scholarly journals 188. Which patients with gram-negative bacteremia need follow-up blood cultures?

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S114-S114
Author(s):  
Jongtak Jung ◽  
Song Mi Moon ◽  
Eu Suk Kim ◽  
Hong Bin Kim ◽  
Ji Hwan Bang ◽  
...  
Keyword(s):  
Risk Factors ◽  
Treatment Response ◽  
Source Control ◽  
Care Hospital ◽  
Predictive Values ◽  
Gram Negative ◽  
Negatively Associated ◽  
Source Of Infection ◽  
Gram Negative Bacteremia

Abstract Background Universal follow-up blood culture (FUBC) in gram-negative bacteremia (GNB) is not recommended, but it has been routinely conducted in many acute-care hospitals. In contrast with Staphylococcus aureus bacteremia, risk factors for positive FUBC in GNB have not been well investigated. Therefore, we tried to identify the risk factors for and develop predictive scores of positive FUBC. Methods All adults (≥18 years-old) with GNB were identified in a tertiary-care hospital during the 2-year period, retrospectively. Death within 2 days of GNB and polymicrobial infection with gram-positive bacteria or fungus were excluded. GNB were classified into eradicable and non-eradicable source of infection groups, according to the possibility of source removal. We performed multivariate analyses for identifying risk factors for positive FUBC and built prediction scores using the coefficients of the multivariate logistic regression models. Results Of total 1,473 GNB, FUBC was drawn in 1,268 (86%) patients and 122 (9.6%) had positive results. In patients with eradicable source of infection, ESBL-producing microorganism, catheter-related bloodstream infection, unfavorable treatment response, and quick sequential organ failure assessment (qSOFA) score (≥2) were associated. On the other hand, administration of effective antibiotics and adequate source control were negatively associated with positive FUBC. In non-eradicable source of infection, end-stage renal disease on hemodialysis, and unfavorable treatment response were related to positive FUBC and administration of effective antibiotics was negatively associated (Table 1). When we built prediction scores according to the coefficients, the areas under the curves were 0.864 (95% confidence interval [CI95] 0.816–0.912) and 0.792 (CI95, 0.721–0.861), respectively. When we applied a cutoff of 0, specificities/negative predictive values in eradicable and non-eradicable source of infection groups were 84.7%/95.6% and 95.5%/95.0%, respectively (Table 2). Conclusion Our prediction scores based on adequate source control and use of effective antibiotics showed high specificities and negative predictive values. Therefore, we could expect these score systems to contribute to reducing unnecessary FUBC in GNB. Disclosures All authors: No reported disclosures.

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

2020 ◽  
Vol 20 (1) ◽  
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.

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

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.

scholarly journals The Changing Landscape of Uncomplicated Gram-Negative Bacteremia: A Narrative Review to Guide Inpatient Management

2020 ◽  
Vol 15 (12) ◽  
pp. 746-753 ◽  
Author(s):  
Jeannie D Chan ◽  
Chloe Bryson-Cahn ◽  
Zahra Kassamali-Escobar ◽  
John B Lynch ◽  
Anneliese M Schleyer
Keyword(s):  
Cost Effective ◽  
Hospital Length ◽  
Antimicrobial Treatment ◽  
Blood Cultures ◽  
Hospital Length Of Stay ◽  
Source Control ◽  
Gram Negative ◽  
Oral Agents ◽  
Gram Negative Bacteremia

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.

scholarly journals Does This Patient Need Blood Cultures? A Scoping Review of Indications for Blood Cultures in Adult Nonneutropenic Inpatients

2020 ◽  
Vol 71 (5) ◽  
pp. 1339-1347 ◽  
Author(s):  
Valeria Fabre ◽  
Sima L Sharara ◽  
Alejandra B Salinas ◽  
Karen C Carroll ◽  
Sanjay Desai ◽  
...  
Keyword(s):  
Risk Factors ◽  
Scoping Review ◽  
Primary Source ◽  
Blood Cultures ◽  
Source Control ◽  
High Likelihood ◽  
Source Of Infection ◽  
Patients At Risk ◽  
High Pretest Probability

