Utility of blood cultures in community-acquired pneumonia requiring hospitalization: influence of antibiotic treatment before admission

Glérant, Jean-Charles; Hellmuth, D.; Schmit, Jean‐Luc; Ducroix, J.P.; Jounieaux, Vincent

doi:10.1016/s0954-6111(99)90010-0

Cited by 58 publications

(51 citation statements)

References 20 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…The diagnostic performance of SF was significantly superior to BC in patients under antibiotic treatment. As expected (6,17), the results of BC were affected by the antibiotic pretreatment, a very common situation in febrile patients admitted to an internal medicine ward. Indeed, in our population, 49% of the patients had been receiving antibiotics for Ն24 h before sampling.…”

Section: Discussionsupporting

confidence: 63%

“…The diagnosis of sepsis relies heavily on blood culture (BC), which detects circulating living bacteria or fungi and tests susceptibility to antimicrobials. However, the sensitivity of BC is limited, particularly when antibiotics have already been administered (6,17), and may not provide time-critical results that can impact on early management (2). Indeed, culturing, identification, and drug-susceptibility testing may require more than 48 h (7).…”

mentioning

confidence: 99%

See 1 more Smart Citation

Diagnostic Performance of a Multiple Real-Time PCR Assay in Patients with Suspected Sepsis Hospitalized in an Internal Medicine Ward

et al. 2012

View full text Add to dashboard Cite

Early identification of causative pathogen in sepsis patients is pivotal to improve clinical outcome. SeptiFast (SF), a commercially available system for molecular diagnosis of sepsis based on PCR, has been mostly used in patients hospitalized in hematology and intensive care units. We evaluated the diagnostic accuracy and clinical usefulness of SF, compared to blood culture (BC), in 391 patients with suspected sepsis, hospitalized in a department of internal medicine. A causative pathogen was identified in 85 patients (22%). Sixty pathogens were detected by SF and 57 by BC. No significant differences were found between the two methods in the rates of pathogen detection (P ‫؍‬ 0.74), even after excluding 9 pathogens which were isolated by BC and were not included in the SF master list (P ‫؍‬ 0.096). The combination of SF and BC significantly improved the diagnostic yield in comparison to BC alone (P < 0.001). Compared to BC, SF showed a significantly lower contamination rate (0 versus 19 cases; P < 0.001) with a higher specificity for pathogen identification (1.00, 95% confidence interval [CI] of 0.99 to 1.00, versus 0.94, 95% CI of 0.90 to 0.96; P ‫؍‬ 0.005) and a higher positive predictive value (1.00, 95% CI of 1.00 to 0.92%, versus 0.75, 95% CI of 0.63 to 0.83; P ‫؍‬ 0.005). In the subgroup of patients (n ‫؍‬ 191) who had been receiving antibiotic treatment for >24 h, SF identified more pathogens (16 versus 6; P ‫؍‬ 0.049) compared to BC. These results suggest that, in patients with suspected sepsis, hospitalized in an internal medicine ward, SF could be a highly valuable adjunct to conventional BC, particularly in patients under antibiotic treatment.

show abstract

Section: Discussionsupporting

confidence: 63%

mentioning

confidence: 99%

Diagnostic Performance of a Multiple Real-Time PCR Assay in Patients with Suspected Sepsis Hospitalized in an Internal Medicine Ward

et al. 2012

View full text Add to dashboard Cite

show abstract

“…3A). This could be due to a drastic decrease in the sensitivity of blood culture after antibiotic therapy (17,19,31). To investigate the relationship of mecA DNA levels to blood culture positivity and antibiotic usage, we analyzed the mecA DNA levels in blood culture-positive and -negative samples subgrouped by the duration of anti-MRSA therapy.…”

Section: Discussionmentioning

confidence: 99%

“…In the case of S. aureus-related infections, it was reported that positive blood cultures during follow-up and the persistence of fever were suggestive of a complicated course (6,15,37). However, the drastic decrease in the sensitivity of blood culture after the initiation of antimicrobial therapy, even when special culture media are used, has made the use of blood cultures to monitor responses to therapy and outcomes very difficult (17,19,31,36). On the other hand, most of the realtime PCR assays used for the detection of MRSA have been qualitative in nature and have used specimens from blood culture bottles or nasal swabs rather than blood samples directly and therefore have provided little information regarding the MRSA load in blood (16,20,24,43,48).…”

mentioning

confidence: 99%

High Levels of mecA DNA Detected by a Quantitative Real-Time PCR Assay Are Associated with Mortality in Patients with Methicillin-Resistant Staphylococcus aureus Bacteremia

