scholarly journals 1039. Surveillance Blood Cultures Associated With Decreased Mortality in Gram-Negative Bacteremia

2018 ◽  
Vol 5 (suppl_1) ◽  
pp. S310-S311
Author(s):  
Stacey A Maskarinec ◽  
David Van Duin ◽  
Felicia Ruffin ◽  
Vance G Fowler Jr ◽  
Joshua T Thaden
Keyword(s):  
Blood Culture ◽  
Hospital Mortality ◽  
Positive Blood Culture ◽  
Blood Cultures ◽  
Statistical Testing ◽  
Chi Square ◽  
Gram Negative ◽  
Staphylococcus Aureus Bacteremia ◽  
Gram Negative Bacteremia ◽  
Persistent Bacteremia

Abstract Background Prior studies have suggested that surveillance blood cultures (SBCs) may not be indicated in the setting of Gram-negative bacteremia (GNB). However, it is unclear how particular microbial species influence the need for SBCs in GNB. Methods We conducted a prospective cohort study of inpatients at Duke with Staphylococcus aureus bacteremia (SAB) and GNB from 2002–2015. Patients who died <24 hours from the first positive blood culture were excluded. Patients provided written informed consent. SBCs were defined as a blood culture drawn from 24 hours to 7 days from initial positive blood culture. Persistent bacteremia was defined as a positive SBC with the same organism. Statistical testing included Fishers exact and chi-square tests. Results There were 2856 episodes of bacteremia over the study period (SAB: 1,147 [40%]; GNB: 1,709 [60%]). SBCs were drawn in 87% (1,003/1,147) of SAB patients and 64% (1,097/1,709) of GNB patients. SBC rates varied by GNB species (P < 0.001), being more commonly drawn for those patients with Pseudomonas bacteremia (128/159 [80%]) than those with Escherichia bacteremia (377/592 [62%]). In GNB, acquisition of SBCs, regardless of positivity, was associated with decreased in-hospital mortality (177/1,173 [15%] vs. 109/536 [20%]; P = 0.008). The in-hospital mortality benefit associated with SBCs varied with GNB species, including Pseudomonas (30/128 [23%] vs. 14/31 [45%]; P = 0.02) and Escherichia (33/377 [9%] vs. 37/215 [17%]; P = 0.003). In-hospital mortality in those with SAB was also lower when SBCs were drawn (143/1003 [14%] vs. 46/144 [32%]; P = 0.0001) (figure). In GNB, positive SBCs, relative to negative SBCs, was associated with increased in-hospital mortality (44/217 [20%] vs. 133/956 [14%]; P = 0.02). Persistent bacteremia occurred in 49% (494/1003) of SAB patients and 20% (217/1097) of GNB patients with SBCs. Persistent bacteremia risk differed by GNB species (P = 0.004), and was highest among those with Stenotrophomonas maltophilia (9/19 [47%]) or Serratia (24/76 [31%]). Conclusion Acquisition of SBCs in patients with GNB was associated with decreased mortality, and this was driven in part by species-specific differences. Disclosures D. Van Duin, achaogen: Scientific Advisor, Consulting fee. shionogi: Scientific Advisor, Consulting fee. Allergan: Scientific Advisor, Consulting fee. Astellas: Scientific Advisor, Consulting fee. Neumedicine: Scientific Advisor, Consulting fee. Roche: Scientific Advisor, Consulting fee. T2 Biosystems: Scientific Advisor, Consulting fee. V. G. Fowler Jr., Merck, Cerexa/Actavis, Pfizer, Advanced Liquid Logis, NIH, MedImmune, Basilea, Karius, Contrafect, Regneron, Genentech, Affinergy, Locus, Medical Surface, Inc., Achaogen, Astellas, Arsanis, Bayer, Cubist, Debiopharm, Durata, Grifols, Medicines Co, Novartis: Collaborator, Consultant and Scientific Advisor, Consulting fee, Research grant and Research support.

