Diagnostic Yield of Initial and Consecutive Blood Cultures in Children With Cancer and Febrile Neutropenia

2020 ◽  
Author(s):  
Gabrielle M Haeusler ◽  
Richard De Abreu Lourenco ◽  
Hannah Clark ◽  
Karin A Thursky ◽  
Monica A Slavin ◽  
...  
Keyword(s):  
Febrile Neutropenia ◽  
Bloodstream Infection ◽  
Healthcare Workers ◽  
Diagnostic Yield ◽  
Infectious Complications ◽  
Blood Cultures ◽  
Children With Cancer ◽  
Persistent Fever ◽  
Empiric Antibiotics ◽  
Clinical Instability

Abstract Background The timing and necessity of repeated blood cultures (BCs) in children with cancer and febrile neutropenia (FN) are unknown. We evaluated the diagnostic yield of BCs collected pre- and post-empiric FN antibiotics. Methods Data collected prospectively from the Australian Predicting Infectious ComplicatioNs in Children with Cancer (PICNICC) study were used. Diagnostic yield was calculated as the number of FN episodes with a true bloodstream infection (BSI) detected divided by the number of FN episodes that had a BC taken. Results A BSI was identified in 13% of 858 FN episodes. The diagnostic yield of pre-antibiotic BCs was higher than of post-antibiotic cultures (12.3% vs 4.4%, P < .001). Two-thirds of the post-antibiotic BSIs were associated with a new episode of fever or clinical instability, and only 2 new BSIs were identified after 48 hours of empiric antibiotics and persistent fever. A contaminated BC was identified more frequently in post-antibiotic cultures. Conclusions In the absence of new fever or clinical instability, BCs beyond 48 hours of persistent fever have limited yield. Opportunity exists to optimize BC collection in this population and reduce the burden of unnecessary tests on patients, healthcare workers, and hospitals.

scholarly journals HIV-Associated Mycobacterium tuberculosis Bloodstream Infection Is Underdiagnosed by Single Blood Culture

2018 ◽  
Vol 56 (5) ◽  
Author(s):  
David A. Barr ◽  
Andrew D. Kerkhoff ◽  
Charlotte Schutz ◽  
Amy M. Ward ◽  
Gerry R. Davies ◽  
...  
Keyword(s):  
South Africa ◽  
Mycobacterium Tuberculosis ◽  
Blood Culture ◽  
Confidence Interval ◽  
Bloodstream Infection ◽  
Diagnostic Yield ◽  
Blood Cultures ◽  
Prospective Evaluation ◽  
Content Type ◽  
Time Point

ABSTRACT We assessed the additional diagnostic yield for Mycobacterium tuberculosis bloodstream infection (BSI) by doing more than one tuberculosis (TB) blood culture from HIV-infected inpatients. In a retrospective analysis of two cohorts based in Cape Town, South Africa, 72/99 (73%) patients with M. tuberculosis BSI were identified by the first of two blood cultures during the same admission, with 27/99 (27%; 95% confidence interval [CI], 18 to 36%) testing negative on the first culture but positive on the second. In a prospective evaluation of up to 6 blood cultures over 24 h, 9 of 14 (65%) patients with M. tuberculosis BSI had M. tuberculosis grow on their first blood culture; 3 more patients (21%) were identified by a second independent blood culture at the same time point, and the remaining 2 were diagnosed only on the 4th and 6th blood cultures. Additional blood cultures increase the yield for M. tuberculosis BSI, similar to what is reported for nonmycobacterial BSI.

scholarly journals Blood Cultures for Persistent Fever in Neutropenic Pediatric Patients Are of Low Diagnostic Yield

2015 ◽  
Vol 5 (2) ◽  
pp. 218-221 ◽  
Author(s):  
Kari Neemann ◽  
Alexandra B. Yonts ◽  
Fang Qiu ◽  
Kari Simonsen ◽  
Stefanie Lowas ◽  
...  
Keyword(s):  
Pediatric Patients ◽  
Diagnostic Yield ◽  
Blood Cultures ◽  
Persistent Fever

scholarly journals 1341. Blood Volume Collected for Blood Cultures in Infants with Suspected Neonatal Sepsis in the NICU

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S682-S682
Author(s):  
Maria S Rueda Altez ◽  
Lamia Soghier ◽  
Joseph M Campos ◽  
James Bost ◽  
Jiaxiang Gai ◽  
...  
Keyword(s):  
Bloodstream Infection ◽  
Blood Volume ◽  
Bloodstream Infections ◽  
Blood Cultures ◽  
Categorical Variables ◽  
Continuous Variables ◽  
Volume Calculation ◽  
Culture Negative ◽  
Time Of Collection ◽  
Rule Out

