Impact on clinical outcome of follow-up blood cultures and risk factors for persistent bacteraemia in patients with gram-negative bloodstream infections: a systematic review with meta-analysis

Gatti, Milo; Bonazzetti, Cecilia; Tazza, Beatrice; Pascale, Renato; Miani, Beatrice; Malosso, Marta; Beci, Giacomo; Marzolla, Domenico; Rinaldi, Matteo; Viale, Pierluigi; Giannella, Maddalena

doi:10.1016/j.cmi.2023.02.024

Cited by 19 publications

(9 citation statements)

References 26 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Indeed, an antibiotic therapy tailored on the specific patient characteristics along with a shortening of the duration of antimicrobial exposure are the cornerstones of antimicrobial stewardship programs [ 26 , 27 ]. Although the lower proportion of secondary BSIs associated with an intra-abdominal source in the post-intervention phase could partially explain the significant reduction observed in terms of duration of antibiotic therapy, it is noteworthy that the achievement of an effective source control represents a cornerstone in the management of Gram-negative BSI, and that this issue was strictly associated with FUBC performance [ 28 ]. Considering the higher proportion of patients underwent to FUBCs coupled with a lower proportion of cases in which source control was not performed reported in the post-intervention phase, it could not be ruled out that these factors could have played a major role in shortening antibiotic treatment duration.…”

Section: Discussionmentioning

confidence: 99%

“…Considering the higher proportion of patients underwent to FUBCs coupled with a lower proportion of cases in which source control was not performed reported in the post-intervention phase, it could not be ruled out that these factors could have played a major role in shortening antibiotic treatment duration. Although performing FUBCs in Gram-negative infections still remains a debated issue, recent meta-analyses found that this procedure was associated with significant reduction in mortality rate [ 28 , 29 ], thus FUBCs may be recommended for the management of critical patients affected by Gram-negative BSIs. However, for optimizing health resources, a proposed risk score could be applied for promptly identifying cases at high-risk for persistent BSIs who may benefit from FUBCs execution [ 28 ].…”

Section: Discussionmentioning

confidence: 99%

“…Although performing FUBCs in Gram-negative infections still remains a debated issue, recent meta-analyses found that this procedure was associated with significant reduction in mortality rate [ 28 , 29 ], thus FUBCs may be recommended for the management of critical patients affected by Gram-negative BSIs. However, for optimizing health resources, a proposed risk score could be applied for promptly identifying cases at high-risk for persistent BSIs who may benefit from FUBCs execution [ 28 ].…”

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

Impact of a multidisciplinary management team on clinical outcome in ICU patients affected by Gram-negative bloodstream infections: a pre-post quasi-experimental study

Rinaldi,

Gatti,

Tonetti

et al. 2024

Ann. Intensive Care

View full text Add to dashboard Cite

Background Bloodstream infections (BSIs) by Gram-negative pathogens play a major role in intensive care patients, both in terms of prevalence and severity, especially if multi-drug resistant pathogens are involved. Early appropriate antibiotic therapy is therefore a cornerstone in the management of these patients, and growing evidence shows that implementation of a multidisciplinary team may improve patients’ outcomes. Our aim was to evaluate the clinical and microbiological impact of the application of a multidisciplinary team on critically ill patients. Methods Pre-post study enrolling critically ill patients with Gram negative bloodstream infection in intensive care unit. In the pre-intervention phase (from January until December 2018) patients were managed with infectious disease consultation on demand, in the post-intervention phase (from January until December 2022) patients were managed with a daily evaluation by a multidisciplinary team composed of intensivist, infectious disease physician, clinical pharmacologist and microbiologist. Results Overall, 135 patients were enrolled during the study period, of them 67 (49.6%) in the pre-intervention phase and 68 (50.4%) in the post-intervention phase. Median age was 67 (58–75) years, sex male was 31.9%. Septic shock, the need for continuous renal replacement therapy and mechanical ventilation at BSI onset were similar in both groups, no difference of multidrug-resistant organisms (MDRO) prevalence was observed. In the post-phase, empirical administration of carbapenems decreased significantly (40.3% vs. 62.7%, p = 0.02) with an increase of appropriate empirical therapy (86.9% vs. 55.2%, p < 0.001) and a decrease of overall antibiotic treatment (12 vs. 16 days, p < 0.001). Despite no differences in delta SOFA and all-cause 30-day mortality, a significant decrease in microbiological failure (10.3% vs. 29.9%, p = 0.005) and a new-onset 30-day MDRO colonization (8.3% vs. 36.6%, p < 0.001) in the post-phase was reported. At multivariable analysis adjusted for main covariates, the institution of a multidisciplinary management team (MMT) was found to be protective both for new MDRO colonization [OR 0.17, 95%CI(0.05–0.67)] and microbiological failure [OR 0.37, 95%CI (0.14–0.98)]. Conclusions The institution of a MMT allowed for an optimization of antimicrobial treatments, reflecting to a significant decrease in new MDRO colonization and microbiological failure among critically ill patients.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Impact of a multidisciplinary management team on clinical outcome in ICU patients affected by Gram-negative bloodstream infections: a pre-post quasi-experimental study

Rinaldi,

Gatti,

Tonetti

et al. 2024

Ann. Intensive Care

View full text Add to dashboard Cite

show abstract

“…A predictive risk score of failure in attaining aggressive beta-lactam PK/PD targets in critically ill patients was developed by assigning to each of the meta-analyzed risk factor showing statistical significance a point value corresponding to the natural log of the estimate rounded to the nearest integer, as previously reported [ 19 ]. Positive point values were considered as increasing the risk, whereas the negative ones were considered as being protective against the risk.…”

