scholarly journals Neither Blood Culture Positivity nor Time to Positivity is Associated with Mortality among Patients Presenting with Severe Manifestations of Sepsis: The FABLED Cohort Study

2021 ◽  
Author(s):  
Katryn Paquette ◽  
David Sweet ◽  
Robert Stenstrom ◽  
Sarah N Stabler ◽  
Alexander Lawandi ◽  
...  
Keyword(s):  
Emergency Department ◽  
Cohort Study ◽  
Blood Culture ◽  
Blood Cultures ◽  
Cell Counts ◽  
Culture Positivity ◽  
Time To Positivity ◽  
Blood Culture Positivity ◽  
Normal White Blood Cell ◽  
Support Fund

Abstract Background Sepsis is a leading cause of morbidity, mortality, and health care costs worldwide. Methods We conducted a multi-center, prospective cohort study evaluating the yield of blood cultures drawn before and after empiric antimicrobial administration among adults presenting to the emergency department with severe manifestations of sepsis (ClinicalTrials.gov: NCT01867905). Enrolled patients who had the requisite blood cultures drawn were followed for 90 days. We explored the independent association between blood culture positivity and its time to positivity in relation to 90-day mortality. Findings 325 participants were enrolled; 90-day mortality among the 315 subjects followed-up was 25·4% (80/315). Mortality was associated with age (mean age in those who died was 72·5 ±15·8 vs. 62·9 ±17·7 years among survivors, p<0·0001), greater Charlson Comorbidity Index (2 (IQR 1,3) vs. 1 (IQR 0,3), p=0·008), dementia (13/80 (16·2%) vs. 18/235 (7·7%), p=0·03), cancer (27/80 (33·8%) vs. 47/235 (20·0%), p=0·015), positive qSOFA score (57/80 (71·2%) vs. 129/235 (54·9%), p=0·009), and normal white blood cell counts (25/80 (31·2%) vs. 42/235 (17·9%), p=0·02). The presence of bacteremia, persistent bacteremia after antimicrobial infusion, and shorter time to blood culture positivity were not associated with mortality. Neither the source of infection nor pathogen affected mortality. Interpretation Although severe sepsis is an inflammatory condition triggered by infection, its 90-day survival is not influenced by blood culture positivity nor its time to positivity. Funding Vancouver Coastal Health; St-Paul’s Hospital Foundation Emergency Department Support Fund; the Fonds de Recherche Santé – Québec (CPY); Intramural Research Program of the NIH, Clinical Center (AL); the Maricopa Medical Foundation

scholarly journals 2243. Using Host Biomarkers and Time to Blood Culture Positivity to Predict Necessity for Echocardiogram in Patients with Staphylococcus aureus Endocarditis

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S767-S767
Author(s):  
Graham Edwardson ◽  
Cecilia Volk ◽  
Victor Nizet ◽  
George Sakoulas ◽  
Warren Rose
Keyword(s):  
Blood Culture ◽  
Positive Blood Culture ◽  
Elevated Serum ◽  
Blood Cultures ◽  
Serum Concentrations ◽  
Bacterial Burden ◽  
Culture Positivity ◽  
Time To Positivity ◽  
Blood Culture Positivity ◽  
Number Of Patients

Abstract Background Patients with complicated S. aureus bacteremia (SaB) require a transesophageal echocardiogram (TEE) to rule out endocarditis. Risks of TEE may exceed benefits in patients with a low pretest probability of endocarditis. Given our prior findings that endovascular bacterial burden drives elevated serum IL-10 concentrations, we hypothesize that time to positive blood culture and IL-10 serum concentrations may be used to risk stratify patients for selection of TEE. We compared time to positive blood culture and serum IL-10 in patients with negative and positive TEE. Methods Patients with SaB were included if they had a diagnosis of primary, endovascular infection source of bacteremia identified by an infectious diseases consult team and a TEE performed. A retrospective chart review was done to identify the time to positivity (hours) of patient blood cultures grown aerobically or anaerobically and TEE results. Sera collected at clinical presentation of these patients were tested for biomarkers IL-10 and IL-1β. Mann–Whitney U test compared the data between the two groups. Results This study included 66 patients with SaB: 17 with negative TEE and 49 with positive TEE. Patients with a positive TEE confirming endocarditis had a faster time to positive blood cultures compared with patients with negative TEE (P = 0.031; figure). IL-10 serum concentrations were significantly higher in patients with positive TEE (26.2 pg/mL) vs. negative TEE (14.39 pg/mL). Time-to-positivity in blood culture was linearly associated serum IL-10 concentrations (P = 0.044; figure). Serum IL-1β concentrations were also higher in TEE positive vs. TEE negative patients (32.1 vs. 14.7 pg/mL, P = 0.067) Conclusion These data lend further evidence to link high endovascular bacterial burden (measured by shorter time to positive blood culture) and serum IL-10 concentrations. As anticipated, patients with positive TEE had significantly shorter time to blood culture positivity and higher IL-10 serum concentrations than those with negative TEE. With further study on a larger number of patients, time to positive blood cultures and serum biomarkers like IL-10 may be used to risk stratify patients for performance of TEE, as well as to select antimicrobial therapy and to adjust treatment duration. Disclosures All authors: No reported disclosures.

