Follow-up Blood Cultures: A 2.0 Diagnostic Tool in Patients With Gram-Negative Bacteremia and Septic Thrombophlebitis

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.

Download Full-text

Predictive scoring models for persistent gram-negative bacteremia that reduce the need for follow-up blood cultures: a retrospective observational cohort study

BMC Infectious Diseases ◽

10.1186/s12879-020-05395-8 ◽

2020 ◽

Vol 20 (1) ◽

Cited By ~ 2

Author(s):

Jongtak Jung ◽

Kyoung-Ho Song ◽

Kang Il. Jun ◽

Chang Kyoung Kang ◽

Nak-Hyun Kim ◽

...

Keyword(s):

Risk Factors ◽

Treatment Response ◽

Blood Cultures ◽

Source Control ◽

Care Hospital ◽

Gram Negative ◽

Scoring Model ◽

Source Of Infection ◽

Gram Negative Bacteremia

Abstract Background Although the risk factors for positive follow-up blood cultures (FUBCs) in gram-negative bacteremia (GNB) have not been investigated extensively, FUBC has been routinely carried out in many acute care hospitals. We attempted to identify the risk factors and develop a predictive scoring model for positive FUBC in GNB cases. Methods All adults with GNB in a tertiary care hospital were retrospectively identified during a 2-year period, and GNB cases were assigned to eradicable and non-eradicable groups based on whether removal of the source of infection was possible. We performed multivariate logistic analyses to identify risk factors for positive FUBC and built predictive scoring models accordingly. Results Out of 1473 GNB cases, FUBCs were carried out in 1268 cases, and the results were positive in 122 cases. In case of eradicable source of infection, we assigned points according to the coefficients from the multivariate logistic regression analysis: Extended spectrum beta-lactamase-producing microorganism (+ 1 point), catheter-related bloodstream infection (+ 1), unfavorable treatment response (+ 1), quick sequential organ failure assessment score of 2 points or more (+ 1), administration of effective antibiotics (− 1), and adequate source control (− 2). In case of non-eradicable source of infection, the assigned points were end-stage renal disease on hemodialysis (+ 1), unfavorable treatment response (+ 1), and the administration of effective antibiotics (− 2). The areas under the curves were 0.861 (95% confidence interval [95CI] 0.806–0.916) and 0.792 (95CI, 0.724–0.861), respectively. When we applied a cut-off of 0, the specificities and negative predictive values (NPVs) in the eradicable and non-eradicable sources of infection groups were 95.6/92.6% and 95.5/95.0%, respectively. Conclusions FUBC is commonly carried out in GNB cases, but the rate of positive results is less than 10%. In our simple predictive scoring model, zero scores—which were easily achieved following the administration of effective antibiotics and/or adequate source control in both groups—had high NPVs. We expect that the model reported herein will reduce the necessity for FUBCs in GNB cases.

Download Full-text

Are Follow-Up Blood Cultures Useful in the Antimicrobial Management of Gram Negative Bacteremia? A Reappraisal of Their Role Based on Current Knowledge

Antibiotics ◽

10.3390/antibiotics9120895 ◽

2020 ◽

Vol 9 (12) ◽

pp. 895

Author(s):

Francesco Cogliati Dezza ◽

Ambrogio Curtolo ◽

Lorenzo Volpicelli ◽

Giancarlo Ceccarelli ◽

Alessandra Oliva ◽

...

Keyword(s):

Critically Ill ◽

Critically Ill Patients ◽

Current Knowledge ◽

Bloodstream Infections ◽

Blood Cultures ◽

Source Control ◽

Candida Spp ◽

Gram Negative ◽

Gram Negative Bacteremia

Bloodstream infections still constitute an outstanding cause of in-hospital morbidity and mortality, especially among critically ill patients. Follow up blood cultures (FUBCs) are widely recommended for proper management of Staphylococcus aureus and Candida spp. infections. On the other hand, their role is still a matter of controversy as far as Gram negative bacteremias are concerned. We revised, analyzed, and commented on the literature addressing this issue, to define the clinical settings in which the application of FUBCs could better reveal its value. The results of this review show that critically ill patients, endovascular and/or non-eradicable source of infection, isolation of a multi-drug resistant pathogen, end-stage renal disease, and immunodeficiencies are some factors that may predispose patients to persistent Gram negative bacteremia. An analysis of the different burdens that each of these factors have in this clinical setting allowed us to suggest which patients’ FUBCs have the potential to modify treatment choices, prompt an early source control, and finally, improve clinical outcome.

