scholarly journals Impact of follow up blood cultures on outcomes of patients with community-onset gram-negative bloodstream infection

2021 ◽  
Vol 34 ◽  
pp. 100811
Author(s):  
Rajiv Amipara ◽  
Hana Rac Winders ◽  
Julie Ann Justo ◽  
P. Brandon Bookstaver ◽  
Joseph Kohn ◽  
...  
Keyword(s):  
Bloodstream Infection ◽  
Blood Cultures ◽  
Gram Negative ◽  
Community Onset

Follow-up blood cultures in Gram-negative bacilli bacteremia: are they needed for critically ill patients?

2020 ◽  
Vol 86 (5) ◽  
Author(s):  
Martina Spaziante ◽  
Alessandra Oliva ◽  
Giancarlo Ceccarelli ◽  
Francesco Alessandri ◽  
Francesco Pugliese ◽  
...  
Keyword(s):  
Critically Ill ◽  
Critically Ill Patients ◽  
Blood Cultures ◽  
Gram Negative

scholarly journals 288. Follow-Up Blood Cultures in Gram-Negative Bacteremia: How Do They Impact Outcomes

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S144-S144
Author(s):  
Azza Elamin ◽  
Faisal Khan ◽  
Ali Abunayla ◽  
Rajasekhar Jagarlamudi ◽  
aditee Dash
Keyword(s):  
Clinical Outcomes ◽  
Antibiotic Treatment ◽  
Readmission Rate ◽  
Blood Cultures ◽  
Categorical Variables ◽  
Gram Negative ◽  
Number Of Patients ◽  
Significant Difference ◽  
The Impact

Abstract Background As opposed to Staphylococcus. aureus bacteremia, there are no guidelines to recommend repeating blood cultures in Gram-negative bacilli bacteremia (GNB). Several studies have questioned the utility of follow-up blood cultures (FUBCs) in GNB, but the impact of this practice on clinical outcomes is not fully understood. Our aim was to study the practice of obtaining FUBCs in GNB at our institution and to assess it’s impact on clinical outcomes. Methods We conducted a retrospective, single-center study of adult patients, ≥ 18 years of age admitted with GNB between January 2017 and December 2018. We aimed to compare clinical outcomes in those with and without FUBCs. Data collected included demographics, comorbidities, presumed source of bacteremia and need for intensive care unit (ICU) admission. Presence of fever, hypotension /shock and white blood cell (WBC) count on the day of FUBC was recorded. The primary objective was to compare 30-day mortality between the two groups. Secondary objectives were to compare differences in 30-day readmission rate, hospital length of stay (LOS) and duration of antibiotic treatment. Mean and standard deviation were used for continuous variables, frequency and proportion were used for categorical variables. P-value < 0.05 was defined as statistically significant. Results 482 patients were included, and of these, 321 (67%) had FUBCs. 96% of FUBCs were negative and 2.8% had persistent bacteremia. There was no significant difference in 30-day mortality between those with and without FUBCs (2.9% and 2.7% respectively), or in 30-day readmission rate (21.4% and 23.4% respectively). In patients with FUBCs compared to those without FUBCs, hospital LOS was longer (7 days vs 5 days, P < 0.001), and mean duration of antibiotic treatment was longer (14 days vs 11 days, P < 0.001). A higher number of patients with FUBCs needed ICU care compared to those without FUBCs (41.4% and 25.5% respectively, P < 0.001) Microbiology of index blood culture in those with and without FUBCs Outcomes in those with and without FUBCs FUBCs characteristics Conclusion Obtaining FUBCs in GNB had no impact on 30-day mortality or 30-day readmission rate. It was associated with longer LOS and antibiotic duration. Our findings suggest that FUBCs in GNB are low yield and may not be recommended in all patients. Prospective studies are needed to further examine the utility of this practice in GNB. Disclosures All Authors: No reported disclosures

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

2020 ◽  
Vol 26 (7) ◽  
pp. 904-910 ◽  
Author(s):  
S.A. Maskarinec ◽  
L.P. Park ◽  
F. Ruffin ◽  
N.A. Turner ◽  
N. Patel ◽  
...  
Keyword(s):  
High Mortality ◽  
Mortality Risk ◽  
Blood Cultures ◽  
High Mortality Risk ◽  
Gram Negative