scholarly journals The Addition of Anaerobic Blood Cultures for Pediatric Patients with Concerns for Bloodstream Infections: Prevalence and Time to Positive Cultures

2020 ◽  
Vol 58 (9) ◽  
Author(s):  
Jennifer Dien Bard ◽  
Todd P. Chang ◽  
Rebecca Yee ◽  
Keya Manshadi ◽  
Nhan Lichtenfeld ◽  
...  
Keyword(s):  
Blood Culture ◽  
Pediatric Patients ◽  
Bloodstream Infections ◽  
Pediatric Emergency ◽  
Blood Cultures ◽  
Secondary Outcome ◽  
Culture Positivity ◽  
Blood Culture Positivity ◽  
Anaerobic Bottle ◽  
Clinically Significant

ABSTRACT Anaerobes are an important but uncommon cause of bloodstream infections (BSIs). For pediatric patients, routine inclusion of an anaerobic blood culture alongside the aerobic remains controversial. We implemented automatic anaerobic blood culture alongside aerobic blood cultures in a pediatric emergency department (ED) and sought to determine changes in recovery of obligate and facultative anaerobes. This was a cohort study in a pediatric ED (August 2015 to July 2018) that began in February 2017. Blood culture positivity results for true pathogens and contaminants were assessed, along with a secondary outcome of time to positivity (TTP) of blood culture. A total of 14,180 blood cultures (5,202 preimplementation and 8,978 postimplementation) were collected, with 8.8% (456) and 7.1% (635) positive cultures in the pre- and postimplementation phases, respectively. Of 635 positive cultures in the postimplementation phase, aerobic blood cultures recovered 7.6% (349/4,615), whereas anaerobic blood cultures recovered 6.6% (286/4,363). In 211/421 (50.0%) paired blood cultures, an organism was recovered in both cultures. The number of cases where organisms were only recovered from an aerobic or an anaerobic bottle in the paired cultures were 126 (30.0%) and 84 (20.0%), respectively. The TTP was comparable regardless of bottle type. Recovery of true pathogens from blood cultures was approximately 7 h faster than recovery of contaminants. Although inclusion of anaerobic blood cultures only recovered 2 (0.69%) obligate anaerobes, it did allow for recovery of clinically significant pathogens that were negative in aerobic blood cultures and supports the routine collection of both bottles in pediatric patients with a concern of bloodstream infections.

scholarly journals Central Line–Associated Bloodstream Infections in Adult Hematology Patients with Febrile Neutropenia An Evaluation of Surveillance Definitions Using Differential Time to Blood Culture Positivity

2013 ◽  
Vol 34 (1) ◽  
pp. 89-92 ◽  
Author(s):  
Joshua T. Freeman ◽  
Anna Elinder-Camburn ◽  
Catherine McClymont ◽  
Deverick J. Anderson ◽  
Mary Bilkey ◽  
...  
Keyword(s):  
Blood Culture ◽  
Febrile Neutropenia ◽  
Positive Predictive Value ◽  
Bloodstream Infections ◽  
Central Line ◽  
Blood Cultures ◽  
National Healthcare ◽  
Culture Positivity ◽  
National Healthcare Safety Network ◽  
Blood Culture Positivity

We used differential time to positivity between central and peripheral blood cultures to evaluate the positive predictive value (PPV) of the National Healthcare Safety Network central line–associated bloodstream infection (CLABSI) surveillance definition among hematology patients with febrile neutropenia. The PPV was 27.7%, which suggests that, when the definition is applied to this population, CLABSI rates will be substantially overestimated.

scholarly journals Hourly Effect of Pretreatment With IV Antibiotics on Blood Culture Positivity Rate in Emergency Department Patients

2019 ◽  
Vol 6 (5) ◽  
Author(s):  
Kenneth H Rand ◽  
Stacy G Beal ◽  
Kimberly Rivera ◽  
Brandon Allen ◽  
Thomas Payton ◽  
...  
Keyword(s):  
Emergency Department ◽  
Blood Culture ◽  
Positive Culture ◽  
Large Data ◽  
Data Set ◽  
Culture Positivity ◽  
Blood Culture Positivity ◽  
Emergency Department Patients ◽  
The Impact ◽  
Culture Positivity Rate

