scholarly journals 62. Follow-Up Blood Culture Practices for Gram-Negative Bloodstream Infections in Immunocompromised Hosts at a Large Academic Medical Center

2021 ◽  
Vol 8 (Supplement_1) ◽  
pp. S42-S42
Author(s):  
Lauren Groft ◽  
James Mease ◽  
Jacqueline Bork ◽  
Ciera L Bernhardi ◽  
J Kristie Johnson ◽  
...  

Abstract Background Routine follow-up blood cultures (FUBC) are strongly recommended for Staphylococcus aureus and Candida spp. bloodstream infections (BSI), but the role of FUBC in Gram-negative (GN) BSI remains controversial. Factors that may result in persistent GN BSI include critical illness, endovascular infection, lack of source control, multidrug resistant organisms (MDRO), end-stage renal disease, or immunocompromised status. As such, FUBC in patients with any of these factors may be warranted to improve clinical outcomes, but the true balance of benefit versus harm remains unknown. Our objective was to evaluate the role of FUBC in immunocompromised patients with GN BSI. Methods This was a retrospective observational cohort of adult, immunocompromised patients treated for confirmed GN BSI between January 2019 and December 2020 at University of Maryland Medical Center. Immunocompromise was defined as active hematologic or solid tumor malignancy at time of BSI diagnosis, history of hematopoietic stem cell transplantation (HSCT) or solid organ transplantation (SOT), or absolute neutrophil count (ANC) < 1000 cells/mm3 at any time 30 days prior to BSI diagnosis. FUBC were defined as blood cultures drawn between 24 hours and 7 days from index blood culture, within the same hospital encounter. Positive FUBC was defined as a FUBC with same pathogenic GN organism identified. Comparison of patient and microbiologic characteristics was made between patients with and without FUBC. Results A total of 146 patients with GN BSI were included. Baseline characteristics are reported in Table 1. FUBC were collected in 129 (88.4%) patients. Neutropenia (49.6% vs. 19.4%, P=0.122), presence of central line (69.8% vs. 30.2%, P=0.061), and hospital-acquired origin of BSI (63.6% vs. 36.4%, P=0.395) resulted in increased frequency of FUBC. Patients with FUBC had a significantly longer post-BSI mean (SD) length of stay (17.3 [35.4] vs. 6.5 [6.0] days; P=0.005). Positive FUBC occurred in only 2 cases (1.4%) and both patients had persistent fevers at time of FUBC. Table 1. Baseline Characteristics Conclusion Positive FUBC were uncommon in this immunocompromised cohort with GN BSI, which challenges the need for routine collection of FUBC in this patient population. Disclosures Ciera L. Bernhardi, PharmD, Servier Pharmaceuticals (Advisor or Review Panel member) J. Kristie Johnson, PhD, D(ABMM), GenMark (Speaker’s Bureau) Kimberly C. Claeys, PharmD, GenMark (Speaker’s Bureau)

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S145-S145
Author(s):  
Rajiv G Amipara ◽  
Hana R Winders ◽  
Julie Ann Justo ◽  
P B Bookstaver ◽  
Joseph Kohn ◽  
...  

Abstract Background Importance of follow up blood cultures (FUBC) for Staphylococcus aureus bloodstream infections (BSI) is well known, but the role of FUBC in gram-negative BSI remains controversial. This retrospective cohort study examined the association between obtaining FUBC and mortality in patients with gram-negative BSI. Methods Adults with first episodes of community-onset monomicrobial BSI due to gram-negative bacilli hospitalized at Prisma Health-Midlands hospitals in Columbia, South Carolina, USA from January 1, 2010 to June 30, 2015 were identified. Patients who died or were discharged from hospital within 72 hours of collection of index blood culture were excluded to minimize impact of survival and selection biases on results, respectively. FUBC were defined as repeat blood cultures obtained between 24 and 96 hours from initial positive blood culture. Cox proportional hazards regression model was used to examine association between obtaining FUBC and 28-day all-cause mortality. Results Among 766 patients with gram-negative BSI, 219 (28.6%) had FUBC obtained and 15 of 219 (6.8%) FUBC were persistently positive. Overall, median age was 67 years, 438 (57%) were women, 457 (60%) had urinary source of infection, and 426 (56%) had BSI due to Escherichia coli. Mortality was significantly lower in patients who had FUBC obtained than in those who did not have FUBC (6.3% vs. 11.7%, log-rank p=0.03). Obtaining FUBC was independently associated with reduced mortality (hazards ratio [HR] 0.49, 95%CI: 0.25–0.90) after adjustments for age (HR 1.35 per decade, 95% CI: 1.13–1.61), cancer (HR 5.90, 95% CI: 3.53–9.84), Pitt bacteremia score (HR 1.38 per point, 95% CI: 1.26–1.50), and inappropriate empirical antimicrobial therapy (HR 2.37, 95% CI: 1.17–4.39). Conclusion Obtaining FUBC was associated with improved survival in hospitalized patients with gram-negative BSI. These observations are consistent with the results of recent publications from Italy and North Carolina supporting utilization of FUBC in the management of gram-negative BSI. Disclosures Julie Ann Justo, PharmD, MS, BCPS-AQ ID, bioMerieux (Speaker’s Bureau)TRC Healthcare (Speaker’s Bureau)


