The Early Chain of Care in Patients with Bacteraemia with the Emphasis on the Prehospital Setting

AbstractPurposeThere is a lack of knowledge about the early phase of severe infection. This report describes the early chain of care in bacteraemia as follows: (a) compare patients who were and were not transported by the Emergency Medical Services (EMS); (b) describe various aspects of the EMS chain; and (c) describe factors of importance for the delay to the start of intravenous antibiotics. It was hypothesized that, for patients with suspected sepsis judged by the EMS clinician, the delay until the onset of antibiotic treatment would be shorter.Basic ProceduresAll patients in the Municipality of Gothenburg (Sweden) with a positive blood culture, when assessed at the Laboratory of Bacteriology in the Municipality of Gothenburg, from February 1 through April 30, 2012 took part in the survey.Main Findings/ResultsIn all, 696 patients fulfilled the inclusion criteria. Their mean age was 76 years and 52% were men. Of all patients, 308 (44%) had been in contact with the EMS and/or the emergency department (ED). Of these 308 patients, 232 (75%) were transported by the EMS and 188 (61%) had “true pathogens” in blood cultures. Patients who were transported by the EMS were older, included more men, and suffered from more severe symptoms and signs.The EMS nurse suspected sepsis in only six percent of the cases. These patients had a delay from arrival at hospital until the start of antibiotics of one hour and 19 minutes versus three hours and 21 minutes among the remaining patients (P =.0006). The corresponding figures for cases with “true pathogens” were one hour and 19 minutes versus three hours and 15 minutes (P =.009).ConclusionAmong patients with bacteraemia, 75% used the EMS, and these patients were older, included more men, and suffered from more severe symptoms and signs. The EMS nurse suspected sepsis in six percent of cases. Regardless of whether or not patients with true pathogens were isolated, a suspicion of sepsis by the EMS clinician at the scene was associated with a shorter delay to the start of antibiotic treatment.AxelssonC, HerlitzJ, KarlssonA, SjöbergH, Jiménez-HerreraM, BångA, JonssonA, BremerA, AnderssonH, GellerstedtM, LjungströmL. The early chain of care in patients with bacteraemia with the emphasis on the prehospital setting. Prehosp Disaster Med. 2016;31(3):272–277.

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Blood test could shorten antibiotic treatment in newborns with suspected sepsis

10.3310/signal-000512 ◽

2017 ◽

Author(s):

Keyword(s):

Antibiotic Treatment ◽

Blood Test ◽

Suspected Sepsis

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

Open Forum Infectious Diseases ◽

10.1093/ofid/ofaa439.331 ◽

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

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Prolonged empiric antibiotics and time to full enteral feed in preterm infants less than 29 weeks of gestational age

Journal of Neonatal-Perinatal Medicine ◽

10.3233/npm-200555 ◽

2021 ◽

pp. 1-5

Author(s):

M.R. Alturk ◽

H. Salama ◽

H. Al Rifai ◽

M. Al Qubaisi ◽

S. Alobaidly

Keyword(s):

Parenteral Nutrition ◽

Preterm Infants ◽

Antibiotic Treatment ◽

Gestational Age ◽

Late Onset ◽

Blood Cultures ◽

Hospital Death ◽

Late Onset Sepsis ◽

Empiric Antibiotic ◽

Antibiotic Courses

BACKGROUND: Early empiric antibiotic exposure appears to negatively influence feeding tolerance in preterm infants. However, the effect of prolonged antibiotic treatment is unknown. The objective of this study was to investigate whether prolonged antibiotics impact the time to full enteral feed in infants less than 29 weeks of gestational age with negative blood cultures. METHODS: Retrospective data for infants less than 29 weeks gestation age were retrieved from the PEARL-Peristat perinatal registry in Qatar. Exclusion criteria were major congenital anomalies, conditions requiring surgery in the first 10 days of life, positive blood cultures in the first 48 hours of life, and death within the first week of life. Antibiotic courses were categorized as prolonged if continued more than 48 hours. The primary outcome was the duration of total parenteral nutrition. RESULTS: Of 199 study infants, 185 (92.9%) underwent antibiotic treatment for > 48 hours despite negative blood cultures. The median duration of parenteral nutrition was not significantly different between the prolonged and short antibiotic groups (25 and 22 days, respectively; p = 0.139). Infants with prolonged antibiotic courses experienced non-significantly higher levels of necrotizing enterocolitis (7.1% and 18.4%, respectively), bronchopulmonary dysplasia (28.6% and 45.4%, respectively), and retinopathy of prematurity (14.3% and 38.4%, respectively). There were no differences in the late-onset sepsis rate (78.6% and 82.1%, respectively) and the in-hospital death rate (7.1% and 7.6%, respectively). CONCLUSIONS: Prolonged antibiotic treatment in infants less than 29 weeks gestation with negative blood cultures has no significant impact on the time to full enteral feed.