Section: Methodsmentioning

confidence: 99%

Impact of attaining aggressive vs. conservative PK/PD target on the clinical efficacy of beta-lactams for the treatment of Gram-negative infections in the critically ill patients: a systematic review and meta-analysis

Gatti,

Cojutti,

Pea

2024

Crit Care

Self Cite

View full text Add to dashboard Cite

Background To perform a systematic review with meta-analysis with the dual intent of assessing the impact of attaining aggressive vs. conservative beta-lactams PK/PD target on the clinical efficacy for treating Gram-negative infections in critical patients, and of identifying predictive factors of failure in attaining aggressive PK/PD targets. Methods Two authors independently searched PubMed-MEDLINE and Scopus database from inception to 23rd December 2023, to retrieve studies comparing the impact of attaining aggressive vs. conservative PK/PD targets on clinical efficacy of beta-lactams. Independent predictive factors of failure in attaining aggressive PK/PD targets were also assessed. Aggressive PK/PD target was considered a100%fT>4xMIC, and clinical cure rate was selected as primary outcome. Meta-analysis was performed by pooling odds ratios (ORs) extrapolated from studies providing adjustment for confounders using a random-effects model with inverse variance method. Results A total of 20,364 articles were screened, and 21 observational studies were included in the meta-analysis (N = 4833; 2193 aggressive vs. 2640 conservative PK/PD target). Attaining aggressive PK/PD target was significantly associated with higher clinical cure rate (OR 1.69; 95% CI 1.15–2.49) and lower risk of beta-lactam resistance development (OR 0.06; 95% CI 0.01–0.29). Male gender, body mass index > 30 kg/m2, augmented renal clearance and MIC above the clinical breakpoint emerged as significant independent predictors of failure in attaining aggressive PK/PD targets, whereas prolonged/continuous infusion administration of beta-lactams resulted as protective factor. The risk of bias was moderate in 19 studies and severe in the other 2. Conclusions Attaining aggressive beta-lactams PK/PD targets provided significant clinical benefits in critical patients. Our analysis could be useful to stratify patients at high-risk of failure in attaining aggressive PK/PD targets.

show abstract

“…Increasingly, data from observational studies and randomized controlled trials (RCTs) support shorter course therapy (7 days) over traditional durations (14 days) for uncomplicated gram-negative BSI, without considering time to bloodstream clearance [ 8–10 ]. On the other hand, recent research has suggested improved clinical outcomes associated with the use of follow-up BCs also in gram-negative BSI [ 11 , 12 ].…”

mentioning

confidence: 99%

Persistence of Detectable Pathogens by Culture-Independent Systems (T2 Magnetic Resonance) in Patients With Bloodstream Infection: Prognostic Role and Possible Clinical Implications

Peri,

O’Callaghan,

Rafiei

et al. 2023

Clinical Infectious Diseases

View full text Add to dashboard Cite

Introduction Persistent S. aureus bacteraemia is associated with metastatic infection and adverse outcomes while Gram-negative bacteraemia is normally transient and shorter course therapy is increasingly advocated for affected patients. Whether the prolonged detection of pathogen DNA in blood by culture-independent systems could have prognostic value and guide management decisions is unknown. Methods We performed a multicentre prospective observational study on 102 patients with bloodstream infection, to compare time to bloodstream clearance according to T2 magnetic resonance and blood cultures over a 4-day follow-up. We also explored the association between duration of detectable pathogens according to T2 Magnetic resonance (Magnetic Resonance-DNAemia, MR-DNAemia) and clinical outcomes. Results Time to bloodstream clearance according to T2 Magnetic Resonance was significantly longer compared to blood culture clearance (HR 0.54, 95%CI 0.39-0.75) and did not differ according to the causative pathogen (p=0.5). Each additional day of MR-DNAemia increased the odds of persistent infection (defined as metastatic infection or delayed source control) both in the overall population (OR 1.98, 95%CI 1.45-2.70) and in S. aureus (OR 1.92, 95%CI 1.12-3.29) and Gram-negative bacteraemia (OR 2.21, 95%CI 1.35-3.60). MR-DNAemia duration was also associated with no improvement in Sequential Organ Failure Assessment score at day 7 from infection onset (OR 1.76, 95%CI 1.21-2.56). Conclusion T2 Magnetic Resonance may help to diagnose bloodstream infection in patients on antimicrobials with negative blood cultures as well as to identify patients with metastatic infection, source control failure or adverse short-term outcome. Future studies may inform its usefulness within the setting of antimicrobial stewardship programs.

show abstract

Impact on clinical outcome of follow-up blood cultures and risk factors for persistent bacteraemia in patients with gram-negative bloodstream infections: a systematic review with meta-analysis

Cited by 19 publications

References 26 publications

Impact of a multidisciplinary management team on clinical outcome in ICU patients affected by Gram-negative bloodstream infections: a pre-post quasi-experimental study

Impact of a multidisciplinary management team on clinical outcome in ICU patients affected by Gram-negative bloodstream infections: a pre-post quasi-experimental study

Impact of attaining aggressive vs. conservative PK/PD target on the clinical efficacy of beta-lactams for the treatment of Gram-negative infections in the critically ill patients: a systematic review and meta-analysis

Persistence of Detectable Pathogens by Culture-Independent Systems (T2 Magnetic Resonance) in Patients With Bloodstream Infection: Prognostic Role and Possible Clinical Implications

Contact Info

Product

Resources

About