Abstract Although it is intuitive that antibiotics administered before obtaining a blood culture would reduce the likelihood of obtaining a positive culture, it is not clear exactly how rapidly and to what extent blood becomes sterile after administration of intravenous (IV) antibiotics. Using a large data set of patients admitted from the UFHealth Shands Adult Emergency Department (ED) between 2012 and 2016 (n = 25 686), we had the opportunity to more closely examine the effect of starting IV antibiotics before vs after obtaining blood cultures. We present data on the effect of pretreatment with IV antibiotics for both septic and nonseptic ED patients on the blood culture positivity rate on an hour-by-hour basis, as well as the effects on distribution of species recovered and the impact of antibiotic resistance in empiric treatment with antibiotics.

scholarly journals Microbiological findings in emergency department patients with sepsis identified by the Sepsis-3 criteria: a single-center prospective population-based cohort study

2021 ◽  
Vol 14 (1) ◽  
Author(s):  
Signe Trille Sørensen ◽  
S. M. Osama Bin Abdullah ◽  
Rune Husås Sørensen ◽  
Ram Dessau ◽  
Niels Høiby ◽  
...  
Keyword(s):  
Emergency Department ◽  
Staphylococcus Aureus ◽  
Cohort Study ◽  
Blood Culture ◽  
Sofa Score ◽  
Blood Cultures ◽  
Microbiological Characteristics ◽  
Increased Risk ◽  
Polymicrobial Infections ◽  
Sirs Criteria

Abstract Background Studies comparing the microbiological profiles among sepsis patients identified with either Sequential Organ Failure Assessment (SOFA) score or systemic inflammatory response syndrome (SIRS) criteria are limited. The aim was to examine if there are differences in the microbiological findings among septic patients identified by Sepsis-3 criteria compared to patients identified by the previous sepsis criteria, SIRS, and without organ failure. A secondary purpose was to examine if we could identify microbiological characteristics with increased risk of 28-day mortality. Methods Prospective cohort study of all adult (≥ 18 years) patients admitted with sepsis to the Emergency Department of Slagelse Hospital, Denmark from 1st October 2017 to 31st March 2018. Information regarding microbiological findings was obtained via linkage between a sepsis database and the local microbiological laboratory data system. Data regarding 28-day mortality were obtained from the Danish Civil Registration System. We used logistic regression to estimate the association between specific microbiological characteristics and 28-day mortality. Results A total of 1616 patients were included; 466 (28.8%; 95% CI 26.6%-31.1%) met SOFA criteria, 398 (24.6%; 95% CI 22.5–26.8%) met SIRS criteria. A total of 127 patients (14.7%; 95% CI 12.4–17.2%) had at least one positive blood culture. SOFA patients had more often positive blood cultures compared to SIRS (13.9% vs. 9.5%; 95 CI on difference 0.1–8.7%). Likewise, Gram-positive bacteria (8.6% vs. 2.8%; 95 CI on difference 2.8–8.8%), infections of respiratory origin (64.8% vs. 57.3%; 95 CI on difference 1.0–14%), Streptococcus pneumoniae (3.2% vs. 1.0%; 95% CI on difference 0.3–4.1) and polymicrobial infections (2.6% vs. 0.3% 95 CI on difference 0.8–3.8%) were more common among SOFA patients. Polymicrobial infections (OR 3.70; 95% CI 1.02–13.40), Staphylococcus aureus (OR 6.30; 95% CI 1.33–29.80) and a pool of “other” microorganisms (OR 3.88; 95% CI 1.34–9.79) in blood cultures were independently associated with mortality. Conclusion Patients identified with sepsis by SOFA score were more often blood culture-positive. Gram-positive pathogens, pulmonary tract infections, Streptococcus pneumoniae, and polymicrobial infections were also more common among SOFA patients. Polymicrobial infection, Staphylococcus aureus, and a group of other organisms were independently associated with an increased risk of death.