Abstract Background Blood cultures have high sensitivity to detect bacteremia in septic neonates when >=1 ml of blood is collected. Neonatologists often cite low confidence in microbiologic sampling as rationale for continuing antibiotics without a focus of infection despite negative blood cultures, resulting in prolonged antimicrobial therapy. We aim to describe the blood culture sample volumes in NICU patients, to identify factors associated with sample volumes < 1ml, and to compare the sample volumes of patients treated for culture-negative sepsis with those with bloodstream infections and those treated for a ≤72-hour sepsis rule-out Methods Data from this observational cohort study were collected retrospectively and prospectively from NICU patients with blood cultures obtained from September 2018 to February 2019. Clinical data were collected through chart review. All inoculated culture bottles were weighed for volume calculation. We determined the association of age, weight, sample source, and time of collection with volume < 1mL. Continuous variables were analyzed using Wilcoxon-Mann-Whitney, and categorical variables using chi-squared test. For aim 3, the volumes of the groups were compared using analysis of variance. Results A total of 310 blood cultures were identified, corresponding to 159 patients. Of these, 49 (16%) were positive. Among the negative blood cultures, 86% were collected in patients who subsequently received antibiotics (Figure 1). Median inoculated volume was 0.6 ml (IQR: 0.1-2.4). Weight and age at time of culture collection, source of sample, and time of collection were not significantly associated with the inoculation of < 1ml of blood. Median volume of blood was 0.6ml (0.3-0.6) for sepsis rule-out, 0.6ml (0.2-0.6) for bloodstream infection, and 0.6ml (0.6-1.4) for culture-negative sepsis. No difference was found among the three groups (p=0.54) Figure 1. Classification of blood cultures identified during study period Conclusion The blood volume collected for cultures in the NICU is lower than recommended. Clinical and environmental characteristics are not significantly associated with the inoculated volume. The volume of blood sampled does not differ in patients with culture-negative sepsis, bloodstream infection and sepsis rule-out, and should not be a justification for longer duration of antibiotic therapy Disclosures All Authors: No reported disclosures

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

scholarly journals Oral ciprofloxacin in the management of children with cancer with lower risk febrile neutropenia

Cancer ◽  
2001 ◽  
Vol 91 (8) ◽  
pp. 1563-1567 ◽  
Author(s):  
Hugo Paganini ◽  
Teresa Rodriguez-Brieshcke ◽  
Pedro Zubizarreta ◽  
Antonio Latella ◽  
Ver�nica Firpo ◽  
...  
Keyword(s):  
Febrile Neutropenia ◽  
Lower Risk ◽  
Children With Cancer ◽  
Oral Ciprofloxacin

#29: Analysis of Mortality Due to Infections in Pediatric Patients in the Oncology Unit of a Third Level Hospital in La Paz, Bolivia

2021 ◽  
Vol 10 (Supplement_2) ◽  
pp. S18-S18
Author(s):  
Trujillo-Gutierrez Marisol ◽  
Rodriguez-Auad Juan Pablo
Keyword(s):  
Causes Of Death ◽  
Infectious Complications ◽  
Morbidity And Mortality ◽  
Induction Phase ◽  
Children With Cancer ◽  
La Paz ◽  
Extended Spectrum Beta Lactamases ◽  
Bacillus Spp ◽  
Causes Of Mortality ◽  
Oncology Unit

Abstract Background In recent decades, advances in cancer treatment have made it possible to improve the prognosis of hemato-oncological patients, however, mortality is still high in developing countries. One of the most important causes of morbidity and mortality during the treatment of children with cancer is infectious complications, especially in the induction phase. The multiple interventions that are carried out during treatment, such as the use of catheters, increase the risk of developing these infections, which can be more frequent if the recommended strategies to prevent them are not applied. The objective of this study was to investigate what were the causes of death in children with cancer at our institution. Methods The medical records of deceased patients were analyzed in the onco-hematology unit of the Children′s Hospital “Dr. Ovidio Aliaga Uria” in the city of La Paz, Bolivia. The causes of mortality, the stage of chemotherapy in which the death occurred, its relationship with infections and the microorganism identified during 2020 were classified. Results During 2020, 19 deaths were found in cancer patients, the mean age was 8.5 years and of which 52% were male. Regarding the basic diagnosis, there was a higher proportion of hematological diseases 68% and solid tumors 32%. Among the causes of death, 58% were due to their underlying pathology where most of the patients were in palliative care or in relapse and 42% were due to infectious causes, of which 62% were in induction phase of chemotherapy. Among the 8 patients who died from infections, the following causes were found: 50% neutropenic colitis, 25% bacteremia and 25% necrotizing fasciitis; in 7 (87.5%) patients the microorganism was isolated in blood culture, these were E. coli 43%, Klebsiella spp 43% and Bacillus spp 14%. Gram negative bacilli (GNB) represented 86% of the isolates and 50% were producers of extended spectrum beta-lactamases (ESBL). Conclusions Considering that infections are preventable and are among the most important causes of mortality in children with cancer in our hospital, it is essential that infection control teams are developed that apply evidence-based strategies to prevent these infections and thus achieve a reduction in morbidity and mortality, applying programs with training of human resources and equipment to reduce these deaths.