Abstract Guidance regarding indications for initial or follow-up blood cultures is limited. We conducted a scoping review of articles published between January 2004 and June 2019 that reported the yield of blood cultures and/or their impact in the clinical management of fever and common infectious syndromes in nonneutropenic adult inpatients. A total of 2893 articles were screened; 50 were included. Based on the reported incidence of bacteremia, syndromes were categorized into low, moderate, and high pretest probability of bacteremia. Routine blood cultures are recommended in syndromes with a high likelihood of bacteremia (eg, endovascular infections) and those with moderate likelihood when cultures from the primary source of infection are unavailable or when prompt initiation of antibiotics is needed prior to obtaining primary source cultures. In syndromes where blood cultures are low-yield, blood cultures can be considered for patients at risk of adverse events if a bacteremia is missed (eg, patient with pacemaker and severe purulent cellulitis). If a patient has adequate source control and risk factors or concern for endovascular infection are not present, most streptococci or Enterobacterales bacteremias do not require routine follow-up blood cultures.

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

Antibiotics ◽  
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.

Risk factors for fecal carriage of IMP-6-producing Enterobacteriaceae at a long-term care hospital in Japan: A follow-up report from the northern Osaka multicentre study group

2018 ◽  
Vol 24 (9) ◽  
pp. 769-772 ◽  
Author(s):  
Hideharu Hagiya ◽  
Norihisa Yamamoto ◽  
Ryuji Kawahara ◽  
Yukihiro Akeda ◽  
Rathina Kumar Shanmugakani ◽  
...  
Keyword(s):  
Risk Factors ◽  
Multicentre Study ◽  
Long Term Care ◽  
Study Group ◽  
Care Hospital ◽  
Term Care ◽  
Fecal Carriage

Reply to comments: duration of antimicrobial therapy for Gram-negative bacteremia secondary to urinary source of infection

Infection ◽  
2018 ◽  
Vol 46 (2) ◽  
pp. 283-284 ◽  
Author(s):  
Majdi N. Al-Hasan ◽  
Avery N. Nelson ◽  
Julie Ann Justo ◽  
Helmut Albrecht ◽  
Joseph Kohn ◽  
...  
Keyword(s):  
Antimicrobial Therapy ◽  
Gram Negative ◽  
Source Of Infection ◽  
Gram Negative Bacteremia

Risk Factors for Methicillin-Resistant Staphylococcus aureus (MRSA) Acquisition in Roommate Contacts of Patients Colonized or Infected With MRSA in an Acute-Care Hospital

2008 ◽  
Vol 29 (7) ◽  
pp. 600-606 ◽  
Author(s):  
Christine Moore ◽  
Jastej Dhaliwal ◽  
Agnes Tong ◽  
Sarah Eden ◽  
Cindi Wigston ◽  
...  
Keyword(s):  
Risk Factors ◽  
Staphylococcus Aureus ◽  
Acute Care ◽  
Significant Risk ◽  
Acute Care Hospital ◽  
Skin Lesions ◽  
Care Hospital ◽  
Methicillin Resistant ◽  
The Impact