Utility of follow-up blood cultures for Gram-negative rod bacteremia in children

2019 ◽  
Vol 25 (9) ◽  
pp. 738-741 ◽  
Author(s):  
Erika Uehara ◽  
Kensuke Shoji ◽  
Masashi Mikami ◽  
Akira Ishiguro ◽  
Isao Miyairi
Keyword(s):  
Blood Cultures ◽  
Gram Negative

Sterilization Of Catheters Using Providone-Iodine Decreases The Incidence Of Catheter-Associated Bloodstream Infection

Blood ◽  
2013 ◽  
Vol 122 (21) ◽  
pp. 2984-2984
Author(s):  
Minako Sugiyama ◽  
Yukayo Terashita ◽  
Junjiro Ohshima ◽  
Tomonobu Sato ◽  
Yuko Cho ◽  
...  
Keyword(s):  
Bloodstream Infection ◽  
Bacterial Infections ◽  
Hematological Malignancies ◽  
Povidone Iodine ◽  
Blood Cultures ◽  
Access Port ◽  
Gram Negative ◽  
Immune Deficiencies ◽  
Definition Of ◽  
Second Period

Abstract Introduction The use of central venous (CV) catheters is crucial for administering chemotherapy to children; however, catheter-related bacterial infections can be life threatening. The guidelines of Centers for Disease Control (CDC) and Prevention recommend ensuring sterile access to CV catheters by scrubbing the access port with an appropriate antiseptic, such as chlorhexidine, povidone-iodine, or 70% alcohol, and accessing the port only with sterile devices. For pediatric patients receiving chemotherapy, our institution uses the Hickman catheter as a CV catheter. Between April 2008 and March 2010, 83% alcohol was used to sterilize the access port. Because a large number of patients acquired subsequent infections including with Bacillus cereus, we used 10% povidone-iodine before accessing the catheter between April 2010 and March 2012. We compared the rates of bacterial infections during these two periods. Patients and Methods We performed blood cultures of patients receiving chemotherapy using venous puncture or a CV catheter before starting antibiotics. We determined the number of positive cultures, identified the infectious agent, and clinically evaluated the infected patients. Between April 2008 and March 2010, we investigated297 patients, of which 207 were treated using CV catheters. The median age of the 207 patients (129 males and 78 females) was 8 years (range, 2 months to 30 years). The indications for chemotherapy included stem-cell transplantation to treat the diseases as follows: hematological malignancies (n=127), malignant solid tumors (n=62), and congenital immune deficiencies (n=18). Between April 2010 and March 2012, we investigated 291 patients, of which 185 were treated using CV catheters. The median age of the 185 patients (129 males and 56 females) was 6 years (range, 10 months to 16 years). The indications for chemotherapy included the following conditions: hematological malignancies (n=98), malignant solid tumors (n=81), pure red-cell aplasia (n=4), and congenital immune deficiencies (n=2). We defined catheter-associated bloodstream infection by detection of common commensal pathogens, such as Staphylococcus species and Bacillus cereus, according to the definitions of the CDC/NHSN along with detection of pathogens from cultures collected from the access port of the CV catheter. Results There was no significant difference between the two groups in patient characteristics such as median age and the period of neutropenia. The frequency of positive blood cultures were 16.4% (34/207) and 11.9% (22/185) (p = 0.224) for the former and latter periods, respectively. In the first period, 61.8% (21/34) of the pathogens isolated were gram-positive (e.g., S. epidermidis) and 41.2% (14/34) were gram-negative (e.g., B cereus). Our definition of catheter-associated bloodstream infection was met by 12.6% (26/207) in these cases. In the second period, 40.9% (9/22) of the pathogens isolated were gram-positive and 40.9% (9/23) were gram-negative (e.g., Enterobacter cloacae). Our definition of catheter-associated bloodstream infection was met by 6.5% (12/185) (p = 0.0658) Notably, B. cereus was not detected in the second period. Conclusion Sterilization of the access port of CV catheters using povidone-iodine decreased catheter-associated bloodstream infection. A significant advantage of using povidone-iodine was eliminating infections with the fatal pathogen, B. cereus. Disclosures: No relevant conflicts of interest to declare.

scholarly journals The Changing Landscape of Uncomplicated Gram-Negative Bacteremia: A Narrative Review to Guide Inpatient Management