2017 ◽  
Vol 55 (7) ◽  
pp. 2116-2126 ◽  
Author(s):  
Matthias Marschal ◽  
Johanna Bachmaier ◽  
Ingo Autenrieth ◽  
Philipp Oberhettinger ◽  
Matthias Willmann ◽  
...  

ABSTRACT Bloodstream infections (BSI) are an important cause of morbidity and mortality. Increasing rates of antimicrobial-resistant pathogens limit treatment options, prompting an empirical use of broad-range antibiotics. Fast and reliable diagnostic tools are needed to provide adequate therapy in a timely manner and to enable a de-escalation of treatment. The Accelerate Pheno system (Accelerate Diagnostics, USA) is a fully automated test system that performs both identification and antimicrobial susceptibility testing (AST) directly from positive blood cultures within approximately 7 h. In total, 115 episodes of BSI with Gram-negative bacteria were included in our study and compared to conventional culture-based methods. The Accelerate Pheno system correctly identified 88.7% (102 of 115) of all BSI episodes and 97.1% (102 of 105) of isolates that are covered by the system's identification panel. The Accelerate Pheno system generated an AST result for 91.3% (95 of 104) samples in which the Accelerate Pheno system identified a Gram-negative pathogen. The overall category agreement between the Accelerate Pheno system and culture-based AST was 96.4%, the rates for minor discrepancies 1.4%, major discrepancies 2.3%, and very major discrepancies 1.0%. Of note, ceftriaxone, piperacillin-tazobactam, and carbapenem resistance was correctly detected in blood culture specimens with extended-spectrum beta-lactamase-producing Escherichia coli ( n = 7) and multidrug-resistant Pseudomonas aeruginosa ( n = 3) strains. The utilization of the Accelerate Pheno system reduced the time to result for identification by 27.49 h ( P < 0.0001) and for AST by 40.39 h ( P < 0.0001) compared to culture-based methods in our laboratory setting. In conclusion, the Accelerate Pheno system provided fast, reliable results while significantly improving turnaround time in blood culture diagnostics of Gram-negative BSI.


2017 ◽  
Vol 06 (03) ◽  
pp. 132-133
Author(s):  
Preetam Kalaskar ◽  
Asha Anand ◽  
Harsha Panchal ◽  
Apurva Patel ◽  
Sonia Parikh ◽  
...  

Abstract Introduction: The treatment of acute myeloid leukemia (AML) consists of induction therapy with anthracyclines and cytarabine followed by two to four cycles of consolidation therapy with high-dose cytarabine after achieving remission. There have been very few studies comparing infections during induction and consolidation. We have analyzed blood cultures of patients with AML during episodes of fever occurring during induction and consolidation, for comparing the bloodstream infections in both the phases. Materials and Methods: Blood cultures of patients during febrile episodes were collected from central venous catheters and peripheral blood, both during induction and consolidation therapy of AML. Results: The study population included 52 AML patients. During induction, there were 52 episodes of fever and 25 (48%) blood cultures were positive, 15 of these blood cultures reported Gram-negative organisms, 9 reported Gram-positive organisms and 1 as yeast. During consolidation, 47 episodes of fever were recorded and blood cultures were positive in 12, of which 7 were Gram-negative, 5 were Gram-positive. Conclusion: The incidence of blood culture positive infections during therapy of AML at our center was higher. The predominant organism isolated was Gram-negative both during induction and consolidation. The incidence of blood culture positive infections had decreased by 50% during consolidation.


