Correlation between time to positivity of blood cultures with clinical presentation and outcomes in patients with Klebsiella pneumoniae bacteraemia: prospective cohort study

Abstract

Time to positivity (TTP) of blood cultures in patients with bacteraemia is considered to be a predictor of outcome for some bacterial species. Two hundred and thirty-one patients with Klebsiella pneumoniae monomicrobial bacteraemia at a hospital from 1 January to 31 December 2007 were prospectively enrolled. TTP <7 h (46 patients, 19.9%) was associated with a higher Pittsburg bacteraemia score (6.2 +/- 5.5 vs. 3.7 +/- 4.3, p 0.002), fewer non-fatal diseases by the McCabe classification (39.1% vs. 64.9%, p 0.002), a higher percentage of patients with liver cirrhosis, active malignancy, and chemotherapy within 3 months (28.3% vs. 11.9%, p 0.007; 28.3% vs. 14.6%, p 0.031; 23.9% vs. 5.4%, p <0.001), more primary bacteraemia (45.7% vs. 22.2%, p 0.002), and a higher 30-day mortality rate (47.8% vs. 21.1%, p <0.001). Risk factors for 30-day mortality in the univariate analysis included higher Pittsburg bacteraemia score (5.8 +/- 5.3 vs. 3.7 +/- 4.3, p 0.002), primary bacteraemia (41.0% vs. 21.8%, p 0.004), TTP <7 h (36.1% vs. 14.1%, p <0.001), and the presence of active malignancy (29.5% vs. 12.9%, p 0.004). In the multivariate analysis, higher Pittsburg bacteraemia score (OR 1.07; 95% CI 1.01-1.14), TTP <7 h (OR 2.46; 95% CI 1.20-5.05) and active malignancy (OR 2.21; 95% CI 1.03-4.73) were the significant factors associated with 30-day mortality. In the Kaplan-Meier survival curve, short TTP was significantly associated with mortality at all time-points after admission. TTP of blood cultures, interpreted with a cut-off point of <7 h, in patients with K. pneumoniae bacteraemia can provide useful prognostic information.

Epidemiology and Outcome of Klebsiella Species Bloodstream Infection: A Population-Based Study

“…8,[21][22][23][24] This was most likely due, in part, to the lack of referral bias in this population-based study; referral patients characteristically have more complications that lead to worse outcomes.…”

Non-typhoidal Salmonella bacteremia among adults: An adverse prognosis in patients with malignancy

“…In a study of K pneumoniae bacteremia, malignancy served as an independent variable for mortality. 22 Conversely, some studies failed to identify malignancy as an independent risk factor for mortality in patients with K pneumoniae 23 or Pseudomonas aeruginosa 20 bacteremia. In the present study, malignancy was significantly associated with mortality in patients with NTS bacteremia.…”

Time to positivity in blood cultures of adults with nontyphoidal Salmonella bacteremia

“…15 Rapid TTP is also an independent predictor of fatal outcome in patients with diversesource Escherichia coli bacteremia, 16 and it is a marker of severe sepsis or shock and meningitis in individuals with bacteremia caused by Streptococcus pneumoniae. 17 However, TTP and the variables associated with it have only been evaluated for a limited number of bacterial species.…”