCs were carried out in 1268 cases, and the results were positive in 122 cases. In case of eradicable source of infection, we assigned points according to the coefficients from the multivariate logistic regression analysis: Extended spectrum beta-lactamase-producing microorganism (+ 1 point), catheter-related bloodstream infection (+ 1), unfavorable treatment response (+ 1), quick sequential organ failure assessment score of 2 points or more (+ 1), administration of effective antibiotics (− 1), and adequate source control (− 2). In case of non-eradicable source of infection, the assigned points were end-stage renal disease on hemodialysis (+ 1), unfavorable treatment response (+ 1), and the administration of effective antibiotics (− 2). The areas under the curves were 0.861 (95% confidence interval [95CI] 0.806–0.916) and 0.792 (95CI, 0.724–0.861), respectively. When we applied a cut-off of 0, the specificities and negative predictive values (NPVs) in the eradicable and non-eradicable sources of infection groups were 95.6/92.6% and 95.5/95.0%, respectively. Conclusions FUBC is commonly carried out in GNB cases, but the rate of positive results is less than 10%. In our simple predictive scoring model, zero scores—which were easily achieved following the administration of effective antibiotics and/or adequate source control in both groups—had high NPVs. We expect that the model reported herein will reduce the necessity for FUBCs in GNB cases.

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Section: Discussioncontrasting

confidence: 81%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Predictive scoring models for persistent gram-negative bacteremia that reduce the need for follow-up blood cultures: a retrospective observational cohort study

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“…Prior studies suggested low yield of FUBC in most patients with GN-BSI [6À9], whereas two more recent investigations demonstrated potential benefit from FUBC [10,11]. In an observational cohort study of GN-BSI in Italy, Giannella and colleagues reported significantly lower mortality in patients with GN-BSI who had FUBC obtained than those who did not have FUBC [10]. Maskarinec and colleagues demonstrated similar results in a large multicenter cohort in North Carolina [11].…”

Section: Introductionmentioning

confidence: 89%

“…However, the role of FUBC in the management of gram-negative BSI (GN-BSI) remains controversial. Prior studies suggested low yield of FUBC in most patients with GN-BSI [6À9], whereas two more recent investigations demonstrated potential benefit from FUBC [10,11]. In an observational cohort study of GN-BSI in Italy, Giannella and colleagues reported significantly lower mortality in patients with GN-BSI who had FUBC obtained than those who did not have FUBC [10].…”

Section: Introductionmentioning

confidence: 99%

Impact of follow up blood cultures on outcomes of patients with community-onset gram-negative bloodstream infection

Amipara¹,

Winders²,

Justo³

et al. 2021

EClinicalMedicine

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Background: The role of follow up blood cultures (FUBC) in the management of gram-negative bloodstream infection (GN-BSI) remains controversial. This retrospective cohort study examines the association between obtaining FUBC and mortality in GN-BSI. Methods: Hospitalized adults with community-onset GN-BSI at Prisma Health-Midlands hospitals in South Carolina, USA from January 1, 2010 to June 30, 2015 were identified. Patients who died or were discharged from hospital within 72 h were excluded to minimize impact of survival and selection biases on results, respectively. Multivariate Cox proportional hazards regression was used to examine association between obtaining FUBC and 28-day all-cause mortality after adjustment for the propensity to obtain FUBC. Findings: Among 766 patients with GN-BSI, 219 (28.6%) had FUBC obtained and 15 of 219 (6.8%) FUBC were persistently positive. Overall, median age was 67 years, 438 (57%) were women, 457 (60%) had urinary source of infection, and 426 (56%) had BSI due to Escherichia coli. Mortality was significantly lower in patients who had FUBC obtained than in those who did not have FUBC (6.3% vs. 11.7%, log-rank p = 0.03). Obtaining FUBC was independently associated with reduced mortality (hazards ratio 0.47, 95% confidence intervals: 0.23À0.87; p = 0.02) after adjustments for age, chronic comorbidities, acute severity of illness, appropriateness of empirical antimicrobial therapy, and propensity to obtain FUBC. Interpretation: Improved survival in hospitalized patients with GN-BSI who had FUBC is consistent with the results of recent publications from Italy and North Carolina supporting utilization of FUBC in management of GN-BSI. Funding: This study had no funding source.

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Association of Follow-up Blood Cultures With Mortality in Patients With Gram-Negative Bloodstream Infections

et al. 2022

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ImportanceObtaining follow-up blood cultures (FUBCs) in patients with Staphylococcus aureus bloodstream infection (BSI) is standard practice, although its utility in patients with gram-negative bacterial BSI (GN-BSI) is unclear.ObjectiveTo examine whether obtaining FUBCs is associated with decreased mortality (key question [KQ] 1) and whether positive vs negative FUBCs are associated with increased mortality (KQ2).Data SourcesMEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, Web of Science, and gray literature were searched from inception to March 11, 2022.Study SelectionTwo investigators used predefined eligibility criteria to independently screen titles, abstracts, and relevant full texts. Randomized clinical trials or observational studies that matched or statistically adjusted for differences in, at minimum, level of acute illness between patients in the intervention (eg, FUBCs obtained) and control (eg, FUBCs not obtained) groups were included in primary analyses. Articles published in languages other than English were excluded.Data Extraction and SynthesisData abstraction and quality assessments were performed by one investigator and verified by a second investigator. Risk of bias was assessed with the Newcastle-Ottawa Scale. Effect sizes were pooled using random-effects models. The study followed the Meta-analysis of Observational Studies in Epidemiology (MOOSE) reporting guideline.Main Outcomes and MeasuresMortality before hospital discharge or up to 30 days from the index blood culture.ResultsFrom 3495 studies, 15 were included (all nonrandomized). In the 5 studies (n = 4378 patients) that met criteria for the KQ1 primary analysis, obtaining FUBCs was associated with decreased mortality (hazard ratio, 0.56; 95% CI, 0.45-0.71). For KQ2, 2 studies met criteria for the primary analysis (ie, matched or statistically adjusted for differences in patients with positive vs negative FUBCs), so an exploratory meta-analysis of all 9 studies that investigated KQ2 (n = 3243 patients) was performed. Positive FUBCs were associated with increased mortality relative to negative blood cultures (odds ratio, 2.27; 95% CI, 1.54-3.34). Limitations of the literature included a lack of randomized studies and few patient subgroup analyses.Conclusions and RelevanceIn this systematic review and meta-analysis, obtaining FUBCs in patients with GN-BSI was associated with decreased mortality. The benefit of FUBCs may stem from identification of patients with positive FUBCs, which was a poor prognostic marker.

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Follow-up blood cultures are associated with improved outcome of patients with gram-negative bloodstream infections: retrospective observational cohort study

Cited by 38 publications

References 19 publications

Predictive scoring models for persistent gram-negative bacteremia that reduce the need for follow-up blood cultures: a retrospective observational cohort study

Predictive scoring models for persistent gram-negative bacteremia that reduce the need for follow-up blood cultures: a retrospective observational cohort study

Impact of follow up blood cultures on outcomes of patients with community-onset gram-negative bloodstream infection

Association of Follow-up Blood Cultures With Mortality in Patients With Gram-Negative Bloodstream Infections

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