scholarly journals Prognostic Value of the Time-to-Positivity in Blood Cultures from Septic Shock Patients with Bacteremia Receiving Protocol-Driven Resuscitation Bundle Therapy: A Retrospective Cohort Study

Antibiotics ◽  
2021 ◽  
Vol 10 (6) ◽  
pp. 683
Author(s):  
Hong-Jun Bae ◽  
June-sung Kim ◽  
Muyeol Kim ◽  
Youn-Jung Kim ◽  
Won Young Kim
Keyword(s):  
Escherichia Coli ◽  
Septic Shock ◽  
Prognostic Value ◽  
Fungal Pathogens ◽  
Tertiary Hospital ◽  
Blood Cultures ◽  
Time To Positivity ◽  
Data Registry ◽  
Significant Difference ◽  
Failure Assessment

Introduction: To evaluate the prognostic value of the time-to-positivity in patients with culture-positive septic shock. Methods: Retrospective study using a prospective data registry was performed at the emergency department of a tertiary hospital. Consecutive adult patients with septic shock (N = 2499) were enrolled between 2014 and 2018. Bacteremia was defined using blood cultures, and viral and fungal pathogens were excluded. The primary outcome was the 28-day mortality. Results: In 803 (46.7%) septic shock patients with bacteremia, median TTP was 10.1 h. The most prevalent isolated bacterial pathogens were Escherichia coli (40.8%) and Klebsiella (23.4%). Although the TTP correlated with a higher sequential organ failure assessment score (Spearman’s rho = −0.12, p < 0.01), it showed no significant difference between the 28-day survivors and non-survivors (10.2 vs. 9.4 days, p = 0.35). In subgroup analysis of the Escherichia coli and Klebsiella bacteremia cases, a shorter TTP showed prognostic value for predicting the 28-day mortality. The optimal TTP cut-off for Escherichia coli and Klebsiella was 10 h and 8 h, respectively. Conclusions: The prognostic value of the TTP in septic shock patients receiving bundle therapy may be limited and its clinical interpretation should only be made on a pathogen-specific basis.

scholarly journals Prognostic roles of time to positivity of blood cultures in patients with Escherichia coli bacteremia

2020 ◽  
Vol 148 ◽  
Author(s):  
Yufang Chen ◽  
Xun Huang ◽  
Anhua Wu ◽  
Xuan Lin ◽  
Pengcheng Zhou ◽  
...  
Keyword(s):  
Escherichia Coli ◽  
Intensive Care Unit ◽  
Septic Shock ◽  
Intensive Care ◽  
Intensive Care Unit Admission ◽  
Blood Cultures ◽  
University Teaching ◽  
Clinical Value ◽  
Prognostic Assessment ◽  
Time To Positivity

Abstract The time to positivity (TTP) of blood cultures has been considered a predictor of clinical outcomes for bacteremia. This retrospective study aimed to determine the clinical value of TTP for the prognostic assessment of patients with Escherichia coli bacteremia. A total of 167 adult patients with E.coli bacteremia identified over a 22-month period in a 3500-bed university teaching hospital in China were studied. The standard cut-off TTP was 11 h in the patient cohort. The septic shock occurred in 27.9% of patients with early TTP (⩽11 h) and in 7.1% of those with a prolonged TTP (>11 h) (P = 0.003). The mortality rate was significantly higher for patients in the early than in the late group (17.7% vs. 4.0%, P < 0.001). Multivariate analysis showed that an early TTP (OR 4.50, 95% CI 1.70–11.93), intensive care unit admission (OR 8.39, 95% CI 2.01–35.14) and neutropenia (OR 4.20, 95% CI 1.55–11.40) were independently associated with septic shock. Likewise, the independent risk factors for mortality of patients were an early TTP (OR 3.80, 95% CI 1.04–12.90), intensive care unit admission (OR 6.45; 95% CI 1.14–36.53), a Pittsburgh bacteremia score ⩾2 (OR 4.34, 95% CI 1.22–15.47) and a Charlson Comorbidity Index ⩾3 (OR 11.29, 95% CI 2.81–45.39). Overall, a TTP for blood cultures within 11 h appears to be associated with worse outcomes for patients with E.coli bacteremia.