2021 ◽  
Vol 8 (Supplement_1) ◽  
pp. S603-S604
Author(s):  
Lauren Groft ◽  
Mandee Noval ◽  
James Mease ◽  
J Kristie Johnson ◽  
Kimberly C Claeys

Abstract Background Molecular rapid diagnostic tests (RDTs) for bloodstream infections (BSI) utilize a variety of technologies and differ substantially in organisms and resistance mechanisms detected. RDT platforms decrease time to optimal antibiotics; however, data on RDTs in special populations, such as immunocompromised are extremely limited. This study aimed to compare theoretical changes in antibiotics based on differences in panel identification of organisms and resistance targets among three commercially available RDT panels. Methods Retrospective cohort of immunocompromised patients treated for gram-negative BSI at University of Maryland Medical Center from January 2018 to September 2020. Immunocompromised was defined as active hematologic or solid tumor malignancy at time of BSI diagnosis, history of hematopoietic stem cell transplantation (HSCT) or solid organ transplantation (SOT), or absolute neutrophil count (ANC) &lt; 1000 cells/mm3 at any time 30 days prior to BSI diagnosis. Verigene BC-GN was performed as standard of care. GenMark ePlex BCID and BioFire FilmArray BCID 2 results were assigned based on respective identifiable organism panels. An infectious diseases clinician blinded to final antimicrobial susceptibility testing (AST) results used RDT results to assign antibiotic treatments for each platform. Decisions were referenced against a priori DOOR-MAT matrices. A partial credit scoring system (0 to 100) was applied to each decision based on final AST results. The mean and standard deviation (SD) were compared across panels using One-Way Repeated Measures ANOVA with modified Bonferroni for multiple comparisons. Results A total of 146 patients met inclusion. Baseline characteristics are summarized in Table 1. The mean (SD) DOOR-MAT scores for the three RDT panels were: 86.1 (24.4) Verigene BC-GN vs. 88.5 (22.2) GenMark BCID vs. 87.2 (24.4) BioFire BCID 2. There was no statistically significant difference between the panels for DOOR-MAT score (P=0.6). Table 1. Baseline Patient Characteristics and Organism Identification Conclusion Within an immunocompromised patient population, differences in organism identification between three commercially available RDT panels did not impact theoretical antibiotic prescribing. Disclosures J. Kristie Johnson, PhD, D(ABMM), GenMark (Speaker’s Bureau) Kimberly C. Claeys, PharmD, GenMark (Speaker’s Bureau)


2011 ◽  
Vol 6 (02) ◽  
pp. 120-125 ◽  
Author(s):  
Babak Pourakbari ◽  
Alireza Sadr ◽  
Mohammad Taghi Haghi Ashtiani ◽  
Setareh Mamishi ◽  
Mahdi Dehghani ◽  
...  

Introduction: Bloodstream infections (BSI) are a serious cause of morbidity and mortality worldwide. Emerging antimicrobial drug resistance among bacterial pathogens causing BSI can limit therapeutic options and complicate patient management. Methodology: To encourage the prudent use of appropriate antibiotics in our pediatric population at Children's Medical Center Hospital, Tehran, Iran, we studied the frequency and antibiogram patterns of blood culture isolates from January 2001 to December 2005. Results: Of 25,223 blood cultures examined, 2,581 (10.23 %) were positive for bacterial growth. The frequency of Gram-positive bacteria isolated was 47.6% (1228 of 2581) and that for Gram-negatives was 52.4% (1353 of 2581). The rates of methicillin (oxacillin) resistance in Staphylococcus aureus and coagulase-negative staphylococci (CoNS) were 79% and 89%, respectively. About 45% of Streptococcus pneumoniae were resistant to trimethoprim-sulfamethoxazole and approximately 66% to penicillin. Among the Gram-negative isolates, Pseudomonas aeruginosa was most frequently isolated, representing 943 (36.7%) over five years. This possibly represents an unrecognized hospital outbreak or contamination of blood culture bottles or other products such as skin disinfectants. Additionally, this pathogen showed extremely high rates of antimicrobial resistance. There were notable differences in frequency of the five most common microorganisms isolated from blood cultures, which can help set priorities for focused infection control efforts. Conclusions: Our findings underscore the need to monitor blood culture isolates and their antimicrobial resistance patterns to observe resistance trends that would influence appropriate empiric treatment and infection control strategies for bacteremic children.  