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Baseline Study for Improving Diagnostic Stewardship at Secondary Health Care Facilities in Nigeria

10.21203/rs.3.rs-829161/v1 ◽

2021 ◽

Author(s):

Abiodun Egwuenu ◽

Adaora Ejikeme ◽

Sara Tomczyk ◽

Anja Von-Laer ◽

Olaniyi Ayobami ◽

...

Keyword(s):

Health Care ◽

Quality Control ◽

Blood Culture ◽

Online Survey ◽

Case Finding ◽

Blood Cultures ◽

Health Care Facilities ◽

Suspected Sepsis ◽

Care Facilities ◽

Secondary Health Care

Abstract BackgroundBlood culture diagnostics are a critical tool for sepsis management and antimicrobial resistance (AMR) surveillance. A baseline study was conducted to assess existing sepsis case finding, blood culture diagnostics and antimicrobial susceptibility testing (AST) at secondary health care facilities to inform the development of diagnostic stewardship improvement strategies in Nigeria.MethodsA cross-sectional online survey was conducted among 25 public secondary health care facilities in Abuja, FCT and Lagos State in Nigeria to evaluate the capacity for pathogen identification and AST. Following this, data were prospectively extracted on all patients with suspected sepsis from electronic medical records at two facilities in Abuja from October 2020 to May 2021 to further assess practices concerning sepsis case-finding, clinical examination findings, samples requested, and laboratory test results. Data were descriptively analysed, and a multivariate logistic regression analysis was conducted to determine factors associated with blood culture requests among suspected sepsis patients.ResultsIn the online survey, 32% (8/25) of facilities reported performing routine blood cultures. Only one had access to a clinical microbiologist, and 28% (7/25) and 4% (1/25) used standard bacterial organisms for quality control of media and quality control strains for AST, respectively. At the two facilities where data abstraction was performed, 7.1% (2924/41066) of patients were found to have suspected sepsis. A majority of the suspected sepsis patients came from the paediatrics department and were outpatients, and the median age was two years. Most did not have vital signs and major foci of infection documented. Blood cultures were only requested for 2.7% (80/2924) of patients, of which twelve were positive for bacteria, mainly Staphylococcus aureus. No clinical breakpoints were used for AST. Inpatients (adjusted odds ratio [aOR]:7.5, 95% CI:4.6 – 12.3) and patients from the urban health care facility (aOR:16.9, 95% CI:8.1 – 41.4) were significantly more likely to have a blood culture requested.ConclusionLow blood culture utilisation remains a key challenge in Nigeria. This has implications for patient care. AMR surveillance and antibiotics use. Diagnostic stewardship strategies should focus on improving access to clinical microbiology expertise, practical guidance on sepsis case finding and improving blood culture utilisation and diagnostics.

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Antibiotic treatment regimens for bone infection after debridement: a study of 902 cases

10.21203/rs.2.18846/v2 ◽

2020 ◽

Author(s):

Xiaohua Wang(Former Corresponding Author) ◽

Li Fang ◽

Yueqi Chen ◽

Shulin Wang ◽

Huan Ma ◽

...

