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.

Follow-up blood cultures in Gram-negative bacilli bacteremia: are they needed for critically ill patients?

2020 ◽  
Vol 86 (5) ◽  
Author(s):  
Martina Spaziante ◽  
Alessandra Oliva ◽  
Giancarlo Ceccarelli ◽  
Francesco Alessandri ◽  
Francesco Pugliese ◽  
...  
Keyword(s):  
Critically Ill ◽  
Critically Ill Patients ◽  
Blood Cultures ◽  
Gram Negative

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 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 Development of Institutional Guidelines for Management of Gram-Negative Bloodstream Infections: Incorporating Local Evidence

2017 ◽  
Vol 52 (10) ◽  
pp. 691-697 ◽  
Author(s):  
Elizabeth B. Nimmich ◽  
P. Brandon Bookstaver ◽  
Joseph Kohn ◽  
Julie Ann Justo ◽  
Katie L. Hammer ◽  
...  
Keyword(s):  
Health Care ◽  
Critically Ill ◽  
Antimicrobial Therapy ◽  
Critically Ill Patients ◽  
Severity Of Illness ◽  
Bloodstream Infections ◽  
Evidence Based ◽  
Gram Negative ◽  
Empirical Antimicrobial Therapy ◽  
Hospital Acquired

Background: Appropriate empirical antimicrobial therapy is associated with improved outcomes of patients with Gram-negative bloodstream infections (BSI). Objective: Development of evidence-based institutional management guidelines for empirical antimicrobial therapy of Gram-negative BSI. Methods: Hospitalized adults with Gram-negative BSI in 2011-2012 at Palmetto Health hospitals in Columbia, SC, USA, were identified. Logistic regression was used to examine the association between site of infection acquisition and BSI due to Pseudomonas aeruginosa or chromosomally mediated AmpC-producing Enterobacteriaceae (CAE). Antimicrobial susceptibility rates of bloodstream isolates were stratified by site of acquisition and acute severity of illness. Retained antimicrobial regimens had predefined susceptibility rates ≥90% for noncritically ill and ≥95% for critically ill patients. Results: Among 390 patients, health care–associated (odds ratio [OR]: 3.0, 95% confidence interval [CI]: 1.5-6.3] and hospital-acquired sites of acquisition (OR: 3.7, 95% CI: 1.6-8.4) were identified as risk factors for BSI due to P aeruginosa or CAE, compared with community-acquired BSI (referent). Based on stratified bloodstream antibiogram, ceftriaxone met predefined susceptibility criteria for community-acquired BSI in noncritically ill patients (95%). Cefepime and piperacillin-tazobactam monotherapy achieved predefined susceptibility criteria in noncritically ill (95% both) and critically ill patients with health care–associated and hospital-acquired BSI (96% and 97%, respectively) and critically ill patients with community-acquired BSI (100% both). Conclusions: Incorporation of site of acquisition, local antimicrobial susceptibility rates, and acute severity of illness into institutional guidelines provides objective evidence-based approach for optimizing empirical antimicrobial therapy for Gram-negative BSI. The suggested methodology provides a framework for guideline development in other institutions.

scholarly journals Clinical Impact of Laboratory Implementation of Verigene BC-GN Microarray-Based Assay for Detection of Gram-Negative Bacteria in Positive Blood Cultures

2016 ◽  
Vol 54 (7) ◽  
pp. 1789-1796 ◽  
Author(s):  
Tamar Walker ◽  
Sandrea Dumadag ◽  
Christine Jiyoun Lee ◽  
Seung Heon Lee ◽  
Jeffrey M. Bender ◽  
...  
Keyword(s):  
Early Identification ◽  
Detection System ◽  
Bloodstream Infections ◽  
Multidrug Resistant ◽  
Blood Cultures ◽  
Gram Negative ◽  
Extended Spectrum Beta Lactamase ◽  
Molecular Tests ◽  
Multidrug Resistant Organisms ◽  
Gram Negative Bacteremia

Gram-negative bacteremia is highly fatal, and hospitalizations due to sepsis have been increasing worldwide. Molecular tests that supplement Gram stain results from positive blood cultures provide specific organism information to potentially guide therapy, but more clinical data on their real-world impact are still needed. We retrospectively reviewed cases of Gram-negative bacteremia in hospitalized patients over a 6-month period before (n =98) and over a 6-month period after (n =97) the implementation of a microarray-based early identification and resistance marker detection system (Verigene BC-GN; Nanosphere) while antimicrobial stewardship practices remained constant. Patient demographics, time to organism identification, time to effective antimicrobial therapy, and other key clinical parameters were compared. The two groups did not differ statistically with regard to comorbid conditions, sources of bacteremia, or numbers of intensive care unit (ICU) admissions, active use of immunosuppressive therapy, neutropenia, or bacteremia due to multidrug-resistant organisms. The BC-GN panel yielded an identification in 87% of Gram-negative cultures and was accurate in 95/97 (98%) of the cases compared to results using conventional culture. Organism identifications were achieved more quickly post-microarray implementation (mean, 10.9 h versus 37.9 h;P< 0.001). Length of ICU stay, 30-day mortality, and mortality associated with multidrug-resistant organisms were significantly lower in the postintervention group (P< 0.05). More rapid implementation of effective therapy was statistically significant for postintervention cases of extended-spectrum beta-lactamase-producing organisms (P= 0.049) but not overall (P= 0.12). The Verigene BC-GN assay is a valuable addition for the early identification of Gram-negative organisms that cause bloodstream infections and can significantly impact patient care, particularly when resistance markers are detected.

scholarly journals Follow-up Blood Cultures: A 2.0 Diagnostic Tool in Patients With Gram-Negative Bacteremia and Septic Thrombophlebitis

2017 ◽  
Vol 66 (7) ◽  
pp. 1154-1155 ◽  
Author(s):  
Giancarlo Ceccarelli ◽  
Simone Giuliano ◽  
Marco Falcone ◽  
Mario Venditti
Keyword(s):  
Diagnostic Tool ◽  
Blood Cultures ◽  
Septic Thrombophlebitis ◽  
Gram Negative ◽  
Gram Negative Bacteremia

scholarly journals 290. Impact of follow up blood cultures on outcomes of patients with gram-negative bloodstream infections

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S145-S145
Author(s):  
Rajiv G Amipara ◽  
Hana R Winders ◽  
Julie Ann Justo ◽  
P B Bookstaver ◽  
Joseph Kohn ◽  
...  
Keyword(s):  
South Carolina ◽  
Blood Culture ◽  
Proportional Hazards ◽  
Bloodstream Infections ◽  
Cox Proportional Hazards ◽  
Blood Cultures ◽  
Gram Negative ◽  
Source Of Infection

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)

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