Utility of the blood culture in infection of the urinary tract with fever in the elderly

Artero, Elisa Álvarez; Núñez, Amaia Campo; Bravo, Moisés García; García-Bravo, M.; Belhassen-García, Moncef; Lledías, Javier Pardo

doi:10.37201/req/156.2020

Cited by 3 publications

(3 citation statements)

References 16 publications

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“…In a meta-analysis with 58 studies and 16.514 patients with bacteremia from different sources [ 40 ], PCT had an area under the summary receiver-operating characteristic curves of 0.79, with a negative predictive value of 95% for bacteremia in the medical ward. In another study, Álvarez et al [ 23 ] described an AUROC of 0.79 for bacteremia in a population of elderly patients with febrile UTI. According to these studies, our data supports the use of PCT as a biomarker of bacteremia in patients with UTIs.…”

Section: Discussionmentioning

confidence: 99%

“…Predictive factors for bacteremia may be relevant for clinical management. Although several studies have studied risk factors for urinary bacteremia, these were retrospective [ 19 , 20 , 21 , 22 ] or analyzed only certain types of UTI, such as those on elderly patients [ 23 , 24 ], catheter-associated UTI [ 21 ], or febrile UTI in the emergency department [ 22 ]. Therefore, there is a need to know the risk factors and clinical significance of bacteremia in patients with complicated community-acquired UTI who require hospital admission.…”

Section: Introductionmentioning

confidence: 99%

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Risk Factors for Bacteremia and Its Clinical Impact on Complicated Community-Acquired Urinary Tract Infection

et al. 2023

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Bacteremia has been associated with severity in some infections; however, its impact on the prognosis of urinary tract infections (UTIs) is still disputed. Our goal is to determine the risk factors for bacteremia and its clinical impact on hospitalized patients with complicated community-acquired urinary tract infections. We conducted a prospective observational study of patients admitted to the hospital with complicated community-acquired UTIs. Clinical variables and outcomes of patients with and without bacteremia were compared, and multivariate analysis was performed to identify risk factors for bacteremia and mortality. Of 279 patients with complicated community-acquired UTIs, 37.6% had positive blood cultures. Risk factors for bacteremia by multivariate analysis were temperature ≥ 38 °C (p = 0.006, OR 1.3 (95% CI 1.1–1.7)) and procalcitonin ≥ 0.5 ng/mL (p = 0.005, OR 8.5 (95% CI 2.2–39.4)). In-hospital and 30-day mortality were 9% and 13.6%, respectively. Quick SOFA (p = 0.030, OR 5.4 (95% CI 1.2–24.9)) and Barthel Index <40% (p = 0.020, OR 4.8 (95% CI 1.3–18.2)) were associated with 30-day mortality by multivariate analysis. However, bacteremia was not associated with 30-day mortality (p = 0.154, OR 2.7 (95% CI 0.7–10.3)). Our study found that febrile community-acquired UTIs and elevated procalcitonin were risk factors for bacteremia. The outcomes in patients with bacteremia were slightly worse, but without significant differences in mortality.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Risk Factors for Bacteremia and Its Clinical Impact on Complicated Community-Acquired Urinary Tract Infection

et al. 2023

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“…The ability to rapidly and accurately identify pathogens is crucial in guiding clinical treatment decisions. Currently, the gold standard for diagnosing infectious diseases relies on conventional testing methods, which unfortunately fail to meet clinical needs in a timely and effective manner due to their extended processing times, vulnerability to contamination, and limited sensitivity [10,11]. In response to these challenges, alternative diagnostic approaches have emerged as front-line methods, including antigen-antibody immunoassays and specific pathogen identification through quantitative PCR (qPCR) or droplet digital (ddPCR).…”

Section: Introductionmentioning

confidence: 99%

Improving pulmonary infection diagnosis with metagenomic next-generation sequencing of bronchoalveolar lavage fluid

Long,

Xia,

Feng

et al. 2024

Journal of Medical Microbiology

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Introduction. Inappropriate use of antibiotics and inadequate therapeutic regimens for early-stage pulmonary infections are major contributors to increased prevalence of complications and mortality. Moreover, due to the limitations in sensitivity of conventional testing, there is an urgent need for more diagnostically efficient methods for the detection and characterization of pathogens in pulmonary infections. Hypothesis/Gap Statement. Metagenomic next-generation sequencing (mNGS) can contribute to the diagnosis and management of pulmonary infections. Aim. This study aimed to evaluate the clinical application and value of mNGS in the diagnosis of clinically suspected pulmonary infections by comparing with conventional testing. Methodology. In this study, the diagnosis performance of mNGS was evaluated using bronchoalveolar lavage fluid (BALF) samples from 143 patients with suspected lung infections. First, we conducted a prospective study on 31 patients admitted to Yuebei People’s Hospital Affiliated to Shantou University Medical College to investigate the clinical value. Then a retrospective analysis was performed by including more patients (n=112) to reduce the random error. Pathogens were detected by mNGS and conventional methods (culture and PCR). Then, the types and cases of detected pathogens, as well as the specificity and sensitivity, were compared between the two methods. We evaluated the performance of mNGS in detecting bacterial, fungal, viral and mixed infections in BALF. The effect of disease severity in pulmonary infections on the integrity of mNGS pathogen detection was also explored. Results. The mNGS provided an earlier and more comprehensive pathogen profile than conventional testing, which in turn prompted a change in clinical medication, which led to improvement in eight patients (8/31=25.81 %) in the presence of other serious comorbidities. In a retrospective analysis, mNGS was much more sensitive than conventional testing in the diagnosis of pulmonary infections (95.33 % vs. 55.56 %; P<0.001), with a 39.77 % increase in sensitivity. The detection rate of mNGS for mixed infections was significantly higher than that of conventional testing methods for both common and severe pneumonia (48/67=71.64 % vs. 12/52=23.08 %, P<0.001; 44/59=74.58 % vs. 11/59=18.64 %, P<0.0001). Conclusion. The sensitivity of mNGS in the diagnosis of pathogenic microorganisms in pulmonary infections far exceeds that of conventional culture tests. As a complementary method to conventional methods, mNGS can help improve the diagnosis of pulmonary infections. In addition, mNGS pathogen integrity detection rate was similar in common and severe pneumonia. We recommend the prompt use of mNGS when mixed or rare pathogen infections are suspected, especially in immunocompromised individuals and/or critically ill individuals.

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Models for bacteraemia risk prediction. Clinical implications

Clemente-Callejo¹,

Julián-Jiménez²,

Candel³

et al. 2022

Rev Esp Quimioter

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Bacteraemia has important consequences for the patient, as it is associated with worse clinical outcomes. On the other hand, unnecessarily obtaining samples for blood cultures increases costs and the workload in the microbiology laboratory. Its diagnosis implies a time delay, but decisions about start antibiotic treatment, discharge, or admits the patient must be taken during the first attention and, therefore, before known the blood cultures results. This manuscript reviews the different strategies based on clinical scores and biomarkers that are useful for predicting bacteraemia and improving initial decision-making.

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Utility of the blood culture in infection of the urinary tract with fever in the elderly

Cited by 3 publications

References 16 publications

Risk Factors for Bacteremia and Its Clinical Impact on Complicated Community-Acquired Urinary Tract Infection

Risk Factors for Bacteremia and Its Clinical Impact on Complicated Community-Acquired Urinary Tract Infection

Improving pulmonary infection diagnosis with metagenomic next-generation sequencing of bronchoalveolar lavage fluid

Models for bacteraemia risk prediction. Clinical implications

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