2020 ◽  
Vol 15 (12) ◽  
pp. 746-753 ◽  
Author(s):  
Jeannie D Chan ◽  
Chloe Bryson-Cahn ◽  
Zahra Kassamali-Escobar ◽  
John B Lynch ◽  
Anneliese M Schleyer
Keyword(s):  
Cost Effective ◽  
Hospital Length ◽  
Antimicrobial Treatment ◽  
Blood Cultures ◽  
Hospital Length Of Stay ◽  
Source Control ◽  
Gram Negative ◽  
Oral Agents ◽  
Gram Negative Bacteremia

Gram-negative bacteremia secondary to focal infection such as skin and soft-tissue infection, pneumonia, pyelonephritis, or urinary tract infection is commonly encountered in hospital care. Current practice guidelines lack sufficient detail to inform evidence-based practices. Specifically, antimicrobial duration, criteria to transition from intravenous to oral step-down therapy, choice of oral antimicrobials, and reassessment of follow-up blood cultures are not addressed. The presence of bacteremia is often used as a justification for a prolonged course of antimicrobial therapy regardless of infection source or clinical response. Antimicrobials are lifesaving but not benign. Prolonged antimicrobial exposure is associated with adverse effects, increased rates of Clostridioides difficile infection, antimicrobial resistance, and longer hospital length of stay. Emerging evidence supports shorter overall duration of antimicrobial treatment and earlier transition to oral agents among patients with uncomplicated Enterobacteriaceae bacteremia who have achieved adequate source control and demonstrated clinical stability and improvement. After appropriate initial treatment with an intravenous antimicrobial, transition to highly bioavailable oral agents should be considered for total treatment duration of 7 days. Routine follow-up blood cultures are not cost-effective and may result in unnecessary healthcare resource utilization and inappropriate use of antimicrobials. Clinicians should incorporate these principles into the management of gram-negative bacteremia in the hospital.

Early Quantitative Determination of Serum Procalcitonin Can Help Distinguishing Strains of Different Bloodstream Infections in Patients with Hematologic Diseases

Blood ◽  
2016 ◽  
Vol 128 (22) ◽  
pp. 3703-3703
Author(s):  
Xiaofeng Luo ◽  
Jinhua Ren ◽  
Zhizhe Chen ◽  
Ting Yang ◽  
Jianda Hu
Keyword(s):  
Quantitative Determination ◽  
Bloodstream Infection ◽  
Large Population ◽  
Bloodstream Infections ◽  
Blood Cultures ◽  
Gram Negative Bacteria ◽  
Gram Positive ◽  
Gram Negative ◽  
Hematologic Diseases ◽  
Fungi Infection

Abstract High procalcitonin (PCT) levels are strongly associated with systemic bacterial infections. PCT is produced in response to bacterial endotoxin and inflammatory cytokines. Few studies are available in the literature on PCT ability to distinguish different strains of bloodstream infections in patients with hematologic diseases. The aim of the present study was to explore the value of determining serum PCT values early, i.e., as soon as blood cultures are positive, in a large population of patients with hematologic diseases. Patients with hematologic diseases admitted to the hematology department of our hospitalfrom January 2013 to March 2016 who had bloodstream infections were retrospectively analyzed. Patients whose blood samples were collected for simultaneous blood culture and PCT test were enrolled in the study, and they were divided into agranulocytosis and non-agranulocytosis groups. Automatic microbial analyzer was used to identify all strains, and PCT levels were analyzed with an automatic electrochemiluminescence system. The relationship between PCT levels and the strains in bloodstream infections was analyzed and compared, and the diagnostic efficacy of PCT was evaluated using the receiver operating characteristic (ROC) curve. A total of 494 bloodstream infection cases that fulfilled the inclusion criteria were included in the study, involving 312 cases of bloodstream infection with single Gram-negative, 146 cases with single Gram-positive, 12 cases with single fungi, 19 cases with polymicrobes, and 5 cases identified as contaminated specimens. Unpaired t-test was used for data analysis. PCT levels for single Gram-negative infection (15.17±2.11 ng/ml) were significantly higher than those for Gram-positive infection (3.30 ± 0.93 ng/ml) (P<0.0001), or those for single fungi infection (0.22 ± 0.04 ng/ml) (P<0.0001). PCT levels for single Gram-positive infection were also significantly higher than those in single fungi infection (P<0.01). In the agranulocytosis group, which included 403 cases, the PCT levels in the single Gram-negative infection (14.14 ± 2.13 ng/ml) were significantly higher than those in single Gram-positive (2.49 ± 0.73 ng/ml) (P<0.0001), or in single fungi infection (0.24 ± 0.04 ng/ml) (P<0.0001). The PCT levels in the single Gram-positive bacterial infection were also significantly higher than those in single fungi infection (P<0.01). In the single Gram-negative bacteria bloodstream infection, we further found that the PCT levels in Enterobacteriaceae infection (17.00 ± 3.04 ng/ml) were significantly higher than those in nonfermentative Gram-negatives infection (6.49 ± 1.50 ng/ml) (P<0.01). ROC analysis was performed on monomicrobial blood cultures. ROC of single Gram-negative and Gram-positive infections revealed that the area under the curve (AUC) was 0.687, the best cut-off value was 0.58 ng/ml, the sensitivity was 60.81% and specificity was 71%. ROC of single Gram-negative and fungi infections revealed that the AUC was 0.795, the best cut-off value was 0.42 ng/ml, the sensitivity was 67% and specificity was 100%. ROC of single Gram-positive and fungi infections revealed that the AUC was 0.6, the best cut-off value was 0.44 ng/ml, the sensitivity was 37% and specificity was 100%. In the non-agranulocytosis group, we only found that the PCT levels in the single Gram-negative infection were significantly higher than those in single Gram-positive infection (P<0.05). In summary, early serum PCT quantitative determination can be used as a routine test to help to distinguish Gram-negative bacteria, Gram-positive bacteria, or fungi bloodstream infections in patients with hematologic diseases. These findings will be of great clinical value to select appropriate antibiotics for patients with hematologic diseases and bloodstream infections. Figure Figure. Disclosures No relevant conflicts of interest to declare.

