Sending Repeat Cultures: Is There a Role in the Management of Bacteremic Episodes? (SCRIBE Study)

Wiggers, J. Brad; Xiong, Wei; Daneman, Nick

doi:10.1093/ofid/ofv133.528

Cited by 4 publications

(11 citation statements)

References 23 publications

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“…Blood culture sets obtained following the first true-positive blood culture within an encounter were considered repeat cultures. Persistent bacteremia was defined as the detection of the initial organism in repeat cultures drawn 2–7 days after the initial positive culture 22 . No detection of the initial organism was defined as cleared bacteremia.…”

Section: Methodsmentioning

confidence: 99%

Blood culture utilization at an academic hospital: Addressing a gap in benchmarking

Chen

Bilker

Hamilton

et al. 2018

Infect. Control Hosp. Epidemiol.

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ObjectiveTo describe the pattern of blood culture utilization in an academic university hospital setting.DesignRetrospective cohort study.SettingA 789-bed tertiary-care university hospital that processes 40,000+blood cultures annually.MethodsWe analyzed blood cultures collected from adult inpatients at the Hospital of the University of Pennsylvania between July 1, 2014, and June 30, 2015. Descriptive statistics and regression models were used to analyze patterns of blood culture utilization: frequency of blood cultures, use of repeat cultures following a true-positive culture, and number of sets drawn per day.ResultsIn total, 38,939 blood culture sets were drawn during 126,537 patient days (incidence rate, 307.7 sets per 1,000 patient days). The median number of blood culture sets drawn per hospital encounter was 2 (range, 1–76 sets). The median interval between blood cultures was 2 days (range, 1–71 days). Oncology services and cultures with gram-positive cocci were significantly associated with greater odds of having repeat blood cultures drawn the following day. Emergency services had the highest rate of drawing single blood-culture sets (16.9%), while oncology services had the highest frequency of drawing ≥5 blood culture sets within 24 hours (0.91%). Approximately 10% of encounters had at least 1 true-positive culture, and 89.2% of those encounters had repeat blood cultures drawn. The relative risk of a patient having repeat blood cultures was lower for those in emergency, surgery, and oncology services than for those in general medicine.ConclusionsOrdering practices differed by service and culture results. Analyzing blood culture utilization can contribute to the development of guidelines and benchmarks for appropriate usage.

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Section: Methodsmentioning

confidence: 99%

Blood culture utilization at an academic hospital: Addressing a gap in benchmarking

Chen

Bilker

Hamilton

et al. 2018

Infect. Control Hosp. Epidemiol.

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“…Given the conflicting results of these current [7,8] and previous [5,6] studies, it is not yet clear whether FUBCs should be used as a routine 'test of cure' or 'test of blood sterilization' in patients with GNB. Repeat blood cultures represent a significant cost burden for hospitals and labour burden for microbiology laboratories [5]. The cost and labour implications of routine FUBCs would certainly be worthwhile, though, if they could improve clinical outcomes for these vulnerable patients.…”

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confidence: 98%

“…Indeed, two previous studies have suggested low yield for repeat blood cultures in GNB. In our retrospective SCRIBE study, 901 GNB episodes were included, with 27% undergoing FUBCs and only 10.9% of those yielding a pathogen [5]. In contrast to earlier published research, we compared patients with FUBCs to those without, as well as those with positive versus negative FUBC results.…”

mentioning

confidence: 99%

“…Differences in FUBC timing definitions may also have played a prominent role in study discrepancies. Three of the studies defined FUBCs as those collected more than 24 hours after the collection of the samples which revealed the index bacteraemia [6e8], while one of the studies defined FUBCs as those which were collected more than 48 hours after the collection of the samples which revealed the index bacteraemia [5]. Inclusion of earlier repeat blood cultures (24e48 hours) after the index bacteraemia would be expected to yield greater rates of positivity.…”

mentioning

confidence: 99%

“…The cost and labour implications of routine FUBCs would certainly be worthwhile, though, if they could improve clinical outcomes for these vulnerable patients. In particular, persistent bacteraemia may highlight the need for further source control [5,8], but perhaps an emphasis on source control should be part of the usual management approach and should not be prompted only by results of screening FUBCs. Further prospective research is needed to confirm whether routine FUBCs improve outcomes in patients with GNB, and if so, the optimal timing of these repeat cultures and how they inform management strategies beyond other information available at the bedside.…”

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confidence: 99%

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The culture of follow-up blood cultures

Wiggers

Daneman

2020

Clinical Microbiology and Infection

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Positive follow-up blood cultures identify high mortality risk among patients with Gram-negative bacteraemia

Park

Ruffin

Turner

et al. 2020

Clinical Microbiology and Infection

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Objectives: The role of follow-up blood cultures (FUBCs) in the management of Gram-negative bacteraemia (GNB) is poorly understood. We aimed to determine the utility of FUBCs in identifying patients with increased mortality risk. Methods: An observational study with a prospectively enrolled cohort of adult inpatients with GNB was conducted at Duke University Health System from 2002 to 2015. FUBCs were defined as blood cultures performed from 24 hours to 7 days from initial positive blood culture. Results: Among 1702 patients with GNB, 1164 (68%) had FUBCs performed. When performed, FUBCs were positive in 20% (228/1113) of cases. FUBC acquisition was associated with lower all-cause in-hospital mortality (108/538, 20%, vs. 176/1164, 15%; p 0.01) and attributable in-hospital mortality (78/538, 15%, vs. 98/1164, 8%; p < 0.0001). Propensity scoreeweighted Cox proportional hazards models revealed that obtaining FUBCs was associated with reductions in all-cause (hazard ratio (HR) 0.629; 95% confidence interval (CI), 0.511e0.772; p < 0.0001) and attributable mortality (HR 0.628; 95% CI, 0.480e0.820; p 0.0007). Positive FUBCs were associated with increased all-cause mortality (49/228, 21%, vs. 110/885, 11%; p 0.0005) and attributable mortality (27/228, 12%, vs. 61/885, 7%; p 0.01) relative to negative FUBCs. Propensity scoreeweighted Cox proportional hazards models revealed that positive FUBCs were associated with increased all-cause (HR 2.099; 95% CI, 1.567e2.811; p < 0.0001) and attributable mortality (HR 1.800; 95% CI, 1.245e2.603; p 0.002). In a calibration analysis, a scoring system accurately identified patients at high risk of positive FUBCs. Conclusions: Rates of positive FUBCs were high and identified patients at increased risk for mortality. Clinical variables can identify patients at high risk for positive FUBCs. FUBCs should be considered in the management of GNB.

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Sending Repeat Cultures: Is There a Role in the Management of Bacteremic Episodes? (SCRIBE Study)

Cited by 4 publications

References 23 publications

Blood culture utilization at an academic hospital: Addressing a gap in benchmarking

Blood culture utilization at an academic hospital: Addressing a gap in benchmarking

The culture of follow-up blood cultures

Positive follow-up blood cultures identify high mortality risk among patients with Gram-negative bacteraemia

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