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

Amipara, Rajiv; Winders, Hana R; Justo, Julie Ann; Bookstaver, P. Brandon; Kohn, Joseph; Al-Hasan, Majdi N.

doi:10.1016/j.eclinm.2021.100811

Cited by 16 publications

(39 citation statements)

References 24 publications

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“…Six studies addressed only KQ1, 6 , 7 , 10 , 21 , 22 , 27 4 addressed only KQ2, 28 , 29 , 30 , 31 and 5 studies addressed both KQs. 5 , 8 , 9 , 11 , 32 Study and patient characteristics of included studies are reported in the Table . There were 8007 patients in studies that addressed KQ1 and 3243 patients in studies that addressed KQ2.…”

Section: Resultsmentioning

confidence: 99%

“…We used the Knapp and Hartung method to adjust the SEs of the estimated coefficients. 23 , 24 One study contained censored data, 9 and censored patients were removed so that only patients with complete follow-up information were included. Robustness of the findings was assessed through influence and sensitivity analyses as detailed in the Results section.…”

Section: Methodsmentioning

confidence: 99%

“…Such matching or statistical adjustment in nonrandomized studies is necessary, because multiple studies have reported that patients with and without FUBCs differ with respect to level of acute illness, age, source of BSI, and other factors that influence mortality. [5][6][7]9,11,21 When quantitative analysis (ie, meta-analysis) of the adjusted estimate effects (eg, hazard ratios…”

Section: Jama Network Open | Infectious Diseasesmentioning

confidence: 99%

“…Six studies addressed only KQ1, 6,7,10,21,22,27 4 addressed only KQ2, [28][29][30][31] and 5 studies addressed both KQs. 5,8,9,11,32 A detailed description of studies that addressed KQ1 and KQ2 is provided in eTable 1 in the Supplement. All 5 studies that met criteria for our KQ1 primary analysis addressed survival bias through 1 or more of the following approaches: exclusion of patients who died within 72 hours of the index positive blood culture, 9,22 treated FUBCs as a time-dependent covariate, 5,7,21 and matching patients with and without FUBCs such that patients who did not have FUBCs survived at least as long as it took for the matched patient to have FUBCs 7 (eTable 1 in the Supplement).…”

Section: Summary Of Included Studiesmentioning

confidence: 99%

“… 3 , 4 , 5 However, FUBCs could also be associated with risks, including increased length of hospital stay and blood culture contaminants that unnecessarily complicate therapy. 6 , 7 , 8 Data from published studies have not clearly established whether FUBCs performed to document clearance of BSI are necessary in patients with GN-BSI, because some, 5 , 7 , 9 but not all, 6 , 10 , 11 studies have reported an association between performance of FUBCs and decreased patient mortality. Thus, the role of FUBCs in the care for patients with GN-BSI is unknown.…”

Section: Introductionmentioning

confidence: 99%

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Association of Follow-up Blood Cultures With Mortality in Patients With Gram-Negative Bloodstream Infections

et al. 2022

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ImportanceObtaining follow-up blood cultures (FUBCs) in patients with Staphylococcus aureus bloodstream infection (BSI) is standard practice, although its utility in patients with gram-negative bacterial BSI (GN-BSI) is unclear.ObjectiveTo examine whether obtaining FUBCs is associated with decreased mortality (key question [KQ] 1) and whether positive vs negative FUBCs are associated with increased mortality (KQ2).Data SourcesMEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, Web of Science, and gray literature were searched from inception to March 11, 2022.Study SelectionTwo investigators used predefined eligibility criteria to independently screen titles, abstracts, and relevant full texts. Randomized clinical trials or observational studies that matched or statistically adjusted for differences in, at minimum, level of acute illness between patients in the intervention (eg, FUBCs obtained) and control (eg, FUBCs not obtained) groups were included in primary analyses. Articles published in languages other than English were excluded.Data Extraction and SynthesisData abstraction and quality assessments were performed by one investigator and verified by a second investigator. Risk of bias was assessed with the Newcastle-Ottawa Scale. Effect sizes were pooled using random-effects models. The study followed the Meta-analysis of Observational Studies in Epidemiology (MOOSE) reporting guideline.Main Outcomes and MeasuresMortality before hospital discharge or up to 30 days from the index blood culture.ResultsFrom 3495 studies, 15 were included (all nonrandomized). In the 5 studies (n = 4378 patients) that met criteria for the KQ1 primary analysis, obtaining FUBCs was associated with decreased mortality (hazard ratio, 0.56; 95% CI, 0.45-0.71). For KQ2, 2 studies met criteria for the primary analysis (ie, matched or statistically adjusted for differences in patients with positive vs negative FUBCs), so an exploratory meta-analysis of all 9 studies that investigated KQ2 (n = 3243 patients) was performed. Positive FUBCs were associated with increased mortality relative to negative blood cultures (odds ratio, 2.27; 95% CI, 1.54-3.34). Limitations of the literature included a lack of randomized studies and few patient subgroup analyses.Conclusions and RelevanceIn this systematic review and meta-analysis, obtaining FUBCs in patients with GN-BSI was associated with decreased mortality. The benefit of FUBCs may stem from identification of patients with positive FUBCs, which was a poor prognostic marker.

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