Accuracy of Nanosphere Verigene Gram-Negative Blood Culture (BC-GN) Test for Rapid Detection of Extended-Spectrum Beta-Lactamases (ESBLs) From Positive Blood Cultures

2019 ◽  
Vol 152 (Supplement_1) ◽  
pp. S17-S18
Author(s):  
Dennise Otero ◽  
Clay Patros ◽  
Erin McElvania ◽  
Kamaljit Singh
Keyword(s):  
Primary Objective ◽  
Blood Cultures ◽  
Diffusion Method ◽  
M Gene ◽  
Disk Diffusion Method ◽  
Gram Negative ◽  
Extended Spectrum Beta Lactamases ◽  
Hospital Acquired ◽  
Community Onset ◽  
Esbl Producers

Abstract Background The rapid and accurate detection of ESBL production in Gram-negative rod (GNR) bacteremia is critical as recent data suggest that carbapenem treatment decreases mortality. At the same time, avoiding widespread empiric carbapenem prescribing is an important goal of antimicrobial stewardship teams. The aim of this retrospective review was to determine the accuracy of a nucleic acid–based test, Luminex Verigene BC-GN panel, to detect ESBL-positive GNRs direct from blood cultures. Methods The Verigene BC-GN was performed on all first positive GNR blood cultures. In addition, routine antibiotic susceptibility testing was performed on all isolates by the disk-diffusion method and included phenotypic ESBL testing using cefotaxime and ceftazidime with and without clavulanate. Escherichia coli, Klebsiella spp., and Proteus mirabilis–positive blood cultures were identified as ESBL producers through either Verigene or phenotypic disk testing. Positive GNR blood cultures from February 2016 to July 2017 were included for review. The primary objective was to determine the sensitivity and specificity of Verigene for detection of ESBLs. The secondary objective was assessing the percent of community-onset and hospital-acquired ESBL-positive blood cultures. Results There were 83 positive blood cultures with ESBL producing GNR included in the primary review. A total of 82 of 83 positive GNR blood cultures were CTX-M gene positive via Verigene (sensitivity 98.8%). All 83 cultures were confirmed as ESBL producers via phenotypic tests. There were no positive Verigene cases with negative phenotypic results. All 68 ESBL E coli–positive cultures were detected by Verigene (100%), 10 ESBL K pneumoniae (100%), and four of the five ESBL P mirabilis–positive cultures (80%). Of the 73 results available for review in the secondary objectives, 68 were community onset (93%) and five were hospital acquired (7%). Conclusion The majority of ESBL-positive blood cultures in a low-prevalence setting were due to CTX-M producers. The Luminex Verigene BC-GN was accurate in detecting ESBL-producing Enterobacteriaceae from blood cultures and can be reliably used to guide antimicrobial therapy.

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