Acquired Antithrombin III (AT III) - Deficiency in Septicaemia

1979 ◽  
Author(s):  
E. Deutsch ◽  
E. Thaler
Keyword(s):  
Septic Shock ◽  
Venous Blood ◽  
Heparin Therapy ◽  
Blood Cultures ◽  
Mean Values ◽  
Negative Results ◽  
Significant Difference ◽  
At Iii ◽  
Group 2 ◽  
Group 1

AT III was measured in 34 patients with clinical and bacteriological evidence of septicaemia using a heparin cofactor assay. Based on the results of positive blood cultures gram-negative septicaemia (G-S) was diagnosed in 10 (group 1) and gram positive septicaemia (G+S) in 9 patients (group 2). From the remaining 15 patients {group 3) blood cultures before onset of antibiotic therapy were not obtained and gave negative results throughout the observation period. Based on bacteria] cultures from other sites than venous blood or bacteriological examination of spinal fluid G-S was assumed in 13 and G+S in 2 patients.In all but one patient of group 1 and one of group 2 AT III activities were decreased below 2 SO of normal controls (n = 91, x = 99.6, SD-8.4) already at the time of the first coagulation screening (patients: n=34, =58.4, SD-16.6). Analysis of var-ance showed no significant difference between the mean values of the three groups at the c per cent (%) level. The minimal AT III activities during the course of the disease were below the norma] range in all patients studied [n=34, =51.2, SD=13.6).Thus AT III deficiency appears to be a constant and early finding in G-S and G+S, causing insufficient inhibition of blood coagulation, and hereby may contribute to irreversible tissue damage caused by microthrombi in septic shock. This deficiency may be an important factor in the failure of heparin therapy to reduce mortality from septic shock.

scholarly journals Development of a Mortality Prediction Model Combined With time to Positivity for Solid Tumor Patients with Escherichia Coli Bacteremia

2020 ◽  
Author(s):  
Qing Zhang ◽  
Haoyang Gao ◽  
Ding Li ◽  
Changsen Bai ◽  
Zheng Li ◽  
...  
Keyword(s):  
Risk Factors ◽  
Escherichia Coli ◽  
Logistic Regression ◽  
Cancer Patients ◽  
Tumor Patients ◽  
Scoring Model ◽  
Time To Positivity ◽  
Significant Difference ◽  
Development And Validation ◽  
Risk Of Cancer

Abstract Background: To develop a scoring model incorporating time to positivity (TTP) into clinical variables for predicting the mortality of tumor patients with Escherichia coli caused bloodstream infection (ECBSI).Methods: A retrospective single center study enrolling hospitalized cancer patients with ECBSI was conducted from 2013 to 2018. The patients were randomly divided into development and validation groups. Univariable and multivariable logistic regression analysis were used to identify risk factors for mortality. The scoring model was developed and validated based on logistic regression coefficients.Results: 315 and 194 patients with ECBSI were included in development and validation groups, respectively. Six significant risk factors for mortality were identified and included in the scoring model: fever ≥ 39℃, inappropriate antibiotic therapy, metastasis, acute respiratory distress (ARDS), blood transfusion, and TTP ≤ 8h. Patients were classified into low-risk (<10% mortality), medium-risk (10%-20% mortality) and high-risk (≥20% mortality) categories based on the predicted mortality rates in each score. The predicted mortality for the three categories was 4.38%, 15.39%, and 51.77%, respectively, in the development group, and 3.72%, 13.88%, and 50.09%, respectively, in the validation group. The model showed excellent discrimination and calibration for both groups, with AUC curves being 0.858 versus 0.835, respectively, and no significant difference in the Hosmer-Lemeshow test (6.709, P=0.48) and the Chi-square test (6.993, P=0.46). Sensitivity and negative predictive values (NPV) increased along with the decrease of cut-off values.Conclusion: The developed TTP-combined scoring model is feasible for clinicians to predict the mortality risk of cancer patients with ECBSI.

scholarly journals Effects of thiamine on vasopressor requirements in patients with septic shock: a prospective randomized controlled trial

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Suttasinee Petsakul ◽  
Sunthiti Morakul ◽  
Viratch Tangsujaritvijit ◽  
Parinya Kunawut ◽  
Pongsasit Singhatas ◽  
...  
Keyword(s):  
Septic Shock ◽  
Sample Size ◽  
Primary Outcome ◽  
Controlled Trial ◽  
Tertiary Hospital ◽  
Double Blind ◽  
Randomized Controlled ◽  
Prospective Randomized Controlled Trial ◽  
Significant Difference ◽  
Dependency Index

