Follow-up blood cultures do not reduce mortality in hospitalized patients with Gram-negative bloodstream infection: a retrospective population-wide cohort study

Ong, Sean W.X.; Luo, Jin; Fridman, Daniel J.; Lee, Samantha M.; Johnstone, Jennie; Schwartz, Kevin L.; Diong, Christina; Patel, Samir N.; MacFadden, Derek; Langford, Bradley; Tong, Steven Y.C.; Brown, Kevin A.; Daneman, Nick

doi:10.1016/j.cmi.2024.03.025

Cited by 2 publications

(5 citation statements)

References 24 publications

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“…Our previous study showed that FUBC was not associated with a clear clinical benefit in terms of reduced mortality, and we do not recommend routine FUBC for all patients with GN-BSI. 14 Most patients from whom FUBC was collected did not have persistent bacteraemia (93.2% in our cohort) and routine FUBC may thus be an inefficient allocation of resources. However, a more selective strategy for FUBC collection may be beneficial in the presence of associated risk factors we and others have identified (e.g.…”

Section: Discussionmentioning

confidence: 72%

“…The description of the original study cohort, including full inclusion and exclusion criteria, has been previously reported. 14 In brief, this cohort included all hospitalized patients >18 years old with GN-BSI between April 2017 and December 2021 in Ontario. For this follow-on analysis, we only considered the subset of patients in that cohort who had received a FUBC 2–5 days from the first positive blood culture.…”

Section: Methodsmentioning

confidence: 99%

“…To further characterize persistent bacteraemia in GN-BSI, we conducted a follow-on analysis of a retrospective observational cohort initially assembled to study the impact of FUBC collection on mortality. 14 We aimed to: (i) identify variables associated with persistent bacteraemia, (ii) evaluate the impact of persistent bacteraemia on mortality and length of stay (LOS) and (iii) describe variation in rates and odds of developing persistent bacteraemia by causative organisms.…”

Section: Introductionmentioning

confidence: 99%

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Epidemiology and clinical relevance of persistent bacteraemia in patients with Gram-negative bloodstream infection: a retrospective cohort study

Ong,

Luo,

Fridman

et al. 2024

Journal of Antimicrobial Chemotherapy

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Objectives The risk factors and outcomes associated with persistent bacteraemia in Gram-negative bloodstream infection (GN-BSI) are not well described. We conducted a follow-on analysis of a retrospective population-wide cohort to characterize persistent bacteraemia in patients with GN-BSI. Methods We included all hospitalized patients >18 years old with GN-BSI between April 2017 and December 2021 in Ontario who received follow-up blood culture (FUBC) 2–5 days after the index positive blood culture. Persistent bacteraemia was defined as having a positive FUBC with the same Gram-negative organism as the index blood culture. We identified variables independently associated with persistent bacteraemia in a multivariable logistic regression model. We evaluated whether persistent bacteraemia was associated with increased odds of 30- and 90-day all-cause mortality using multivariable logistic regression models adjusted for potential confounders. Results In this study, 8807 patients were included; 600 (6.8%) had persistent bacteraemia. Having a permanent catheter, antimicrobial resistance, nosocomial infection, ICU admission, respiratory or skin and soft tissue source of infection, and infection by a non-fermenter or non-Enterobacterales/anaerobic organism were associated with increased odds of having persistent bacteraemia. The 30-day mortality was 17.2% versus 9.6% in those with and without persistent bacteraemia (aOR 1.65, 95% CI 1.29–2.11), while 90-day mortality was 25.5% versus 16.9%, respectively (aOR 1.53, 95% CI 1.24–1.89). Prevalence and odds of developing persistent bacteraemia varied widely depending on causative organism. Conclusions Persistent bacteraemia is uncommon in GN-BSI but is associated with poorer outcomes. A validated risk stratification tool may be useful to identify patients with persistent bacteraemia.

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Section: Discussionmentioning

confidence: 72%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Epidemiology and clinical relevance of persistent bacteraemia in patients with Gram-negative bloodstream infection: a retrospective cohort study

Ong,

Luo,

Fridman

et al. 2024

Journal of Antimicrobial Chemotherapy

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“…Documentation of microbiological clearance is crucial in the case of candidemia to establish treatment duration [29]. For sure, the indiscriminate use of FUBCs in uncomplicated Gram-negative BSI does not seem to exert a beneficial effect, on the contrary, potentially driving an increase in the length of stay [30], but in the presence of complicated forms the achievement of microbiological eradication should be determined to appropriately monitor response.…”

Section: Catheter-related Bloodstream Infections (Crbsis) Complicated...mentioning

confidence: 99%

“…In particular, the swift decline in PCT levels, followed by sustained normalization of serum concentration despite the ongoing presence of bacteremia, suggests a potential mechanism of immune tolerance. This involves the selective suppression of specific proinflammatory pathways activated by bacterial endotoxins or cytokines, which could hinder PCT production and cause a prolonged clinically benign course despite the failure to eliminate the microorganism [30].…”

Section: Catheter-related Bloodstream Infections (Crbsis) Complicated...mentioning

confidence: 99%

Short Course Antibiotic Therapy for Catheter-Related Septic Thrombosis: “Caveat Emptor!”: Duration of Therapy Should Not Be Set a Priori

Maraolo,

Ceccarelli,

Venditti

et al. 2024

Pathogens

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There is a growing body of evidence showing no significant difference in clinical outcomes in patients with uncomplicated Gram-negative bloodstream infections (BSIs) receiving 7 or 14 days of therapy. However, the scenario may differ when complicated forms of BSI, such as catheter-related BSIs (CRBSIs) burdened by septic thrombosis (ST), are considered. A recent study showed that a short course of antimicrobial therapy (≤3 weeks) had similar outcomes to a prolonged course on CRBSI-ST. From this perspective, starting from the desirable goal of shortening the treatment duration, we discuss how the path to the correct diagnosis and management of CRBSI-ST may be paved with several challenges. Indeed, patients with ST due to Gram-negative bacteria display prolonged bacteremia despite an indolent clinical course, requiring an extended course of antibiotic treatment guided by negative FUBCs results, which should be considered the real driver of the decision-making process establishing the length of antibiotic therapy in CRBSI-ST. Shortening treatment of complicated CRBSIs burdened by ST is ambitious and advisable; however, a dynamic and tailored approach driven by a tangible outcome such as negative FUBCs rather than a fixed-duration paradigm should be implemented for the optimal antimicrobial duration.

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Follow-up blood cultures do not reduce mortality in hospitalized patients with Gram-negative bloodstream infection: a retrospective population-wide cohort study

Cited by 2 publications

References 24 publications

Epidemiology and clinical relevance of persistent bacteraemia in patients with Gram-negative bloodstream infection: a retrospective cohort study

Epidemiology and clinical relevance of persistent bacteraemia in patients with Gram-negative bloodstream infection: a retrospective cohort study

Short Course Antibiotic Therapy for Catheter-Related Septic Thrombosis: “Caveat Emptor!”: Duration of Therapy Should Not Be Set a Priori

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