Real World Evaluation of the Impact of Implementation of the VIRTUO Blood Culture System in a Tertiary Care Hospital

2021 ◽  
Author(s):  
Miguel A Chavez ◽  
Satish Munigala ◽  
Carey-Ann D. Burnham ◽  
Melanie L. Yarbrough ◽  
David K Warren
Keyword(s):  
Blood Culture ◽  
Recovery Rate ◽  
Culture System ◽  
Medical Center ◽  
Tertiary Care ◽  
Blood Cultures ◽  
Blood Culture System ◽  
Culture Positivity ◽  
Blood Culture Positivity ◽  
The Impact

The bioMerieux BACT/ALERT VIRTUO (VIRTUO) blood culture system used in combination with resin-containing media may enhance the growth of microorganisms. Our objective was to assess the impact of transitioning to the VIRTUO system in comparison to the VersaTREK blood culture system at a tertiary care medical center. We retrospectively reviewed all blood cultures performed at a 1250-bed academic medical center between January-December 2018 (VersaTREK) and January-December 2019 (VIRTUO). Blood culture positivity rates and contamination rates were compared pre- versus post-VIRTUO implementation. Of 101,438 blood cultures performed during the study period, 48,839 (48.1%) were processed pre-implementation and 52,599 (51.9%) post-implementation. The blood culture positivity rate increased from 8.1% pre-implementation to 11.7% post-implementation (p<0.001). Staphylococcus aureus was the most frequently isolated species in both time periods and had higher recovery rate post-implementation (1.5% of all blood cultures obtained pre- vs. 3.4% post-implementation, p<0.001). A higher recovery rate in the post-implementation period was also noted for coagulase-negative staphylococci (1.9% pre- vs. 2.7% post-implementation, p<0.001), as well as modest but statistically significant changes for E. coli (0.8% vs. 1.0%, p<0.001), K. pneumoniae (0.4% vs. 0.5%, p=0.005) and Candida albicans . (0.1% vs. 0.2%, p=0.038). The inpatient blood culture contamination rate was higher post-implementation (1.5% pre- vs. 1.9% post-implementation, p<0.001). The VIRTUO blood culture system was associated with a higher observed proportion of positive blood cultures compared to the previous VersaTREK system. Future studies are needed to assess whether an increased rate of positive blood cultures is associated with changes in clinical outcomes.

Blood culture positivity rate for Trypanosoma cruzi in patients with chronic Chagas disease differs among different clinical forms

2020 ◽  
Author(s):  
Marco Antonio Prates Nielebock ◽  
Luciana de Freitas Campos Miranda ◽  
Pedro Emmanuel Alvarenga Americano do Brasil ◽  
Thayanne Oliveira de Jesus S. Pereira ◽  
Aline Fagundes da Silva ◽  
...  
Keyword(s):  
Blood Culture ◽  
Trypanosoma Cruzi ◽  
Chagas Disease ◽  
Positive Blood Culture ◽  
Blood Cultures ◽  
Culture Positivity ◽  
Blood Culture Positivity ◽  
All Cause Mortality ◽  
Chronic Chagas Disease ◽  
Culture Positivity Rate

Abstract Background The purpose of this research was to compare the clinical and epidemiological characteristics of patients with chronic Chagas disease with and without positive blood cultures for Trypanosoma cruzi. Methods This was a retrospective longitudinal study that included 139 patients with chronic Chagas disease who underwent blood culture for T. cruzi. Blood cultures were performed using Novy–MacNeal–Nicolle medium enriched with Schneider's medium. Multivariate Cox proportional hazards regression analysis adjusting for age and sex was performed to identify if positive blood culture for T. cruzi was associated with all-cause mortality. Results The blood culture positivity rate was 30.9%. Most patients were born in the Northeast and Southeast regions of Brazil. Patients with positive blood cultures were older (52±13 vs 45±13 y; p=0.0009) and more frequently women (72.1% vs. 53.1%; p=0.03) than patients with negative blood cultures. The frequency of patients with cardiac or cardiodigestive forms was higher among patients with positive vs negative blood cultures (74.4% vs 54.1%; p=0.02). A total of 28 patients died during a mean follow-up time of 6.6±4.1 y. A positive blood culture was associated with all-cause mortality (hazard ratio 2.26 [95% confidence interval 1.02 to 5.01], p=0.045). Conclusions We found a higher proportion of patients with Chagas heart disease among patients with T. cruzi–positive blood cultures. A positive blood culture was associated with an increased risk of all-cause mortality. Therefore T. cruzi persistence may influence Chagas disease pathogenesis and prognosis.

scholarly journals 650. Clinical Performance Evaluation of Virtuo Blood Culture System in a Tertiary Care Hospital

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S383-S383
Author(s):  
Miguel A Chavez ◽  
Satish Munigala ◽  
Carey-Ann Burnham ◽  
Melanie L Yarbrough ◽  
David K Warren
Keyword(s):  
Blood Culture ◽  
Recovery Rate ◽  
Culture System ◽  
Tertiary Care ◽  
Blood Cultures ◽  
Care Hospital ◽  
Blood Culture System ◽  
Culture Positivity ◽  
Blood Culture Positivity ◽  
Staphylococcus Spp