Download Full-text

Follow-up Blood Cultures in Gram-Negative Bacteremia: Are They Needed?

Clinical Infectious Diseases ◽

10.1093/cid/cix648 ◽

2017 ◽

Vol 65 (11) ◽

pp. 1776-1779 ◽

Cited By ~ 34

Author(s):

Christina N Canzoneri ◽

Bobak J Akhavan ◽

Zehra Tosur ◽

Pedro E Alcedo Andrade ◽

Gabriel M Aisenberg

Keyword(s):

Blood Cultures ◽

Gram Negative ◽

Gram Negative Bacteremia

Download Full-text

Incidence and utility of follow-up blood cultures in cancer patients with gram-negative bacteremia

Diagnostic Microbiology and Infectious Disease ◽

10.1016/j.diagmicrobio.2021.115444 ◽

2021 ◽

pp. 115444

Author(s):

Amber B Clemmons ◽

Henry N Young ◽

Christopher M Bland ◽

Brittany Jackson ◽

Miki Hayashi ◽

...

Keyword(s):

Cancer Patients ◽

Blood Cultures ◽

Gram Negative ◽

Gram Negative Bacteremia

Download Full-text

Predictive scoring models for persistent gram-negative bacteremia that reduce the need for follow-up blood cultures: a retrospective observational cohort study

10.21203/rs.3.rs-40407/v1 ◽

2020 ◽

Author(s):

Jongtak Jung ◽

Kyoung-Ho Song ◽

Kang Il Jun ◽

Chang Kyoung Kang ◽

Nak-Hyun Kim ◽

...

Keyword(s):

Risk Factors ◽

Treatment Response ◽

Blood Cultures ◽

Source Control ◽

Gram Negative ◽

Scoring Model ◽

Source Of Infection ◽

Gram Negative Bacteremia ◽

Positive Results

Abstract Background: Although the risk factors for positive follow-up blood cultures (FUBCs) in gram-negative bacteremia (GNB) have not been investigated extensively, FUBC has been routinely carried out in many acute care hospitals. We attempted to identify the risk factors and develop a predictive scoring model for positive FUBC in GNB cases.Methods: All adults with GNB in a tertiary care hospital were retrospectively identified during a 2-year period, and GNB cases were assigned to eradicable and non-eradicable groups based on whether removal of the source of infection was possible. We performed multivariate logistic analyses to identify risk factors for positive FUBC and built predictive scoring models accordingly. Results: Out of 1,473 GNB cases, FUBCs were carried out in 1,268 cases, and 122 produced positive results. In patient with eradicable source of infection, we assigned points according to the coefficients from the multivariate logistic regression analysis: Extended spectrum beta-lactamase producing microorganism (+1 point), Catheter-related bloodstream infection(+1), unfavorable treatment response (+1), and quick sequential organ failure assessment score of 2 points or more (+1), administration of effective antibiotics (-1), and adequate source control (-2). In non-eradicable source of infection, assigned points were end-stage renal disease on hemodialysis (+1), unfavorable treatment response (+1) and the administration of effective antibiotics (-2). The areas under the curves were 0.861 (95% confidence interval [95CI] 0.806-0.916) and 0.792 (95CI, 0.724-0.861), respectively. When we applied a cut-off of 0, the specificities and negative predictive values (NPVs) in the eradicable and non-eradicable sources of infection groups were 95.6/92.6% and 95.5/95.0%, respectively.Conclusions: FUBC is commonly carried out in GNB cases, but the rate of positive results is less than 10%. In our simple predictive scoring model, zero scores—which were easily achieved following the administration of effective antibiotics and/or adequate source control in both groups—had high NPVs. We expect that the model reported herein will reduce the necessity for FUBCs in GNB cases.

Download Full-text

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

Minerva Anestesiologica ◽

10.23736/s0375-9393.20.14040-9 ◽

2020 ◽

Vol 86 (5) ◽

Cited By ~ 2

Author(s):

Martina Spaziante ◽

Alessandra Oliva ◽

Giancarlo Ceccarelli ◽

Francesco Alessandri ◽

Francesco Pugliese ◽

...

Keyword(s):

Critically Ill ◽

Critically Ill Patients ◽

Blood Cultures ◽

Gram Negative

Download Full-text

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

Download Full-text