Keyword(s):

Recurrence Rate ◽

Antibiotic Treatment ◽

Bone Infection ◽

Oral Antibiotic ◽

Oral Antibiotics ◽

Treatment Regimens ◽

Intravenous Antibiotics ◽

Abnormal Rate ◽

Oral Group ◽

Liver And Kidney

Abstract Purpose: Our aim was to investigate the clinical efficacy and complications of antibiotics treatment duration for the patients of bone infection. Methods: We retrospectively analyzed the patients with bone infection admitted to our hospital between March 2013 and October 2018. The surgical debridement was performed and the patients were divided into three groups: IV group (Intravenous antibiotics for 2 weeks); Oral group (Intravenous antibiotics for 2 weeks followed by oral antibiotics for 4 weeks); Rifampicin group (Intravenous antibiotics for 2 weeks followed by oral antibiotics plus rifampicin for 4 weeks). The infection control rate and complications were compared. Results ： A total of 902 patients were enrolled, the infection sites included 509 tibias, 228 femurs, 32 humeri, 23 radii and ulnae, 40 calcanei, 23 multiple-site infections and the other sites 47 cases. After at least 6 months of follow-up, 148 (16.4%) patients had recurrence of infection. The recurrence rate of IV group was 17.9%, which was no significant higher than that of Oral group (10.1%) or Rifampicin group (10.5%). The abnormal rate of Glutamic-pyruvic transaminase(ALT) in IV group was 15.1%, which was lower than that of Oral group (18.0%) and Rifampicin group (27.4%), P=0.026. The positive rates of proteinuria in the three groups were 3.2%, 4.5%, and 9.3%, respectively, P=0.020. Conclusion: After debridement of bone infection, the additional oral antibiotic treatment may increase the damage of liver and kidney, and can not significantly reduce the infection recurrence rate. Therefore, it is recommended to adopt short-term systemic antibiotic treatment after debridement.

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Cardiovascular

ACoRN: Acute Care of at-Risk Newborns ◽

10.1093/med/9780197525227.003.0004 ◽

2021 ◽

pp. 97-150

Keyword(s):

Volume Expansion ◽

Prostaglandin E1 ◽

Coarctation Of The Aorta ◽

Treatment Modalities ◽

Left Heart ◽

Suspected Sepsis ◽

Intravenous Antibiotics ◽

Anomalous Pulmonary Venous Return ◽

The Difference ◽

Left Heart Syndrome

The cardiovascular chapter focuses on signs of shock—when cardiac output cannot meet the oxygen and energy requirements of vital organs—central cyanosis, and cardiac arrythmia. It identifies and prioritizes the need for immediate stabilization, cardiorespiratory support, and management. Stabilization includes clinical assessment of circulation, pulse oximetry, and determining whether cyanosis can respond to oxygen. The difference between cyanosis of cardiac and respiratory origins is explained and illustrated, along with implications for diagnosis and treatment. Anatomical abnormalities of the heart and abnormal heart rhythms are considered separately. Specific conditions are described and illustrated: hypoplastic left heart syndrome, coarctation of the aorta, persistent pulmonary hypertension of the newborn, cyanotic heart disease, transposition of the great arteries, tricuspid atresia, and total anomalous pulmonary venous return. Related procedures and treatment modalities (e.g., volume expansion, prostaglandin E1, transfusion, or intravenous antibiotics for suspected sepsis) are described. Three case scenarios highlight differences between shock and circulatory instability without shock.

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Infective endocarditis

Challenging Concepts in Congenital and Acquired Heart Disease in the Young ◽

10.1093/med/9780198759447.003.0012 ◽

2020 ◽

pp. 163-176

Author(s):

Salim Jivanji ◽

Rubya Adamji ◽

Michael Rigby

Keyword(s):

Infective Endocarditis ◽

Aortic Valve ◽

Oral Hygiene ◽

Aortic Valve Disease ◽

Dental Hygiene ◽

Right Ventricular Outflow Tract ◽

Ventricular Outflow Tract ◽

Blood Cultures ◽

Valve Disease ◽

Symptoms And Signs

A young patient with previously repaired mixed aortic valve disease presented to his local hospital with symptoms and signs consistent with infective endocarditis. Following confirmation of Streptococcus viridans in his blood cultures, he underwent initial antibiotic treatment, followed by surgical resection of his right ventricular outflow tract vegetation. This chapter examines the difficulty in making a diagnosis of infective endocarditis, the devastating nature of its course, and the challenges in managing this condition. Finally, it explores the association of infective endocarditis with poor dental hygiene, the importance of promoting effective oral hygiene, and the evolving evidence in the use of antibiotic prophylaxis.

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P1456 Pacemaker and percutaneous aortic valve endocarditis - a complex decision

European Heart Journal - Cardiovascular Imaging ◽

10.1093/ehjci/jez319.883 ◽

2020 ◽

Vol 21 (Supplement_1) ◽

Author(s):

A Cardoso ◽

G Dias ◽

P Von Hafe ◽

B Faria ◽

M Fernandes ◽

...