ATG Use Is Associated with Frequent Occurrence of Positive Blood Cultures in Patients in the Early Phase After Hematopoietic Stem Cell Transplantation

Blood ◽  
2011 ◽  
Vol 118 (21) ◽  
pp. 4564-4564
Author(s):  
Marek Seweryn ◽  
Urszula Jarosz ◽  
Malgorzata Krawczyk-Kulis ◽  
Miroslaw Markiewicz ◽  
Grzegorz Helbig ◽  
...  
Keyword(s):  
Stem Cell ◽  
Hematopoietic Stem Cell Transplantation ◽  
Blood Culture ◽  
Stem Cell Transplantation ◽  
Positive Blood Culture ◽  
Blood Cultures ◽  
Gram Negative Bacteria ◽  
Hematopoietic Stem ◽  
Gram Negative ◽  
Gram Positive Bacteria

Abstract Abstract 4564 Background: Infectious complications remain an important cause of morbidity and mortality in the early phase after hematopoietic stem cell transplantation (HSCT). Aim: The aim of this study was to assess the frequency of positive blood cultures and its potential correlation with different studied parameters in large patient population studied in the first 30 days after HSCT. Material and methods: 431 patients at median age of 47 years (range 18–85) transplanted between 2009–2011 for hematological and non-hematological malignancies were included in our analysis. There were 242 males and 189 females. Results: The indications for autologous and allogeneic HSCT were following: AML – 105 (24%), NHL – 86 (20%), MM – 75 (17,5%), HL – 48 (11%), ALL – 40 (9%), MDS – 17 (4%), AA – 15 (3,5%), CML – 12 (2,8%), PNH – 11 (2,6%), connective tissue diseases – 5 (1,2%), CLL – 3 (0,7%) and other – 14 (3,2%). The following transplant procedures were performed: ABCT – 213 (49%), ABMT – 3 (0,7%), alloBCT – 56 (13%), alloBMT – 21 (5%), URDBCT – 87 (20%), URDBMT – 51 (12%). Pre-transplant ATG and anti-CD52 antibody were used in 142 (33%) and 5 (1.2%) patients, respectively. Amongst 431 transplanted patients, 495 blood cultures were collected; range 0–8 (median 1). Eighty seven blood samples were positive (17,6%). The following pathogens were detected: gram-positive bacteria in 48% (n=42), gram-negative bacteria in 38% (n=33), fungi in 1% (n=1) and both G(+) and G(−) bacteria in 13%(n=11). The gram-positive bacteria included: Staphylococcus epidermidis: 21 (50%), Micrococcus spp: 4 (9%), Enterococcus faecium: 3 (7%), Enterococcus faecalis: 3 (7%), Streptococcus haemolyticus: 3 (7%). The following gram-negative bacteria were found: Enterobacter cloacae: 10 (30%), Escherichia coli: 7 (21%), Pseudomonas aeruginosa: 5 (15%), Klebsiella pneumonia: 5 (15%). Candida albicans was detected only in one case. The use of ATG was associated with higher number of total blood draw and positive blood cultures. No significant correlation was found between the specific pathogen and the use of ATG. Male gender was associated with significantly higher number of blood sampling and with tendency to higher number of positive blood cultures. The type of conditioning regimen, the source of stem cell and the donor origin (auto vs sibling vs unrelated) did not influence the number of positive blood culture. There was tendency to higher number of blood intake, but not positive blood culture in patients transplanted in NR if compared to PR or CR. Conclusions: Positive blood cultures were positive in about 20% of patients after HSCT. Only pre-transplant ATG use was associated with the higher number of positive blood culture. Disclosures: No relevant conflicts of interest to declare.

scholarly journals Identification of Gram-negative bacilli directly from positive blood culture vials

2007 ◽  
Vol 56 (4) ◽  
pp. 475-479
Author(s):  
Siew Yong Ng ◽  
Lee Ling Kwang ◽  
Thean Yen Tan
Keyword(s):  
Blood Culture ◽  
Positive Blood Culture ◽  
Clinical Management ◽  
Blood Cultures ◽  
Potential Saving ◽  
Biochemical Tests ◽  
Gram Negative ◽  
Genus Level ◽  
Direct Inoculation ◽  
Genus Identification

The provision of rapid results from positive blood cultures is important for the clinical management of septicaemia. This study tested the accuracy of direct inoculation of biochemical tests from positive blood culture vials for the identification of members of the Enterobacteriaceae and Acinetobacter species. A hundred and eighty-one samples were included in the study, with 25 % subsequently excluded as a result of mixed colonial growth. The study method successfully identified 133 (98 %) isolates from 136 vials to genus level and was technically simple to perform, requiring an additional 3 min for the processing of each positive vial. The results of this study demonstrate that a direct inoculation method provides acceptable genus identification of Gram-negative bacilli in positive blood culture vials, with a potential saving of 24 h compared with traditional methods.