Abstract Background Bloodstream infections are a major cause of morbidity and mortality. BACT/ALERT VIRTUO (VIRTUO) blood culture system is an automated, closed system used with resin-containing media which may enhance the growth of microorganisms. Our objective was to assess the real-world performance of the VIRTUO system. Methods We retrospectively reviewed all blood cultures performed between January-December 2018 (VersaTREK) and January-December 2019 (VIRTUO) at a 1250-bed academic medical center. Blood culture positivity rates, contamination rates, and time from collection to arrival in the laboratory were compared pre- versus post-VIRTUO implementation. Contamination was defined as a single blood culture with common skin microbiota. Results A total of 101803 blood cultures were performed during the study period: 48969 (48.1%) were processed with VersaTREK system and 52834 (51.9%) with VIRTUO system. A decreased median time from collection until arrival to the laboratory was seen post-implementation (2.0 pre- vs. 0.8 hours post-implementation, p&lt; 0.001). The positivity rate increased from 3987 (8.1%) pre-implementation to 6141 (11.6%) post-implementation (p &lt; 0.001) (Table and Figure). Staphylococcus aureus was the most frequently isolated species for both periods and had higher recovery rate with the VIRTUO system (717 (1.5%) pre- vs. 1764 (3.3%) post-implementation, p&lt; 0.001). Higher recovery rate was also noted for other Staphylococcus spp. in the post-implementation period (985 (2.0%) pre- vs. 1644 (3.1%) post-implementation, p&lt; 0.001). No difference in the organism recovery rate was noted for Streptococcus spp., Enterococcus faecium, E. faecalis, Pseudomonas aeruginosa, Enterobacterales, and Candida spp. The inpatient contamination rate was higher post-implementation (1.5% pre- vs. 1.9% post-implementation, p &lt; 0.001). Comparison of blood culture positivity rate pre- vs. post-implementation, by culture location Daily positivity rate for blood cultures processed at BJH during the study period Conclusion The VIRTUO system showed a higher rate of positive blood cultures compared to the VersaTREK system primarily from a higher detection of Staphylococcus spp. Further studies are needed to assess whether an increased rate of positive blood cultures is associated with changes in management and clinical outcomes. Disclosures All Authors: No reported disclosures

scholarly journals Antibiotic Use Prior to Hospital Presentation Among Individuals With Suspected Enteric Fever in Nepal, Bangladesh, and Pakistan

2020 ◽  
Vol 71 (Supplement_3) ◽  
pp. S285-S292
Author(s):  
Krista Vaidya ◽  
Kristen Aiemjoy ◽  
Farah N Qamar ◽  
Samir K Saha ◽  
Dipesh Tamrakar ◽  
...  
Keyword(s):  
Blood Culture ◽  
Disease Severity ◽  
Enteric Fever ◽  
Clinical Care ◽  
Prevalence Ratio ◽  
Antibiotic Use ◽  
Urine Samples ◽  
Mixed Effect ◽  
Culture Positivity ◽  
Blood Culture Positivity

Abstract Background Antibiotic use prior to seeking care at a hospital may reduce the sensitivity of blood culture for enteric fever, with implications for both clinical care and surveillance. The Surveillance for Enteric Fever in Asia Project (SEAP) is a prospective study of enteric fever incidence in Nepal, Bangladesh, and Pakistan. Nested within SEAP, we evaluated the accuracy of self-reported antibiotic use and investigated the association between antibiotic use and blood culture positivity. Methods Between November 2016 and April 2019, we collected urine samples among a subset of SEAP participants to test for antibiotic use prior to the hospital visit using an antibacterial activity assay. All participants were asked about recent antibiotic use and had a blood culture performed. We used mixed-effect logit models to evaluate the effect of antimicrobial use on blood culture positivity, adjusted for markers of disease severity. Results We enrolled 2939 patients with suspected enteric fever. Antibiotics were detected in 39% (1145/2939) of urine samples. The correlation between measured and reported antibiotic use was modest (κ = 0.72). After adjusting for disease severity, patients with antibiotics in their urine were slightly more likely to be blood culture positive for enteric fever; however, the effect was not statistically significant (prevalence ratio, 1.22 [95% confidence interval, .99–1.50]). Conclusions The reliability of self-reported prior antibiotic use was modest among individuals presenting with fever to tertiary hospitals. While antibiotics are likely to reduce the sensitivity of blood culture, our findings indicate that there is still considerable value in performing blood culture for individuals reporting antibiotic use.

Sign in / Sign up

Export Citation Format

Share Document