Chang

Lin

et al. 2009

J Clin Microbiol

View full text Add to dashboard Cite

Persistent methicillin-resistant Staphylococcus aureus (MRSA) bacteremia is known to be a poor prognostic factor. While several PCR assays for the detection of MRSA in various clinical samples were recently reported, the possibility that a quantitative PCR assay could be used to quantify and monitor MRSA bacteremia has not been explored. In this study, we established a quantitative real-time PCR assay for the mecA gene using known copy numbers of a plasmid containing mecA DNA as a standard and the previously described mecA-specific primers and probe (P. Francois et al., J. Clin. Microbiol. 41:254-260, 2003). We employed this assay to examine 250 sequential whole-blood samples from 20 adult patients, including 13 survivors and 7 nonsurvivors, with culture-proven MRSA bacteremia at the intensive care units of National Taiwan University Hospital between 1 July 2006 and 31 January 2007. The levels of mecA DNA in the nonsurvivors were significantly higher than those in the survivors during the three periods of bacteremia examined (days 0 to 2, 3 to 5, and 6 to 8) (P ‫؍‬ 0.003 by two-tailed Mann-Whitney U test). Moreover, the nonsurvivors had higher mecA DNA levels than the survivors after 3 days and 7 days of anti-MRSA therapy (medians for nonsurvivors and survivors at 3 days, 5.86 and 4.30 log copies/ml, respectively; medians for nonsurvivors and survivors at 7 days, 5.21 and 4.36 log copies/ml, respectively; P ‫؍‬ 0.02 and P ‫؍‬ 0.04, respectively, by two-tailed Mann-Whitney U test). Together, these findings suggest that the level of mecA DNA in blood could potentially be used to monitor MRSA bacteremia and evaluate responses to therapy.Methicillin-resistant Staphylococcus aureus (MRSA) is a pathogen that is one of the most common causes of both community-acquired and nosocomial infections worldwide, especially in intensive care units (ICUs) (5,8,33,49). In the past two decades, the proportion of MRSA infections has increased dramatically, and up to 60% of S. aureus isolates from ICUs were reported to be methicillin resistant (26). Compared with cases of bacteremia caused by methicillin-susceptible S. aureus (MSSA) strains, cases of bacteremia caused by MRSA strains have been shown to be associated with more persistent infections, more recurrent episodes, longer hospital stays, and higher rates of mortality (3,6,11,13,14,27). Because of the high rates of mortality and the refractoriness of MRSA bacteremia to treatment, MRSA bacteremia has become a very challenging infectious disease (18,21,38,39,42).It has recently been demonstrated that high bacterial loads in blood correlate with disease severity in patients with infections caused by Haemophilus influenzae, Streptococcus pneumoniae, and Neisseria meningitidis (4,22,35,41), as well as in a murine model of Serratia marcescens infection (25). In the case of S. aureus-related infections, it was reported that positive blood cultures during follow-up and the persistence of fever were suggestive of a complicated course (6,15,37). However, the drastic decrease in the sen...

show abstract

“…72 Moreover, this test, including antimicrobial susceptibility, requires .72 hours for bacteria, and .60 hours for fungi, 69 and BCs are always collected before initiating antibiotic therapy in order to increase the sensitivity. 73 In spite of these limitations, a positive BC remains an important diagnostic clue or a confirmation for the physicians. The optimal assay result depends on volume of sample, moment of sampling, and accuracy with which this is carried out.…”

Section: Molecular Techniques For Assay Of Sepsis In Positive Bcsmentioning

confidence: 99%

In vitro diagnosis of sepsis: a review

Marcello

Tumolo²,

Donno³

et al. 2016

PLMI

View full text Add to dashboard Cite

Sepsis, severe sepsis and septic shock, systemic inflammatory response, and other related manifestations represent a relevant medical problem with high morbidity and mortality, despite the improvements in diagnosis, treatment, and preventive measures over the last few decades. The limited knowledge of the pathophysiology in association with the lack of in vitro diagnostic methods for the certain and quick determination of the causative microbiological agents and their antibiotic resistance means the condition is still critical and of high impact in health care. The current gold standard method to detect the sepsis-causing pathogens, which is based on blood culture, is still insufficiently sensitive and slow. The new culture-independent molecular biology-based techniques can lead to the identification of a broad range of microorganisms and resistance markers within a few hours and with high sensitivity and specificity; nevertheless, limitations of, for example, the polymerase chain reaction-based methods still hamper their application in the clinical routine. This review summarizes the in vitro diagnostic methods and their approach in the clinical diagnosis of the bloodstream infections, and explores their advantages and disadvantages at the current state of the art. A quick analysis of the future prospective in multiplex technologies for microbiological diagnosis of sepsis is also provided.

show abstract

Utility of blood cultures in community-acquired pneumonia requiring hospitalization: influence of antibiotic treatment before admission

Cited by 58 publications

References 20 publications

Diagnostic Performance of a Multiple Real-Time PCR Assay in Patients with Suspected Sepsis Hospitalized in an Internal Medicine Ward

Diagnostic Performance of a Multiple Real-Time PCR Assay in Patients with Suspected Sepsis Hospitalized in an Internal Medicine Ward

High Levels of mecA DNA Detected by a Quantitative Real-Time PCR Assay Are Associated with Mortality in Patients with Methicillin-Resistant Staphylococcus aureus Bacteremia

In vitro diagnosis of sepsis: a review

Contact Info

Product

Resources

About