Automated Alerts Coupled with Antimicrobial Stewardship Intervention Lead to Decreases in Length of Stay in Patients with Gram-Negative Bacteremia

2014 ◽  
Vol 35 (2) ◽  
pp. 132-138 ◽  
Author(s):  
Jason M. Pogue ◽  
Ryan P. Mynatt ◽  
Dror Marchaim ◽  
Jing J. Zhao ◽  
Viktorija O. Barr ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Blood Culture ◽  
Antimicrobial Stewardship ◽  
Positive Blood Culture ◽  
Medical Center ◽  
Intervention Group ◽  
Gram Negative ◽  
Gram Negative Bacteremia ◽  
Appropriate Therapy ◽  
The Impact

Objective.To assess the impact of active alerting of positive blood culture data coupled with stewardship intervention on time to appropriate therapy, length of stay, and mortality in patients with gram-negative bacteremia.Design.Quasi-experimental retrospective cohort study in patients with gram-negative bacteremia at the Detroit Medical Center from 2009 to 2011.Setting.Three hospitals (1 community, 2 academic) with active antimicrobial stewardship programs within the Detroit Medical Center.Patients.All patients with monomicrobial gram-negative bacteremia during the study period.Intervention.Active alerting of positive blood culture data coupled with stewardship intervention (2010-2011) compared with patients who received no formalized stewardship intervention (2009).Results.Active alerting and intervention led to a decreased time to appropriate therapy (8 [interquartile range (IQR), 2-24] vs 14 [IQR, 2-35] hours; P = .014) in patients with gram-negative bacteremia. After controlling for differences between groups, being in the intervention arm was associated with an independent reduction in length of stay (odds ratio [OR], 0.73 [95% confidence interval (CI), 0.62-0.86]), correlating to a median attributable decrease in length of stay of 2.2 days. Additionally, multivariate modeling of patients who were not on appropriate antimicrobial therapy at the time of initial culture positivity showed that patients in the intervention group had a significant reduction in both length of stay (OR, 0.76 [95% CI, 0.66-0.86]) and infection-related mortality (OR, 0.24 [95% CI, 0.08-0.76]).Conclusions.Active alerting coupled with stewardship intervention in patients with gram-negative bacteremia positively impacted time to appropriate therapy, length of stay, and mortality and should be a target of antimicrobial stewardship programs.

Processing of Positive Blood Cultures Using a Total Laboratory Automation System: Workflow and Clinical Validation

2019 ◽  
Vol 152 (Supplement_1) ◽  
pp. S31-S32
Author(s):  
Kaitlin Mitchell ◽  
Abby Crozier ◽  
Carey-Ann Burnham ◽  
Melanie Yarbrough
Keyword(s):  
Blood Culture ◽  
Positive Blood Culture ◽  
Culture Broth ◽  
Blood Cultures ◽  
Laboratory Automation ◽  
Clinical Testing ◽  
Gram Negative ◽  
Automated Processing ◽  
Total Laboratory Automation ◽  
Anaerobic Media