2020 ◽  
Vol 7 (4) ◽  
Author(s):  
Hayato Mitaka ◽  
Tessa Gomez ◽  
Young Im Lee ◽  
David C Perlman

Abstract Background The value of follow-up blood cultures (FUBCs) to document clearance of bacteremia due to Gram-negative bacilli (GNB) has not been well established. Although previous studies suggested that the yield of FUBCs for GNB bacteremia is low, it remains to be elucidated for whom FUBC may be beneficial and for whom it is unnecessary. Methods A retrospective cohort study was performed at 4 acute care hospitals to identify risk factors for positive FUBCs with GNB bacteremia and to better guide clinicians’ decisions as to which patients may or may not benefit from FUBCs. Participants included adult patients with GNB bacteremia who had FUBCs and were admitted between January 2017 and December 2018. The primary outcomes were the factors associated with positive FUBCs and the yield of FUBCs with and without the factors. Results Of 306 patients with GNB bacteremia who had FUBCs, 9.2% (95% confidence interval, 6.2%–13.0%) had the same GNB in FUBCs. In the multivariate logistic regression analysis, end-stage renal disease on hemodialysis, intravascular device, and bacteremia due to extended-spectrum β-lactamase or carbapenemase-producing organism were identified as independent predictors of positive FUBCs with GNB bacteremia. Approximately 7 FUBCs and 30 FUBCs were needed for patients with ≥1 or no risk factors, respectively, to yield 1 positive result. SummaryThis multi-site retrospective cohort study found that among patients with gram-negative bacilli (GNB) bacteremia, having ESRD on hemodialysis, intravascular devices, or bacteremia due to multi-drug resistant GNB were each independently associated with having a positive follow-up blood culture. Conclusions Follow-up blood culture may not be necessary for all patients with GNB bacteremia and has the highest yield in patients with 1 or more risk factors.


2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S90-S90
Author(s):  
Orly Hadar ◽  
Amy Van ◽  
Carla McWilliams ◽  
Luis Wulff ◽  
Linda Godinez

Abstract Background Bloodstream infections remain a significant cause of morbidity and mortality. No guidelines for the management of noncatheter-associated Gram-negative septicemia exist. There is considerable debate regarding the role of follow-up blood cultures. Studies have shown inadequate antibiotic therapy increases mortality in Gram-negative sepsis. We evaluated factors associated with a higher likelihood of positive follow-up blood cultures (FUBC). Methods A retrospective cohort study was conducted to look at factors associated with an increased likelihood of positive FUBC. Data were obtained via Epic chart review. Empiric antimicrobial regimens were reviewed in all patients with MDRO infections. Results We identified 1,527 patients ≥18 years admitted with gram-negative septicemia from January 1, 2013 through January 1, 2018. A total of 8.4% had positive FUBC. Patients with positive FUBC had a younger median age than the no-growth group (64.7 vs. 69.4, P <0.001). Admission systolic blood pressure was lower in the group with positive FUBC than the no-growth group (107 vs. 116, P = 0.008). The odds ratio for positive FUBC for cardiac device was 2.08 (95% CI = [0.97, 4.35], P = 0.061); central line infection (vs. urinary tract infection) adjusted odds ratio was 2.08 (95% CI = [1.10, 3.95], P = 0.025). The positive FUBC group had a larger proportion of multidrug-resistant organisms (MDRO) (21.9% vs. 10.4%, P < 0.001) with an odds ratio of 2.40 (95% CI = [1.53, 3.78]). In this group, those who received inadequate empiric antibiotics had a significantly higher percentage of repeat positive results (78.6% vs. 57.1%, P = 0.033). In summary, patients with either an MDRO, a central line infection (vs. urinary tract infection), or the presence of a cardiac device (vs. no cardiac device present) had over twice the odds of positive FUBC than those without. Conclusion Though the role of FUBC for Gram-negative septicemia has been brought into question, our results show that the presence of central lines, cardiac devices, infections with MDRO organisms, or inadequate empiric antibiotics on admission were factors strongly correlated with subsequent positive FUBC. Therefore, we believe that repeating blood cultures in this subset of patients require further study and consideration. Disclosures All authors: No reported disclosures.