Abstract Background Thiamine, an essential vitamin for aerobic metabolism and glutathione cycling, may decrease the effects of critical illnesses. The objective of this study was to determine whether intravenous thiamine administration can reduce vasopressor requirements in patients with septic shock. Methods This study was a prospective randomized double-blind placebo-controlled trial. We included adult patients with septic shock who required a vasopressor within 1–24 h after admission between March 2018 and January 2019 at a tertiary hospital in Thailand. Patients were divided into two groups: those who received 200 mg thiamine or those receiving a placebo every 12 h for 7 days or until hospital discharge. The primary outcome was the number of vasopressor-free days over 7 days. The pre-defined sample size was 31 patients per group, and the study was terminated early due to difficult recruitment. Results Sixty-two patients were screened and 50 patients were finally enrolled in the study, 25 in each group. There was no difference in the primary outcome of vasopressor-free days within the 7-day period between the thiamine and placebo groups (mean: 4.9 days (1.9) vs. 4.0 days (2.7), p = 0.197, mean difference − 0.9, 95% CI (− 2.9 to 0.5)). However, the reductions in lactate (p = 0.024) and in the vasopressor dependency index (p = 0.02) at 24 h were greater among subjects who received thiamine repletion vs. the placebo. No statistically significant difference was observed in SOFA scores within 7 days, vasopressor dependency index within 4 days and 7 days, or 28-day mortality. Conclusions Thiamine was not associated to a significant reduction in vasopressor-free days over 7-days in comparison to placebo in patients with septic shock. Administration of thiamine could be associated with a reduction in vasopressor dependency index and lactate level within 24 h. The study is limited by early stopping and low sample size. Trial registration TCTR, TCTR20180310001. Registered 8 March 2018, http://www.clinicaltrials.in.th/index.php?tp=regtrials&menu=trialsearch&smenu=fulltext&task=search&task2=view1&id=3330.

P942 Time to positivity of blood cultures in patients Escherichia coli bacteraemia

2007 ◽  
Vol 29 ◽  
pp. S247
Author(s):  
G. Peralta ◽  
B. Ceballos ◽  
L. Garcìa-Mauriño ◽  
M.P. Roiz ◽  
J.C. Garrido ◽  
...  
Keyword(s):  
Escherichia Coli ◽  
Blood Cultures ◽  
Time To Positivity

scholarly journals Impact of SARS-COV-2 on the diagnosis of community bacteremia in a tertiary hospital

2022 ◽  
Author(s):  
Saray Mormeneo Bayo ◽  
Miguel Moreno Hijazo ◽  
María Pilar Palacián Ruíz, ◽  
María Cruz Villuendas Usón
Keyword(s):  
Escherichia Coli ◽  
Emergency Department ◽  
Staphylococcus Aureus ◽  
Tertiary Hospital ◽  
Blood Cultures ◽  
Contamination Rate ◽  
Beta Lactamases ◽  
E Coli ◽  
Number Of Patients ◽  
Extended Spectrum Beta Lactamases

Objective. We carry out an analysis of the bacteremia diagnosed in the Emergency Department during 2020, coinciding with the period of the pandemic. Method. We performed a retrospective analysis from March 4, 2020 to December 31, 2020. Results. The number of patients who went to the Emergency Department during the study period and the number of extracted blood cultures decreased by 46.79% and 35.7% compared to the same period in 2019 (p <0.05). 320 bacteremia occurred while 507 occurred in 2019, assuming a decrease of 36.8% (p <0.05). The positivity rate of blood cultures was 7.09% in 2020 and 7.23% in 2019 and the contamination rate was 7.07 % in 2020 and 5.67% in 2019. The most frequently isolated microorganism was Escherichia coli, followed by Staphylococcus aureus and Klebsiella pneumoniae. A 6.62% of the isolated E. coli were carriers of extended-spectrum beta-lactamases (ESBL). The percentage of methicillin-resistant S. aureus was 12.9 % and that of K. pneumoniae ESBL was 11.54%. Conclusion. During the SARS-CoV-2 pandemic there has been a decrease in the number of bacteremia diagnoses, it is possible that attention was focused especially on COVID, forgetting other diseases, such as bacteremia.

Social-Economic Burden of Patients with Bloodstream Infections Caused by Extended-Spectrum β-Lactamase-Producing Escherichia Coli

2020 ◽  
Author(s):  
Yuan Wang ◽  
Tingting Xiao ◽  
Yunying Zhu ◽  
Jing Ye ◽  
Kai Yang ◽  
...  
Keyword(s):  
Escherichia Coli ◽  
Economic Burden ◽  
Bloodstream Infections ◽  
Medical Costs ◽  
Tertiary Hospital ◽  
Interquartile Range ◽  
E Coli ◽  
Extended Spectrum ◽  
Significant Difference ◽  
Third Line