Abstract Automated systems for culture-based microbiology are in the early phase of implementation in clinical laboratories. Here, our objective was to evaluate the performance of the BD Kiestra Total Laboratory Automation (TLA) System for inoculation, incubation, and imaging of positive blood culture broth specimens. To optimize parameters for clinical testing, 56 clinical specimens were processed using both TLA and manual standard-of-care (SOC) methods. For TLA processing, 3 mL positive blood culture broth (35 VersaTREK: 19 aerobic, 16 anaerobic; 21 BD BACTEC: 15 aerobic, 6 anaerobic) was transferred to a no-additive vacutainer using a safety adapter and syringe. This aliquot was then placed on TLA for fully automated processing: 10 µL was inoculated to blood, chocolate, and MacConkey agar (Remel) and, for anaerobic bottles only, Brucella blood agar (Hardy Diagnostics). Kiestra cross-streak pattern 5 was optimal for obtaining isolated colonies and was superior to quadrant-streaking methods. Additional media types were added based on Gram stain results of the positive blood specimen: CandiSelect (Bio-Rad) and Sabouraud Dextrose (Remel) were added if yeast were identified, and Colistin Nalidixic Acid agar (Remel) for Gram stains with mixed Gram-positive and Gram-negative morphology. Plates were imaged at 6, 8, 10, 12, 18, 38, and 62 hours. Anaerobic media were placed by the system in a media stacker, incubated off-line, and then imaged on the TLA at 24, 48, and 72 hours. SOC cultures were evaluated after overnight incubation and on days 2 and 3. Organism identification was performed using MALDI-TOF MS (Bruker). Based on our evaluation, optimal parameters for clinical implementation of TLA were identified. Microbial growth was scant at 6 hours of incubation, but by 8 hours, small discrete colonies were observed for most aerobes. Thus, imaging parameters selected for routine clinical testing were 8, 18, and 38 hours for aerobic media and one image taken at 38 hours for anaerobic media. TLA and SOC culture results had 96% agreement (29 Gram positive, 12 Gram negative, 5 mixed, 6 yeast, 1 no growth). Two specimens with a second low-abundance bacterial population were observed on TLA that were not observed with SOC. Reproducibility of TLA was tested by processing 6 positive samples in triplicate and found to be 100%. There was no carryover or contamination noted between specimens processed simultaneously on TLA. To evaluate if implementation of TLA impacted epidemiology of positive blood cultures, we compared the 10 most common organisms recovered pre- and post-TLA implementation (August-November 2017 compared to August-November 2018). We found these organisms were not significantly impacted by TLA processing. In conclusion, automated processing of positive blood cultures improves laboratory workflows and facilitates faster workup at 8 hours of incubation. These results demonstrate that automation is a viable avenue for the processing of positive blood cultures.

scholarly journals 283. Epidemiology and Clinical Significance of Persistent Bacteremia in Severely Burned Patients

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S142-S143
Author(s):  
Lisa Townsend ◽  
Julie Rizzo ◽  
Ana E Markelz ◽  
Dana M Blyth
Keyword(s):  
Blood Culture ◽  
Clinical Significance ◽  
Positive Blood Culture ◽  
Univariate Analysis ◽  
Total Body Surface Area ◽  
Burn Patients ◽  
Gram Negative ◽  
Skin Flora ◽  
Duration Of Hospitalization ◽  
Persistent Bacteremia

Abstract Background Recent literature questions the utility of follow-up blood cultures (FUBC), especially for gram-negative bloodstream infections (BSIs). This has yet to be evaluated in the burn intensive care unit (BICU), where many BSIs are gram-negative. We evaluated the FUBC frequency, positivity rate, and clinical significance of persistent BSI (p-BSI) in BICU patients. Methods Patients ≥ 18 years old admitted to the US Army Institute of Surgical Research for combat-related thermal burns from 1/2003–6/2014 were included. P-BSI was defined as the same organism isolated from initial and FUBC (within 1–5 days). Non-p-BSI (np-BSI) included patients without subsequent isolation of the same organism between 1–5 days post-positive blood culture. Exclusion criteria were initial blood culture with usual skin flora, polymicrobial BSI, fungemia, and death within 24 hours of notification of initial positive blood culture. Those factors significantly associated with mortality on univariate analysis were evaluated with binomial logistic regression (BLR). Results Of 126 patients meeting inclusion criteria with BSI, 53 (42.1%) had p-BSI and 73 (57.9%) had np-BSI (table 1). 50 (67.6%) np-BSI patients had FUBC. P-BSI and np-BSI patients did not differ in age, gender, or race, but p-BSI and np-BSI patients had median total body surface area (TBSA) burns of 47 (IQR 34–63) and 35.3 (IQR 23.3–56.6), respectively (p=0.021). P-BSI patients had longer hospitalizations, ICU stays, and intubations (p< 0.01; table 1). Microbiology did not differ between p-BSI and np-BSI (p=0.517). Notably, 20 (37.7%) p-BSI patients died compared to 8 (10.8%) np-BSI patients (p< 0.001; table 2). BLR revealed that p-BSI (p=0.031), TBSA (p< 0.001), ISS (p=0.008), and length of ICU stay (p=0.002) and intubation (p< 0.001) were independently significantly associated with mortality. Table 1: Clinical characteristics of burn patients with and without persistent bacteremia Table 2: Univariate analysis evaluating associations with mortality in burn patients with bacteremia Conclusion P-BSI was common in this burn population. Severe burns and longer duration of hospitalization, ICU stays, and intubation, but not microbiology were associated with p-BSI. However, p-BSI (in addition to more traditionally identified risk factors like TBSA and duration of hospitalization, ICU, and ventilator days), was independently associated with increased mortality. FUBC may serve as an additional prognostic factor in burn patients with BSI. Disclosures All Authors: No reported disclosures

