Time to positivity in bloodstream infection is not a prognostic marker for mortality: analysis of a prospective multicentre randomized control trial

Hamilton, Fergus; Evans, R. J.; Ghazal, Peter; MacGowan, Alasdair

doi:10.1016/j.cmi.2021.05.043

Cited by 10 publications

(16 citation statements)

References 32 publications

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“…The results from this study were from a single-region cohort study with a single laboratory, making extrapolations difficult. For example, Hamilton et al [ 17 ] found a median TTP of 17.1 hours in bacteremia with β-hemolytic streptococci compared to the 10.4 hours in our study. The reason for this difference is unknown but could be due to different blood culture systems, different TTP of different groups or species of β-hemolytic streptococci, or logistics.…”

Section: Discussioncontrasting

confidence: 51%

“…Similar findings have been observed with TTP and other Gram-positive bacteria, suggesting that TTP may be an important prognostic factor in patients with bacteremia. However, in a recent study published by Hamilton et al, TTP correlated with mortality rate only for Candida and β-hemolytic streptococci and not for other major pathogens [ 17 ]. In that study, β-hemolytic streptococci were divided into groups based on the Lancefield group antigen, which does not always correlate with the species.…”

Section: Discussionmentioning

confidence: 99%

“…Invasive infections with S pyogenes have a substantial mortality ranging from 8% to 23% within 30 days of infection [ 17 , 19 ]. In our cohort, the mortality was only 10%, although most of the patients developed sepsis during hospital stay.…”

Section: Discussionmentioning

confidence: 99%

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Time to Blood Culture Positivity: An Independent Predictor of Mortality in Streptococcus Pyogenes Bacteremia

Bläckberg

Svedevall

Lundberg

et al. 2022

Open Forum Infectious Diseases

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Background Streptococcus pyogenes bacteraemia is a severe condition with high mortality. Time to blood culture positivity (TTP) is known to predict the outcome in bacteraemia with other pathogens. This study aimed to determine the association between TTP and outcome in S. pyogenes bacteraemia. Methods This retrospective observational cohort study comprised adults with S. pyogenes bacteraemia, identified through the laboratory database between 2015 and 2018, in the Region of Skåne, Sweden. Correlations between TTP and outcomes were investigated. Primary outcome was death within 30 days and secondary outcomes were presence of sepsis or disease deterioration within the first 48 hours. Results A total of 347 episodes of S. pyogenes bacteraemia were identified of which 61 were excluded resulting in 286 included episodes. Median TTP was 10.4 hours, (interquartile range 8.4-11.4). Thirty-day mortality was 10 %. Median TTP was shorter in patients who died within 30 days compared to survivors (8.6 vs 10.4 hours, p < 0.001). In a multivariable logistic regression, shorter TTP was associated with 30-day mortality when adjusting for age, Charlson comorbidity index and focus of infection (OR 3.7, 95% CI 1.2-11.3, p = 0.02). There was no statistically significant difference in TTP between patients with sepsis within 48 hours and those who did not have sepsis. Additionally, there was no statistically significant difference in TTP between patients with disease deterioration compared to those who did not deteriorate. Conclusions Knowledge on TTP might be a tool to determine the prognosis of a given patient with S. pyogenes bacteraemia.

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Section: Discussioncontrasting

confidence: 51%

Section: Discussionmentioning

confidence: 99%

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Time to Blood Culture Positivity: An Independent Predictor of Mortality in Streptococcus Pyogenes Bacteremia

Bläckberg

Svedevall

Lundberg

et al. 2022

Open Forum Infectious Diseases

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“…13 Although this is possible, we have previously shown that "time to positivity", a proxy for bacterial load, is no different in transplant patients than non-transplant patients in this cohort, and time to appropriate therapy in this study was the same across both cohorts. 14 Also, in this cohort, infections with Pseudomonas spp (associated with worse outcomes) were higher in the transplant cohort, while coagulase negative staphylococci (often felt to be marginally pathogenic) were higher in the non-transplant cohort. Regardless, given that early therapy improves outcomes in bloodstream infection, even small changes in patient behaviour (e.g.…”

Section: Other Literaturementioning

confidence: 68%

Patients with transplantation have reduced mortality in bacteraemia: Analysis of data from a randomised trial

Hamilton¹,

Evans²,

Ghazal³

et al. 2022

Journal of Infection

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“…A recent meta-analysis concludes that a short TTP is a prognostic marker associated with mortality and septic shock, applicable for most analyzed species except Candida spp., but it has substantial limitations [ 131 ]. Although there is evidence in favor of TTP being associated with worse prognosis in bacteremia due to S. aureus [ 132 , 133 ], E. coli [ 134 ], S. pneumoniae [ 135 ], P. aeruginosa [ 136 ], or K. pneumoniae [ 137 ], not all cases have been able to demonstrate this association between TTP and mortality [ 138 ]. Furthermore, a linear relationship is not always found, with a worse prognosis being described with both short and long TTP for S. aureus [ 139 ], and with long TTP for C. albicans [ 138 , 140 ].…”

Section: Can Time To Positivity Of Blood Cultures Be a Predictor Of E...mentioning

confidence: 99%

Unresolved issues in the epidemiology and diagnosis of bacteremia: an opinion paper

Alonso-Menchén¹,

Muñóz²,

Sánchez‐Carrillo³

et al. 2022

Rev Esp Quimioter

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Bacteremia is an important cause of morbidity and mortality worldwide and, despite the diagnostic and therapeutic advances of the last decades, the evidence supporting many diagnostic aspects of bacteremia is scarce. Information on the epidemiological evolution of this entity is limited and many methodological aspects of blood culture collection and analysis are under discussion. Furthermore, the recommendations of the main scientific societies on many of these aspects are variable and, in many cases, have not been updated recently. In this scenario, we have arranged a series of questions on different aspects of bacteremia and reviewed the literature trying to find proper answers for them. We offer our opinion on the topics where the evidence was weak. The topics covered include epidemiological aspects of bacteremia, indications for blood culture extraction, methods for obtaining and incubating samples, or ways of transmitting results from the microbiology laboratory. We do not intend to summarize the current clinical practice guidelines, nor will we deal with the therapeutic management of this entity. The aim of this paper is to review the current perspective on the diagnosis of bacteremia with a critical approach, to point out the gaps in the literature, to offer the opinion of a team dedicated to infectious diseases and clinical microbiology, and to identify some areas of knowledge on which future studies should focus.

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Time to positivity in bloodstream infection is not a prognostic marker for mortality: analysis of a prospective multicentre randomized control trial

Abstract: Time-to-positivity in bloodstream infection is not a prognostic marker for mortality: analysis of a prospective multicentre randomised control trial, Clinical Microbiology and Infection,

Cited by 10 publications

References 32 publications

Time to Blood Culture Positivity: An Independent Predictor of Mortality in Streptococcus Pyogenes Bacteremia

Time to Blood Culture Positivity: An Independent Predictor of Mortality in Streptococcus Pyogenes Bacteremia

Patients with transplantation have reduced mortality in bacteraemia: Analysis of data from a randomised trial

Unresolved issues in the epidemiology and diagnosis of bacteremia: an opinion paper

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