scholarly journals Prescribing Empiric Antibiotics for Febrile Neutropenia: Compliance with Institutional Febrile Neutropenia Guidelines

Pharmacy ◽  
2018 ◽  
Vol 6 (3) ◽  
pp. 83 ◽  
Author(s):  
Doaa Naeem ◽  
Majed Alshamrani ◽  
Mohammed Aseeri ◽  
Mansoor Khan
Keyword(s):  
Febrile Neutropenia ◽  
Cancer Patients ◽  
Bacterial Infections ◽  
Cross Sectional Study ◽  
Cross Sectional ◽  
Management Guidelines ◽  
Empiric Antibiotics ◽  
Inappropriate Use ◽  
Common Diagnosis ◽  
The Mean

Background: Febrile neutropenia (FN) is an oncologic emergency which should be treated immediately with empiric antibiotics. Different institutions observe different antibiograms and use different FN management guidelines. Our center implemented FN management guidelines for adult cancer patients in 2009. Hence, we decided to assess compliance with FN management guidelines and to describe the pattern of bacterial infections. Method: We conducted a cross-sectional study on all adult cancer patients admitted with FN. Data were collected from electronic medical records between January and December 2014. Results: One hundred FN episodes met the study inclusion criteria. The mean age of the patients was 41 ± 17 years; 52% (52 patients) were women. The most common diagnosis was lymphoma (33%). In terms of compliance to institutional FN guidelines, 55% of patients received guideline non-compliant treatment. The most common non-compliant treatment was incorrect amikacin dosing in 31% of patients, followed by incorrect vancomycin dosing in 20%, incorrect piperacillin/tazobactam dosing in 19%, inappropriate use of carbapenems in 18%, and non-compliant vancomycin use in 12% of patients. Bacterial isolates were only observed in 19% of the FN episodes. Among these 19 episodes of FN, Gram-negative pathogens were predominant and were identified in 74% of the episodes, followed by Gram-positive pathogens in 16% and polymicrobial pathogens in 10%. The mean time to defervescence was 2.21 ± 2 days. Conclusion: Our study concluded that there was a high percentage of non-compliance with our institutional FN management guidelines. We recommend following appropriate empiric antibiotic doses and indications as per institutional guidelines.

scholarly journals 847. The Effect of Antimicrobial Administration on Blood Culture Positivity in Patients with Severe Manifestations of Sepsis

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S15-S16
Author(s):  
Matthew P Cheng ◽  
Robert Stenstrom ◽  
Katryn Paquette ◽  
Sarah Stabler ◽  
Murtaza Akhter ◽  
...  
Keyword(s):  
Blood Culture ◽  
Antimicrobial Therapy ◽  
Diagnostic Yield ◽  
The United States ◽  
Blood Cultures ◽  
Microbial Pathogens ◽  
Absolute Difference ◽  
Recovery Rates ◽  
Pathogen Recovery ◽  
Antimicrobial Administration

Abstract Background Current guidelines recommend obtaining blood cultures prior to antimicrobial therapy in patients with sepsis. Administering antimicrobials immediately without waiting for blood cultures could potentially decrease time to treatment and improve outcomes, but it is unclear the degree to which this strategy impacts diagnostic yield. Methods We performed a patient-level, single-arm, diagnostic trial. Seven urban emergency departments affiliated with academic medical centers across Canada and the United States participated in the study. Adults ≥18 years of age presenting to the emergency department with evidence of severe manifestations of sepsis, including a systolic blood pressure <90 mmHg and/or a serum lactate ≥4 mmol/L were included. Study participants had 2 sets of blood cultures drawn prior to and immediately following antimicrobial administration. The primary outcome was the difference in blood culture pathogen recovery rates before and after administration of antimicrobial therapy. Results Of the 3,164 participants screened, 325 were included in the study (mean age, 65.6 years; 63.0% men) and had repeat blood cultures drawn after the initiation of antimicrobial therapy (median time of 70 minutes, IQR 50 to 110 minutes). Pre-antimicrobial blood cultures were positive for one or more microbial pathogens in 102/325 (31.4%) patients. Fifty-four participants (52.9%) had matching blood culture results after initiation of antimicrobial treatment. The absolute difference in pathogen recovery rates was 14.5% ([95% CI 8.0 to 21.0%]; P < 0.0001) between pre- and post-antimicrobial blood cultures. Results were consistent in an analysis of the per-protocol population (absolute difference, 13.3% [95% CI 6.1 to 20.4%]; P < 0.0001). Including the results of other microbiological cultures done as part of routine care, microbial pathogens were recovered in 69 of 102 (67.7%) participants (absolute difference, 10.2% [95% CI 3.4 to 16.8%]; P < 0.0001). Conclusion Among patients with severe manifestations of sepsis, the administration of empiric antimicrobial therapy significantly reduces the yield of pathogen recovery when blood cultures are drawn shortly after treatment initiation. Disclosures All Authors: No reported Disclosures.

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