Inpatient utilization of blood cultures drawn in an urban ED

Roque, Pedro; Oliver, Brian G.; Anderson, L.; Mulrow, Mary; Drachman, Dave; Stapczynski, Stephan; LoVecchio, Frank

doi:10.1016/j.ajem.2010.10.022

Cited by 9 publications

(8 citation statements)

References 9 publications

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“…Regardless of the method used, even negative results do not exclude severe infection. In the literature, the true positive rate of blood cultures is ranked between 5–10% and a further five percent are false positives due to contamination [ 6 , 7 , 8 ]. The costs of unnecessary blood culture requests, especially when false positive are included, are substantial [ 9 , 10 ].…”

Section: Introductionmentioning

confidence: 99%

Utility of Sepsis Biomarkers and the Infection Probability Score to Discriminate Sepsis and Systemic Inflammatory Response Syndrome in Standard Care Patients

et al. 2013

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Physicians are regularly faced with severely ill patients at risk of developing infections. In literature, standard care wards are often neglected, although their patients frequently suffer from a systemic inflammatory response syndrome (SIRS) of unknown origin. Fast identification of patients with infections is vital, as they immediately require appropriate therapy. Further, tools with a high negative predictive value (NPV) to exclude infection or bacteremia are important to increase the cost effectiveness of microbiological examinations and to avoid inappropriate antibiotic treatment. In this prospective cohort study, 2,384 patients with suspected infections were screened for suffering from two or more SIRS criteria on standard care wards. The infection probability score (IPS) and sepsis biomarkers with discriminatory power were assessed regarding their capacity to identify infection or bacteremia. In this cohort finally consisting of 298 SIRS-patients, the infection prevalence was 72%. Bacteremia was found in 25% of cases. For the prediction of infection, the IPS yielded 0.51 ROC-AUC (30.1% sensitivity, 64.6% specificity). Among sepsis biomarkers, lipopolysaccharide binding protein (LBP) was the best parameter with 0.63 ROC-AUC (57.5% sensitivity, 67.1% specificity). For the prediction of bacteremia, the IPS performed slightly better with a ROC-AUC of 0.58 (21.3% sensitivity, 65% specificity). Procalcitonin was the best discriminator with 0.78 ROC-AUC, 86.3% sensitivity, 59.6% specificity and 92.9% NPV. Furthermore, bilirubin and LBP (ROC-AUC: 0.65, 0.62) might also be considered as useful parameters. In summary, the IPS and widely used infection parameters, including CRP or WBC, yielded a poor diagnostic performance for the detection of infection or bacteremia. Additional sepsis biomarkers do not aid in discriminating inflammation from infection. For the prediction of bacteremia procalcitonin, and bilirubin were the most promising parameters, which might be used as a rule for when to take blood cultures or using nucleic acid amplification tests for microbiological diagnostics.

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Section: Introductionmentioning

confidence: 99%

Utility of Sepsis Biomarkers and the Infection Probability Score to Discriminate Sepsis and Systemic Inflammatory Response Syndrome in Standard Care Patients

et al. 2013

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“…Roque y cols. 25 , analizaron una cohorte retrospectiva de 1.124 pacientes que ingresaban al servicio de urgencias con solicitud de hemocultivos, de los cuales la proporción de verdaderos positivos fue 10,3%. Las variables asociadas con positividad de los hemocultivos fueron la edad, el uso de quimioterapia en los seis meses anteriores al reclutamiento, la frecuencia cardíaca > 100 latidos por minuto, la natremia disminuida y el aumento del nitrógeno ureico sanguíneo.…”

Section: Discussionunclassified

Desarrollo y validación de un modelo predictor para bacteriemia en pacientes hospitalizados por el servicio de urgencias con sospecha de infección

Cuervo

Correa

Garcés

et al. 2016

Rev. chil. infectol.

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“…Previous studies of blood culture utilization have focused on inappropriate use in the emergency department, 17 , 18 outpatient clinic, 19 and neurosurgical ICU 20 21 Studies in the PICU have been limited to the immediate postoperative period or to specific periods surrounding an educational campaign 22 …”

Section: Discussionmentioning

confidence: 99%

Impact of Mandatory Public Reporting of Central Line–Associated Bloodstream Infections on Blood Culture and Antibiotic Utilization in Pediatric and Neonatal Intensive Care Units

Flett

Ozonoff

Sandora

et al. 2015

Infect. Control Hosp. Epidemiol.

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Inpatient utilization of blood cultures drawn in an urban ED

Cited by 9 publications

References 9 publications

Utility of Sepsis Biomarkers and the Infection Probability Score to Discriminate Sepsis and Systemic Inflammatory Response Syndrome in Standard Care Patients

Utility of Sepsis Biomarkers and the Infection Probability Score to Discriminate Sepsis and Systemic Inflammatory Response Syndrome in Standard Care Patients

Desarrollo y validación de un modelo predictor para bacteriemia en pacientes hospitalizados por el servicio de urgencias con sospecha de infección

Impact of Mandatory Public Reporting of Central Line–Associated Bloodstream Infections on Blood Culture and Antibiotic Utilization in Pediatric and Neonatal Intensive Care Units

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