Abstract Background: The prevalence of infections with extended-spectrum β-lactamase-producing Escherichia coli (ESBL-EC) is increasing worldwide, but the economic impact of ESBL-EC bloodstream infections (BSI) has not been comprehensively evaluated.Methods: A retrospective cohort including patients hospitalized at a tertiary hospital between January 2013 and December 2016 who confirmed with BSI of ESBL-EC or non-ESBL-EC was set. Clinical data and medical costs were collected by chart review of electronic and paper medical records. The socio-economic burden was evaluated with DALYs.Results: A total of 580 patients with E. coli BSI, comprising 333 patients (57.4%) with ESBL-EC BSI and 247 patients (42.6%) with non-ESBL-EC BSI, were identified. There were no significant differences in comorbidity and severity of patients between ESBL-EC and non-ESBL-EC BSIs. The median length of stay (LOS) after bacteremia was 12 days for ESBL-EC(interquartile range, 7 to 21), versus 11 days for non-ESBL-EC (interquartile range, 7 to 21) (P =0.38), and appropriate empirical antimicrobial therapy occurred in 87.4% versus 89.9% (P =0.353). The mortalities were 20.1% versus 17.4% (P =0.41). Patients with ESBL-EC did not have significant difference in-hospital medical costs than those with non-ESBL-EC (median, $8048.68 vs $7476.84, respectively,with a difference of $571.84,P=0.321). In non-ESBL-EC group, 247 patients lost 531.05 DALYs in total, with an average of 2.15 DALYs per person,while in ESBL-EC group, 333 patients lost 692.64 DALYs in total, with an average of 2.08 DALYs per person. There is no significant difference in average DALY(P=0.343).Conclusions: In conclusion, patients with BSI due to ESBL-EC did not cost more than patients with BSI due to non-ESBL-EC. This phenomenon may be attributed to timely and effective antibiotic treatment，but the intitial empiric thrapy with second or third line antibitoics in non-ESBL-EC BSI should be corrected.

scholarly journals Effect of Surgical Setting on Hospital-Reported Outcomes for Elective Lumbar Spinal Procedures: Tertiary Versus Community Hospitals

2019 ◽  
Vol 10 (4) ◽  
pp. 375-383 ◽  
Author(s):  
Tristan B. Weir ◽  
Neil Sardesai ◽  
Julio J. Jauregui ◽  
Ehsan Jazini ◽  
Michael J. Sokolow ◽  
...  
Keyword(s):  
Pay For Performance ◽  
Linear Regression Analysis ◽  
Degenerative Spondylolisthesis ◽  
Hospital Costs ◽  
Patient Characteristics ◽  
Tertiary Hospital ◽  
Community Hospitals ◽  
Single Level ◽  
Significant Difference ◽  
Reported Data

Study Design: Retrospective cohort study. Objective: As hospital compensation becomes increasingly dependent on pay-for-performance and bundled payment compensation models, hospitals seek to reduce costs and increase quality. To our knowledge, no reported data compare these measures between hospital settings for elective lumbar procedures. The study compares hospital-reported outcomes and costs for elective lumbar procedures performed at a tertiary hospital (TH) versus community hospitals (CH) within a single health care system. Methods: Retrospective review of a physician-maintained, prospectively collected database consisting of 1 TH and 4 CH for 3 common lumbar surgeries from 2015 to 2016. Patients undergoing primary elective microdiscectomy for disc herniation, laminectomy for spinal stenosis, and laminectomy with fusion for degenerative spondylolisthesis were included. Patients were excluded for traumatic, infectious, or malignant pathology. Comparing hospital settings, outcomes included length of stay (LOS), rates of 30-day readmissions, potentially preventable complications (PPC), and discharge to rehabilitation facility, and hospital costs. Results: A total of 892 patients (n = 217 microdiscectomies, n = 302 laminectomies, and n = 373 laminectomy fusions) were included. The TH served a younger patient population with fewer comorbid conditions and a higher proportion of African Americans. The TH performed more decompressions ( P < .001) per level fused; the CH performed more interbody fusions ( P = .007). Cost of performing microdiscectomy ( P < .001) and laminectomy ( P = .014) was significantly higher at the TH, but there was no significant difference for laminectomy with fusion. In a multivariable stepwise linear regression analysis, the TH was significantly more expensive for single-level microdiscectomy ( P < .001) and laminectomy with single-level fusion ( P < .001), but trended toward significance for laminectomy without fusion ( P = .052). No difference existed for PPC or readmissions rate. Patients undergoing laminectomy without fusion were discharged to a facility more often at the TH ( P = .019). Conclusions: We provide hospital-reported outcomes between a TH and CH. Significant differences in patient characteristics and surgical practices exist between surgical settings. Despite minimal differences in hospital-reported outcomes, the TH was significantly more expensive.

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