Microbial Cell-Free DNA Identifies Etiology of Bloodstream Infections, Persists Longer Than Conventional Blood Cultures, and its Duration of Detection is Associated with Metastatic Infection in Patients with Staphylococcus aureus and Gram-Negative Bacteremia

2021 ◽  
Author(s):  
Emily M Eichenberger ◽  
Christiaan R de Vries ◽  
Felicia Ruffin ◽  
Batu Sharma-Kuinkel ◽  
Lawrence Park ◽  
...  
Keyword(s):  
Staphylococcus Aureus ◽  
Blood Culture ◽  
Bloodstream Infection ◽  
Blood Cultures ◽  
Microbial Cell ◽  
Cell Free Dna ◽  
Gram Negative ◽  
Free Dna ◽  
Metastatic Infection ◽  
Gram Negative Bacteremia

Abstract Background Microbial cell-free DNA (mcfDNA) sequencing of plasma can identify presence of a pathogen in a host. This study evaluated the duration of pathogen detection by mcfDNA sequencing vs. conventional blood culture in patients with bacteremia. Methods Blood samples from patients with culture-confirmed bloodstream infection were collected within 24 hours of the index positive blood culture and 48 to 72 hours thereafter. mcfDNA was extracted from plasma and next-generation sequencing (NGS) applied. Reads were aligned against a curated pathogen database. Statistical significance was defined with Bonferroni adjustment for multiple comparisons (p < 0.0033). Results A total of 175 patients with Staphylococcus aureus bacteremia (SAB; n=66), Gram-negative bacteremia (GNB; n=74), or non-infected controls (n=35) were enrolled. The overall sensitivity of mcfDNA sequencing compared to index blood culture was 89.3% (125/140) and the specificity was 74.3%. Among patients with bacteremia, pathogen specific mcfDNA remained detectable for significantly longer than conventional blood cultures (median 15 days vs. 2 days; p<0.0001). Each additional day of mcfDNA detection significantly increased the odds of metastatic infection (Odds Ratio [OR]: 2.89; 95% Confidence Interval [CI]: 1.53-5.46; p=0.0011). Conclusions Pathogen mcfDNA identified the bacterial etiology of bloodstream infection for a significantly longer interval than conventional cultures, and its duration of detection was associated with increased risk for metastatic infection. mcfDNA could play a role in the diagnosis of partially treated endovascular infections.

Impact of rapid diagnostics with antimicrobial stewardship support for children with positive blood cultures: A quasi-experimental study with time trend analysis

2020 ◽  
Vol 41 (8) ◽  
pp. 883-890
Author(s):  
Alison C. Tribble ◽  
Jeffrey S. Gerber ◽  
Warren B. Bilker ◽  
Ebbing Lautenbach
Keyword(s):  
Blood Culture ◽  
Antimicrobial Stewardship ◽  
Positive Blood Culture ◽  
Interrupted Time Series ◽  
Blood Cultures ◽  
Hospitalized Children ◽  
Gram Positive ◽  
Gram Negative ◽  
Definitive Therapy ◽  
Quasi Experimental

AbstractObjective:Evaluate the clinical impact of the implementation of VERIGENE gram-positive blood culture testing (BC-GP) coupled with antimicrobial stewardship result notification for children with positive blood cultures.Design:Quasi-experimental study.Setting:Quaternary children’s hospital.Patients:Hospitalized children aged 0–21 years with positive blood culture events 1 year before and 1 year after implementation of BC-GP testing.Methods:The primary outcome was time to optimal antibiotic therapy for positive blood cultures, defined as receiving definitive therapy without unnecessary antibiotics (pathogens) or no antibiotics (contaminants). Secondary outcomes were time to effective therapy, time to definitive therapy, and time to stopping vancomycin, length of stay, and 30-day mortality. Time-to-therapy outcomes before and after the intervention were compared using Cox regression models and interrupted time series analyses, adjusting for patient characteristics and trends over time. Gram-negative events were included as a nonequivalent dependent variable.Results:We included 264 preintervention events (191 gram-positive, 73 gram-negative) and 257 postintervention events (168 gram-positive, 89 gram-negative). The median age was 2.9 years (interquartile range, 0.3–10.1), and 418 pediatric patients (80.2%) had ≥1 complex chronic condition. For gram-positive isolates, implementation of BC-GP testing was associated with an immediate reduction in time to optimal therapy and time to stopping vancomycin for both analyses. BC-GP testing was associated with decreased time to definitive therapy in interrupted time series analysis but not Cox modeling. No such changes were observed for gram-negative isolates. No changes in time to effective therapy, length of stay, or mortality were associated with BC-GP.Conclusions:The implementation of BC-GP testing coupled with antimicrobial stewardship result notification was associated with decreased time to optimal therapy and time to stopping vancomycin for hospitalized children with gram-positive blood culture isolates.