2021 ◽  
Vol 15 (5) ◽  
pp. 1074-1079
Author(s):  
Sadaf Munir ◽  
Saima Inam ◽  
Aqsa Aslam ◽  
Maria Aslam ◽  
Usman Nasir ◽  
...  

Background: Bloodstream infections (BSIs) are an important frequent health problem in terms of their high incidence and lethal outcomes. The bacteria that frequently cause bacteremia are Staphylococcus, Streptococcus, Enterococcus, Escherichia coli, Klebsiella, Enterobacter, Pseudomonas, Neisseria and Haemophilus. Gram negative rods constitute a significant bulk in BSIs. The bloodstream infections due to multidrug resistant pathogens are on the rise globally making treatment more challenging. Aim: To identify the gram negative organisms causing blood stream infections and assess their susceptibility pattern so as to provide guidance for the empirical treatment hoping for better clinical outcome. Methodology: A retrospective, cross-sectional descriptive study carried out in Pathology Laboratory of Sharif City Hospital, Lahore. All the blood culture samples received in Microbiology laboratory between June 2017 to June 2019 were included in the study by non-probability consecutive sampling. Blood cultures were proceeded by subculturing on 1st and 5th day on MacConkey and Blood agar. The colonies obtained were identified through gram staining and biochemical profile. API20E was used for Enterobacteriaceae. Antibiotic susceptibility testing of the pathogens was by Kirby Bauer disc diffusion method. Results: In the current study 663 blood cultures were analyzed. Only 11.9% exhibited positive microbial growth. 55.7% of the positive cultures revealed gram negative bacteria. Among the pathogens isolated, E.coli was found to be responsible for BSIs in 22.7% cases, followed by Salmonella Typhi 20.4% and Klebsiella pneumoniae 18.1%.The gram negative rods exhibited a very high resistance for penicillins, cephalosporins and fluoroquinolones. The efficacy of aminoglycosides and results for carbapenems susceptibility were hopeful. Conclusion: The study shows that the Gram negative bacteria causing BSIs have shown unsatisfactory susceptibility to most of the commonly prescribed antimicrobials. The rising drug resistance has a major impact on the selection and prescription of antibiotics and calls for judicious use of antibiotics. Keywords: Gram Negative Organisms, Blood Culture, Antimicrobial Susceptibility Pattern


Author(s):  
Asifa Nazir ◽  
Ifshana Sana ◽  
Bushra Yousuf Peerzada ◽  
Tabindah Farooq

Background: Bacterial bloodstream infections (BSIs) are important causes of morbidity and mortality world-wide. The choice of antimicrobial therapy for bloodstream infections is often empirical and based on the knowledge of local antimicrobial activity profiles of the most common bacteria causing such infections. The objective of the study was to determine the pattern of bacterial isolates from the blood cultures in a teaching hospital and determine their antibiotic resistance and provide guidelines for choosing an effective antibiotic therapy in cases of septicaemia.Methods: The etiological and antimicrobial susceptibility profile of blood cultures over a period of one year at a tertiary care hospital was studied. Blood culture positive isolates were identified by BacT/Alert3D, an automated blood culture system, while as identification of the isolates from these samples and their antimicrobial sensitivity testing was performed with Vitek2 Compact.Results: There were 2231 blood culture samples, of which 565 (25.3%) were identified to be culture positive. Out of 565 positive cultures, 447 (79.1%) showed bacterial growth; Gram positive were 306 (54.2%) and Gram negative were 141 (24.9%). Candida species were isolated from 118 (20.9%) of positive samples. The most frequently identified Gram-positive bacteria were Coagulase-negative staphylococci 208 (67.9%) and the most common Gram-negative isolates were Acinetobacter species 89 (63.1%). The most sensitive drugs for gram-positive isolates were vancomycin, and linezolid while as gram-negative isolates showed 100% sensitivity to colistin and tigecycline.Conclusions: This study reveals a significant prevalence of bacterial isolates in blood and it highlights the need for periodic surveillance of etiologic agent and antibiotic susceptibility to prevent further emergence and spread of resistant bacterial pathogens.


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