Evaluation of early clinical failure criteria for gram-negative bloodstream infections

Rac, Hana; Gould, Alyssa P; Bookstaver, P Brandon; Justo, Julie Ann; Kohn, Joseph; Al-Hasan, Majdi N.

doi:10.1016/j.cmi.2019.05.017

Cited by 20 publications

(16 citation statements)

References 28 publications

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“…Patients at increased risk of death after bacteremia could be identified in real time according to prognostic factors. Previous studies have reported that multiple clinical factors, including underlying medical conditions, previous antibiotics exposure, and severity of bacteremia, were independently associated with poor outcome in patients with BSI ( 19 , 20 ). Patient-related factors, including older age, female sex, and recent hospitalization, were additional significant predictors of mortality ( 21 ).…”

Section: Discussionmentioning

confidence: 98%

Clinical Profile, Prognostic Factors, and Outcome Prediction in Hospitalized Patients With Bloodstream Infection: Results From a 10-Year Prospective Multicenter Study

Jin

Zhao

et al. 2021

Front. Med.

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Background: Bloodstream infection (BSI) is one of the most common serious bacterial infections worldwide and also a major contributor to in-hospital mortality. Determining the predictors of mortality is crucial for prevention and improving clinical prognosis in patients with nosocomial BSI.Methods: A nationwide prospective cohort study was conducted from 2007 until 2016 in 16 teaching hospitals across China. Microbiological results, clinical information, and patient outcomes were collected to investigate the pathogenic spectrum and mortality rate in patients with BSI and identify outcome predictors using multivariate regression, prediction model, and Kaplan–Meier analysis.Results: No significant change was observed in the causative pathogen distribution during the 10-year period and the overall in-hospital mortality was 12.83% (480/3,741). An increased trend was found in the mortality of patients infected with Pseudomonas aeruginosa or Acinetobacter baumannii, while a decreased mortality rate was noted in Staphylococcus aureus-related BSI. In multivariable-adjusted models, higher mortality rate was significantly associated with older age, cancer, sepsis diagnosis, ICU admission, and prolonged hospital stay prior to BSI onset, which were also determined using machine learning-based predictive model achieved by random forest algorithm with a satisfactory performance in outcome prediction.Conclusions: Our study described the clinical and microbiological characteristics and mortality predictive factors in patients with BSI. These informative predictors would inform clinical practice to adopt effective therapeutic strategies to improve patient outcomes.

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Section: Discussionmentioning

confidence: 98%

Clinical Profile, Prognostic Factors, and Outcome Prediction in Hospitalized Patients With Bloodstream Infection: Results From a 10-Year Prospective Multicenter Study

Jin

Zhao

et al. 2021

Front. Med.

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“…Antimicrobial susceptibility testing was performed and interpreted according to Clinical Laboratory and Standards Institute criteria. Delayed clinical response to initial antimicrobial therapy was defined as presence of 2 early clinical failure criteria between 72 and 96 h of index GN-BSI (Supplementary Appendix 1) [18]. Patients with GN-BSI evaluable for source control included those with intra-abdominal, skin and soft tissue, and central venous catheter infections since imaging is not routinely recommended and opportunities for source control are scarce among those with other sources of infection.…”

Section: Definitionsmentioning

confidence: 99%

Impact of follow up blood cultures on outcomes of patients with community-onset gram-negative bloodstream infection

Amipara¹,

Winders²,

Justo³

et al. 2021

EClinicalMedicine

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Background: The role of follow up blood cultures (FUBC) in the management of gram-negative bloodstream infection (GN-BSI) remains controversial. This retrospective cohort study examines the association between obtaining FUBC and mortality in GN-BSI. Methods: Hospitalized adults with community-onset GN-BSI at Prisma Health-Midlands hospitals in South Carolina, USA from January 1, 2010 to June 30, 2015 were identified. Patients who died or were discharged from hospital within 72 h were excluded to minimize impact of survival and selection biases on results, respectively. Multivariate Cox proportional hazards regression was used to examine association between obtaining FUBC and 28-day all-cause mortality after adjustment for the propensity to obtain FUBC. Findings: Among 766 patients with GN-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 0.47, 95% confidence intervals: 0.23À0.87; p = 0.02) after adjustments for age, chronic comorbidities, acute severity of illness, appropriateness of empirical antimicrobial therapy, and propensity to obtain FUBC. Interpretation: Improved survival in hospitalized patients with GN-BSI who had FUBC is consistent with the results of recent publications from Italy and North Carolina supporting utilization of FUBC in management of GN-BSI. Funding: This study had no funding source.

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“…Our findings are novel but expected. Despite the numerous complex scores and clinical risk factors for mortality prediction using baseline variables captured at bacteremia onset [3,19,28,29], few studies have discussed the relationship between unfavorable outcomes and early clinical failure in the response to initial antimicrobial therapy [30]. Focusing on patients initially experiencing severe sepsis and septic shock, it was reasonably understandable that the timing of discontinuing vasopressor agents (i.e., the hypotension period) was indicative of a substantial parameter in the response to AAT administration herein.…”

Section: Discussionmentioning

confidence: 99%

The Hypotension Period after Initiation of Appropriate Antimicrobial Administration Is Crucial for Survival of Bacteremia Patients Initially Experiencing Severe Sepsis and Septic Shock

Lee

Yang

et al. 2020

JCM

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Bacteremia is linked to substantial morbidity and medical costs. However, the association between the timing of achieving hemodynamic stability and clinical outcomes remains undetermined. Of the multicenter cohort consisted of 888 adults with community-onset bacteremia initially complicated with severe sepsis and septic shock in the emergency department (ED), a positive linear-by-linear association (γ = 0.839, p < 0.001) of the time-to-appropriate antibiotic (TtAa) and the hypotension period after appropriate antimicrobial therapy (AAT) was exhibited, and a positive trend of the hypotension period after AAT administration in the 15-day (γ = 0.957, p = 0.003) or 30-day crude (γ = 0.975, p = 0.001) mortality rate was evidenced. Moreover, for every hour delay of the TtAa, 30-day survival dropped an average of 0.8% (adjusted odds ratio [AOR], 1.008; p < 0.001); and each additional hour of the hypotension period following AAT initiation notably resulted in with an average 1.1% increase (AOR, 1.011; p < 0.001) in the 30-day crude mortality rate, after adjusting all independent determinants of 30-day mortality recognized by the multivariate regression model. Conclusively, for bacteremia patients initially experiencing severe sepsis and septic shock, prompt AAT administration might shorten the hypotension period to achieve favourable prognoses.

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Evaluation of early clinical failure criteria for gram-negative bloodstream infections

Cited by 20 publications

References 28 publications

Clinical Profile, Prognostic Factors, and Outcome Prediction in Hospitalized Patients With Bloodstream Infection: Results From a 10-Year Prospective Multicenter Study

Clinical Profile, Prognostic Factors, and Outcome Prediction in Hospitalized Patients With Bloodstream Infection: Results From a 10-Year Prospective Multicenter Study

Impact of follow up blood cultures on outcomes of patients with community-onset gram-negative bloodstream infection

The Hypotension Period after Initiation of Appropriate Antimicrobial Administration Is Crucial for Survival of Bacteremia Patients Initially Experiencing Severe Sepsis and Septic Shock

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