scholarly journals 649. Clinical Implementation of a Rapid Susceptibility Testing Procedure, Directly From a Positive Blood Culture Using the Vitek®2 System on Gram Negative Rods

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S383-S383
Author(s):  
Charma Henry ◽  
Dustin Evans ◽  
Daniel Navas ◽  
Arleen Barker ◽  
Chonnapat Somyos ◽  
...  
Keyword(s):  
Blood Culture ◽  
Positive Blood Culture ◽  
Susceptibility Testing ◽  
Testing Procedure ◽  
Turnaround Time ◽  
National Average ◽  
Major Error ◽  
Clinical Implementation ◽  
Salmonella Spp ◽  
Gram Negative

Abstract Background The national average of identification and susceptibility for organisms isolated from positive blood culture to final susceptibility based on growth on solid media is 48 hours. The goal of this research was to prove that the Vitek®2 (bioMérieux, Inc.) system can provide an accurate and reliable susceptibility result directly from positive blood culture for Gram negative rods and reduce the turnaround time (TAT) from positive blood culture to the final susceptibility. Methods An FDA-modified validation procedure was performed on positive blood cultures directly from the bottle to the VITEK®2 System for susceptibility testing. The protocol tested and validated an aliquot of 50uL of blood directly from the positive bottle into 10 mL of saline (1:200). The solution was vortexed and 3mL were placed in the VITEK®2 test tube. This protocol was intended only for Gram negative rods using the AST-GN70, AST-GN81 & AST-GN801 cards. This protocol followed the CLSI M52 and M100 guidelines. Results 515 organisms from clinical blood culture samples from July 2018 to October 2019 were evaluated. Organisms included, but were not limited to: E. coli, K. pneumoniae, Enterobacter spp., and P. aeruginosa, Proteus spp., Salmonella spp., Acinetobacter spp., and S. maltophilia. There were 5,201 drug/bug combinations. AdventHealth Orlando achieved an essential agreement of 99.32% (n=5,166), minor error 0.74% (n=39) major error 0.02% (n=1) and very major error 0.49% (n=2). A 100% agreement was achieved on detection of ESBL, CRE, and MDR organisms. Conclusion Rapid direct blood culture protocol using the VITEK®2 System and the AST-GN cards is accurate, reliable and can be performed with less than 1 minute hands-on time. The protocol can be implemented in any laboratory at no additional costs or modification where the current VITEK®2 AST-GN panels are in use. This protocol was clinically implemented at AdventHealth Orlando on July 15, 2019. Compared with the national average of 72 hours, the TAT obtained during this study was 23 hours from positive blood culture to final susceptibility, a significant reduction of 25 hours. The authors encourage bioMérieux Inc. to evaluate and explore the opportunity to expand the use of the VITEK®2 system for this application with the appropriate clinical trial. Disclosures All Authors: No reported disclosures

Risk factors and clinical outcomes associated with blood culture contamination

2021 ◽  
pp. 1-7
Author(s):  
Justin M. Klucher ◽  
Kevin Davis ◽  
Mrinmayee Lakkad ◽  
Jacob T. Painter ◽  
Ryan K. Dare
Keyword(s):  
Risk Factors ◽  
Logistic Regression ◽  
Blood Culture ◽  
Hospital Mortality ◽  
Clinical Outcomes ◽  
Tertiary Care ◽  
Blood Cultures ◽  
Hospital Charges ◽  
Patient Specific ◽  
Contaminated Blood