Keyword(s):

Aortic Valve ◽

Enterococcus Faecalis ◽

Antibiotic Treatment ◽

Severe Aortic Stenosis ◽

Blood Cultures ◽

Chronic Obstructive ◽

Heart Team ◽

Complex Situation ◽

Surgical Risk ◽

High Surgical Risk

Abstract CASE REPORT We describe the case of a 64-year-old man who was referred because of a fever. He had history of hypertension, dyslipidemia, atrial fibrillation, chronic obstructive pulmonary disease and a right lung pneumectomy due to epidermoid lung cancer diagnosed twenty-five years ago. He implanted dual-chamber definite pacemaker ten years ago and had a transcatheter aortic valve implantation (TAVI) in the previous year due to severe aortic stenosis and a high surgical risk. He was hospitalized 2 months ago because of a respiratory infection. Blood cultures were positive for an Enterococcus faecalis. A transthoracic echocardiogram was performed and had no evidence of vegetations. After one month, he had recurrence of fever and was again admitted. On physical examination he was hemodynamically stable, with signs of peripheral congestion and no heart murmur on cardiac auscultation. Blood cultures were again positive for Enterococcus faecalis. The transesophageal echocardiogram (TEE) showed a biologic aortic valve with thickened leaflets and small nodular structures suggestive of vegetations. There was a small periprosthetic leak and no obstruction or suspected perivalvular abscesses. There was also a small vegetation with 0,45*0,3 cm in the auricular pacemaker lead. A thoraco-abdomino-pelvic computed tomography scan showed no embolic complications. A diagnosis of pacemaker and TAVI endocarditis was made. The patient started directed antibiotic therapy (ceftriaxone and ampicillin). The case was discussed in Heart Team and because of high surgical risk, medical treatment was decided. The patient completed antibiotic treatment with negative blood cultures and apyrexia. A repeated TEE showed persistence of vegetations, without development of local complications. It was decided to discharge the patient under palliative suppressive antibiotic treatment with levofloxacin after discussion with the infectious disease doctor. In a follow-up evaluation, he remained clinically stable, without recurrence of fever. DISCUSSION As TAVI procedures are performed more frequently, a higher number of late complications are expected. Prosthetic valve endocarditis after TAVI is a complex situation, whose treatment strategy is not well-defined, particularly because these patients are usually of high surgical risk. This case describes a complex clinical picture and highlights the difficulty in decision-making in these situations. Also, it pretends to reinforce the need to discuss in a Heart Team the best treatment options.

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The Efficacy of Blood Culture in Postoperative Patients

The American Surgeon ◽

10.1177/000313481007601035 ◽

2010 ◽

Vol 76 (10) ◽

pp. 1172-1175 ◽

Cited By ~ 1

Author(s):

Jenny J. Lee ◽

David R. Martin

Keyword(s):

National Research Council ◽

Bloodstream Infections ◽

Central Line ◽

Blood Cultures ◽

Blood Cell Count ◽

Blood Draw ◽

Suspected Sepsis ◽

Wound Classification ◽

Preoperative Antibiotics ◽

Rule Out

Blood cultures are often obtained in postoperative patients to rule out bloodstream infections. Our study objectives were to determine the efficacy of blood cultures in postoperative patients with suspected sepsis and to determine variables predisposing patients to positive cultures. This was a retrospective study including patients with blood cultures drawn from January to March 2009 at our institution. We recorded demographics, presence of fever (temperature 101.5°F or higher), elevated white blood cell count (12,000/μL or greater), central line, diabetes, intensive care unit admission, postoperative day of blood draw, National Research Council surgical wound classification, and pre- or postoperative antibiotics. Blood cultures were drawn from 150 patients undergoing surgery within 30 days prior. Sixteen had positive cultures and nine were true-positives (6.3%). There was no statistical difference ( P > 0.05) between patients with positive and negative cultures except that those with negative cultures were more likely to have received preoperative antibiotics ( P = 0.0186). Blood cultures are invasive, expensive tests with low yield. We recommend that blood cultures be drawn in patients not receiving preoperative antibiotics who have undergone surgery more than 4 days before culture.

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