Objective.To identify risk factors for acquisition of methicillin-resistant Staphylococcus aureus (MRSA) in patients exposed to an MRSA-colonized roommate.Design.Retrospective cohort study.Setting.A 472-bed acute-care teaching hospital in Toronto, Canada.Patients.Inpatients who shared a room between 1996 and 2004 with a patient who had unrecognized MRSA colonization.Methods.Exposed roommates were identified from infection-control logs and from results of screening for MRSA in the microbiology database. Completed follow-up was defined as completion of at least 2 sets of screening cultures (swab samples from the nares, the rectum, and skin lesions), with at least 1 set of samples obtained 7–10 days after the last exposure. Chart reviews were performed to compare those who did and did not become colonized with MRSA.Results.Of 326 roommates, 198 (61.7%) had completed follow-up, and 25 (12.6%) acquired MRSA by day 7–10 after exposure was recognized, all with strains indistinguishable by pulsed-field gel electrophoresis from those of their roommate. Two (2%) of 101 patients were not colonized at day 7–10 but, with subsequent testing, were identified as being colonized with the same strain as their roommate (one at day 16 and one at day 18 after exposure). A history of alcohol abuse (odds ratio [OR], 9.8 [95% confidence limits {CLs}, 1.8, 53]), exposure to a patient with nosocomially acquired MRSA (OR, 20 [95% CLs, 2.4,171]), increasing care dependency (OR per activity of daily living, 1.7 [95% CLs, 1.1, 2.7]), and having received levofloxacin (OR, 3.6 [95% CLs, 1.1,12]) were associated with MRSA acquisition.Conclusions.Roommates of patients with MRSA are at significant risk for becoming colonized. Further study is needed of the impact of hospital antimicrobial formulary decisions on the risk of acquisition of MRSA.

scholarly journals 116. Risk Factors and Clinical Outcomes of Carbapenem Non-Susceptible Gram-Negative Bacteremia in Patients with Acute Myelogenous Leukemia

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S89-S89
Author(s):  
Dong Hoon Shin ◽  
Kang Il Jun ◽  
Song Mi Moon ◽  
Wan Beom Park ◽  
Ji Hwan Bang ◽  
...  
Keyword(s):  
Risk Factors ◽  
Clinical Outcomes ◽  
Acute Myelogenous Leukemia ◽  
Myelogenous Leukemia ◽  
Resistant Organism ◽  
Time Interval ◽  
Gram Negative ◽  
Gram Negative Bacteremia ◽  
Acute Myelogenous ◽  
Independent Risk Factors

Abstract Background Early administration of susceptible antibiotics is crucial in Gram-negative bacteremia (GNB), especially in immunocompromised patients. We aimed to explore risk factors and clinical outcomes of carbapenem non-susceptible (Carba-NS) GNB in patients with acute myelogenous leukemia (AML). Methods Cases of all GNB during induction or consolidation chemotherapy for AML in a 15-year period in a tertiary hospital were retrospectively reviewed. Independent risk factors for Carba-NS GNB were sought and its clinical outcomes were compared with those of carbapenem susceptible (Carba-S) GNB. Results Among 485 GNB cases from 930 patients, 440 (91%) were Carba-S and 45 (9%) were Carba-NS GNB. Frequent Carba-NS isolates were Stenotrophomonas maltophilia (n = 23), Pseudomonas aeruginosa (n = 11), and Acinetobacter baumannii (n = 10). Independent risk factors for Carba-NS GNB were carbapenem use at the onset of GNB (aOR [95% CI], 78.6 [24.4–252.8]; P < 0.001), the isolation of imipenem-resistant A. baumannii in the prior 1 year (aOR [95% CI], 14.6 [2.7–79.9]; P = 0.002), time interval from chemotherapy to GNB ≥20 days (aOR [95% CI], 4.7 [1.7–13.1]; P = 0.003), and length of hospital stay ≥30 days (aOR [95% CI], 3.4 [1.3–9.1]; P = 0.013). Except breakthrough GNBs which occurred during carbapenem treatment, the frequency of Carba-NS GNB was 48% (19/40) in cases having ≥2 risk factors other than carbapenem use. 30-day overall mortality (Carba-NS, 36% vs. Carba-S, 6%; P < 0.001) and in-hospital mortality (Carba-NS, 47% vs. Carba-S, 9%; P < 0.001) were significantly higher in Carba-NS GNB. Conclusion Carba-NS GNB in AML patients was independently associated with the use of carbapenem, the past isolation of resistant organism, and late onset of GNB, and its clinical outcomes were poorer than those of Carba-S GNB. Carba-NS organisms should be considered for antibiotic selection in AML patients having these risk factors. Disclosures All authors: No reported disclosures.

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