Abstract Objective: To determine patient-specific risk factors and clinical outcomes associated with contaminated blood cultures. Design: A single-center, retrospective case-control risk factor and clinical outcome analysis performed on inpatients with blood cultures collected in the emergency department, 2014–2018. Patients with contaminated blood cultures (cases) were compared to patients with negative blood cultures (controls). Setting: A 509-bed tertiary-care university hospital. Methods: Risk factors independently associated with blood-culture contamination were determined using multivariable logistic regression. The impacts of contamination on clinical outcomes were assessed using linear regression, logistic regression, and generalized linear model with γ log link. Results: Of 13,782 blood cultures, 1,504 (10.9%) true positives were excluded, leaving 1,012 (7.3%) cases and 11,266 (81.7%) controls. The following factors were independently associated with blood-culture contamination: increasing age (adjusted odds ratio [aOR], 1.01; 95% confidence interval [CI], 1.01–1.01), black race (aOR, 1.32; 95% CI, 1.15–1.51), increased body mass index (BMI; aOR, 1.01; 95% CI, 1.00–1.02), chronic obstructive pulmonary disease (aOR, 1.16; 95% CI, 1.02–1.33), paralysis (aOR 1.64; 95% CI, 1.26–2.14) and sepsis plus shock (aOR, 1.26; 95% CI, 1.07–1.49). After controlling for age, race, BMI, and sepsis, blood-culture contamination increased length of stay (LOS; β = 1.24 ± 0.24; P < .0001), length of antibiotic treatment (LOT; β = 1.01 ± 0.20; P < .001), hospital charges (β = 0.22 ± 0.03; P < .0001), acute kidney injury (AKI; aOR, 1.60; 95% CI, 1.40–1.83), echocardiogram orders (aOR, 1.51; 95% CI, 1.30–1.75) and in-hospital mortality (aOR, 1.69; 95% CI, 1.31–2.16). Conclusions: These unique risk factors identify high-risk individuals for blood-culture contamination. After controlling for confounders, contamination significantly increased LOS, LOT, hospital charges, AKI, echocardiograms, and in-hospital mortality.

scholarly journals 48. Association of Rapid Pathogen Identification and Pharmacist Intervention on Time to Optimal Antimicrobial Therapy for Bloodstream Infections at Two Community Hospitals

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S47-S47
Author(s):  
Bryant M Froberg ◽  
Nicholas Torney
Keyword(s):  
Blood Culture ◽  
Hospital Mortality ◽  
Positive Blood Culture ◽  
Antimicrobial Therapy ◽  
Length Of Hospital Stay ◽  
Bloodstream Infections ◽  
Pharmacist Intervention ◽  
Pathogen Identification ◽  
Community Hospitals ◽  
Significant Difference

Abstract Background As many as 1 in 3 patients with bloodstream infections at community hospitals receive inappropriate empiric antimicrobial therapy. Studies have shown that the coupling of real-time intervention with rapid pathogen identification improves patient outcomes and decreases health-system costs at large, tertiary academic centers. The aim of this study was to assess if similar outcomes could be obtained with the implementation of real-time pharmacist intervention to rapid pathogen identification at two smaller, rural community hospitals. Methods This was a pre-post implementation study that occurred from September of 2019 to March 2020. This study included patients ≥18 years of age admitted with one positive blood culture. Patients were excluded if they were pregnant, had a polymicrobial blood culture, known culture prior to admission, hospice consulted prior to admission, expired prior to positive blood culture, or transferred to another hospital within 24 hours of a positive blood culture. Endpoints of patients prior to intervention were compared to patients post-implementation. The primary endpoint was time to optimal antimicrobial therapy. Secondary endpoints included time to effective antimicrobial therapy, in-hospital mortality, length of hospital stay, and overall cost of hospitalization. Results Of 212 patients screened, 88 patients were included with 44 patients in each group. Both groups were similar in terms of comorbidities, infection source, and causative microbial. No significant difference was seen in the mean time to optimal antimicrobial therapy (27.3±35.5 hr vs 19.4± 30 hr, p=0.265). Patients in the post-implementation group had a significantly higher mean hospitalization cost ($24,638.87± $11,080.91 vs $32,722.07±$13,076.73, p=0.013). There was no significant difference in time to effective antimicrobial therapy, in-hospital mortality, or length of hospital stay. Conclusion There were no between-group differences in the primary outcome of time to optimal therapy, with a higher mean hospitalization cost after implementation. These results suggest further antimicrobial stewardship interventions are needed, along with larger studies conducted in the community hospital settings. Disclosures All Authors: No reported disclosures

Sign in / Sign up

Export Citation Format

Share Document