Follow-up Blood Cultures in Gram-Negative Bacteremia: Are They Needed?

Canzoneri, Christina N.; Akhavan, Bobak; Tosur, Zehra; Andrade, Pedro E Alcedo; Aisenberg, Gabriel M

doi:10.1093/cid/cix648

Cited by 82 publications

(69 citation statements)

References 9 publications

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“…Our study revealed that FUBCs were performed in most of the patients with GNB, but less than 10% produced positive results. In contrast to gram-positive bacteremia, positive FUBC results were not common in GNB [1,3].…”

Section: Discussionmentioning

confidence: 69%

“…Although the positive rate of detection from follow-up blood cultures (FUBCs) in gram-negative bacteremia (GNB) is relatively low (5.8-10.9%) [1][2][3], and the risk factors for persistent GNB have not been investigated extensively, FUBCs have been routinely conducted in cases of GNB in many acute care hospitals [1][2][3][4]. Unnecessary routine blood cultures are invasive, and false positives due to contamination increase medical costs and time spent in hospitals [2,5].…”

Section: Introductionmentioning

confidence: 99%

“…Unnecessary routine blood cultures are invasive, and false positives due to contamination increase medical costs and time spent in hospitals [2,5]. The authors of a previous study identi ed the risk factors for persistent bacteremia, and fever was found to be the only risk factor associated with GNB [1]. Owing to the rarity of persistent GNB, the previous study had limitations, including an insu cient number of persistent GNB cases.…”

Section: Introductionmentioning

confidence: 99%

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Predictive scoring models for persistent gram-negative bacteremia that reduce the need for follow-up blood cultures: a retrospective observational cohort study

Jung

Song

Jun

et al. 2020

Preprint

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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.

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Section: Discussionmentioning

confidence: 69%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Predictive scoring models for persistent gram-negative bacteremia that reduce the need for follow-up blood cultures: a retrospective observational cohort study

Jung

Song

Jun

et al. 2020

Preprint

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“…Interestingly, almost all previous studies included fever as a criterion. Some included microbiological persistence as a criterion for early treatment failure; however, follow-up blood cultures are not routinely recommended in GN-BSI [9,23].…”

Section: Discussionmentioning

confidence: 99%

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

Rac

Gould

Bookstaver

et al. 2020

Clinical Microbiology and Infection

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“…The literature for gram-negative BSI has significantly changed treatment recommendations by supporting shorter treatment durations [ 28 ], early switch to oral antibiotics [ 29 ], and demonstrating lack of benefit of repeat blood cultures [ 30 ]. Using an approach that is well described in gram-positive infections, Erickson and colleagues conducted a single-center, retrospective cohort evaluation of an antimicrobial stewardship bundle coupled with rapid diagnostic tests (RDTs) for uncomplicated gram-negative bacteremia [ 13 ].…”

Section: Resultsmentioning

confidence: 99%

A Baker’s Dozen of Top Antimicrobial Stewardship Intervention Publications in 2019

Stover

Chahine

Cluck

et al. 2020

Open Forum Infectious Diseases

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Staying current on literature related to antimicrobial stewardship can be challenging given the ever-increasing number of published articles. The Southeastern Research Group Endeavor (SERGE-45) identified antimicrobial stewardship-related peer-reviewed literature that detailed an actionable intervention for 2019. The top 13 publications were selected using a modified Delphi technique. These manuscripts were reviewed to highlight the actionable intervention used by antimicrobial stewardship programs to provide key stewardship literature for teaching and training as well as to identify potential intervention opportunities within one’s institution

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Follow-up Blood Cultures in Gram-Negative Bacteremia: Are They Needed?

Abstract: FUBC added little value in the management of GNB bacteremia. Unrestrained use of blood cultures has serious implications for patients including increased healthcare costs, longer hospital stays, unnecessary consultations, and inappropriate use of antibiotics.

Cited by 82 publications

References 9 publications

Predictive scoring models for persistent gram-negative bacteremia that reduce the need for follow-up blood cultures: a retrospective observational cohort study

Predictive scoring models for persistent gram-negative bacteremia that reduce the need for follow-up blood cultures: a retrospective observational cohort study

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

A Baker’s Dozen of Top Antimicrobial Stewardship Intervention Publications in 2019

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