Utility of obtaining blood cultures in febrile neutropenic patients undergoing bone marrow transplantation

Serody, Jonathan S.; Berrey, M. Michelle; Albritton, Karen; O'Brien, S; Capel, Eileen; Bigelow, Sharon H.; Weber, David J.; Gabriel, Don A.; Wiley, Joseph M.; Schell, Michael J.; Gilligan, Peter H.; Shea, Thomas C.

doi:10.1038/sj.bmt.1702535

Cited by 54 publications

(50 citation statements)

References 28 publications

(20 reference statements)

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“…The situation is different for persistent fever during antibiotic therapy and for diagnosis of IFI which may otherwise not be detected by blood cultures. In the setting of persistent fever during antibiotic therapy, the role for blood cultures is very small, since several studies show that a new pathogen is detected in Ͻ1% of cases (4,15). Our study confirms this finding as we also had only one patient with a newly positive result after the start of antimicrobial therapy.…”

Section: Discussionsupporting

confidence: 79%

“…While systemic infection is the most common cause of a febrile neutropenia episode (FNE) with significant effects on morbidity and mortality, only 30% of blood cultures taken at the onset of fever are positive (11,15). Nonetheless, patients with FNEs are treated with broad-spectrum antimicrobial agents regardless of the result of their blood culture (7) because potentially life-threatening infections need early treatment to ensure better clinical outcome.…”

mentioning

confidence: 99%

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Utility of a Commercially Available Multiplex Real-Time PCR Assay To Detect Bacterial and Fungal Pathogens in Febrile Neutropenia

et al. 2009

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Infection is the main treatment-related cause of mortality in cancer patients. Rapid and accurate diagnosis to facilitate specific therapy of febrile neutropenia is therefore urgently warranted. Here, we evaluated a commercial PCR-based kit to detect the DNA of 20 different pathogens (SeptiFast) in the setting of febrile neutropenia after chemotherapy. Seven hundred eighty-four serum samples of 119 febrile neutropenic episodes (FNEs) in 70 patients with hematological malignancies were analyzed and compared with clinical, microbiological, and biochemical findings. In the antibiotic-naïve setting, bacteremia was diagnosed in 34 FNEs and 11 of them yielded the same result in the PCR. Seventy-three FNEs were negative in both systems, leading to an overall agreement in 84 of 119 FNEs (71%). During antibiotic therapy, positivity in blood culture occurred only in 3% of cases, but the PCR yielded a positive result in 15% of cases. In six cases the PCR during antibiotic treatment detected a new pathogen repetitively; this was accompanied by a significant rise in procalcitonin levels, suggestive of a true detection of infection. All patients with probable invasive fungal infection (IFI; n ‫؍‬ 3) according to the standards of the European Organization for Research and Treatment of Cancer had a positive PCR result for Aspergillus fumigatus; in contrast there was only one positive result for Aspergillus fumigatus in an episode without signs and symptoms of IFI. Our results demonstrate that the SeptiFast kit cannot replace blood cultures in the diagnostic workup of FNEs. However, it might be helpful in situations where blood cultures remain negative (e.g., during antimicrobial therapy or in IFI).While systemic infection is the most common cause of a febrile neutropenia episode (FNE) with significant effects on morbidity and mortality, only 30% of blood cultures taken at the onset of fever are positive (11,15). Nonetheless, patients with FNEs are treated with broad-spectrum antimicrobial agents regardless of the result of their blood culture (7) because potentially life-threatening infections need early treatment to ensure better clinical outcome. Noninfective causes of a systemic reaction culminating in a rise in temperature such as tumor fever, drug fever, or transfusion reactions complicate the diagnostic challenge in cancer patients. In addition, the etiology of a deterioration of an FNE during antimicrobial therapy is often difficult to elucidate, since blood cultures are infrequently positive once effective antimicrobial therapy has started (4). Pathogens such as molds which are rarely found in blood cultures are not uncommon in patients with FNEs, particularly if they suffer from hematological malignancies. For these reasons, FNE is one of the conditions where new diagnostic tools to distinguish an infection from a nonmicrobial cause for fever or to identify rare pathogens are most urgently needed. In the past, raised levels of indirect markers such as procalcitonin (PCT) and interleukin 6 (3, 16) have been shown to be ...

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Section: Discussionsupporting

confidence: 79%

mentioning

confidence: 99%

Utility of a Commercially Available Multiplex Real-Time PCR Assay To Detect Bacterial and Fungal Pathogens in Febrile Neutropenia

et al. 2009

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“…Blood culture rarely isolates causative organisms after initiation of antibiotic therapy. 15,25 Antibiotics decrease the yield of blood cultures, and routine collection of blood samples may not be helpful in allo-SCT recipients. However, our study revealed a high incidence of 'occult' BSI in these patients.…”

Section: Discussionmentioning

confidence: 99%

“…1,[9][10][11][12] Although blood culture is the standard method for obtaining a definitive diagnosis of bacteremia, the usefulness of surveillance blood culture has not been adequately evaluated in patients who are on antibiotic prophylaxis. [13][14][15] Serody et al 15 found that blood culture failed to isolate causative organisms in patients developing neutropenic fever while on prophylactic antibiotics. Furthermore, in allo-SCT recipients, inflammatory reactions are frequently absent during neutropenia, and are easily masked by immunosuppressive agents, particularly corticosteroids.…”

mentioning

confidence: 99%

Value of surveillance blood culture for early diagnosis of occult bacteremia in patients on corticosteroid therapy following allogeneic hematopoietic stem cell transplantation

Chizuka¹,

Kami²,

Kanda

et al. 2005

Bone Marrow Transplant

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Summary:Bloodstream infection (BSI) is a significant complication following allogeneic hematopoietic stem cell transplantation (allo-SCT). Corticosteroids mask inflammatory responses, delaying the initiation of antibiotics. We reviewed medical records of 69 allo-SCT patients who had been on 40.5 mg/kg prednisolone to investigate the efficacy of weekly surveillance blood cultures. A total of 36 patients (52%) had positive cultures, 25 definitive BSI and 11 probable BSI. Pathogens in definitive BSI were Staphylococcus epidermidis (n ¼ 7), S. aureus (n ¼ 4), Entrococcus faecalis (n ¼ 3), Pseudomonas aeruginosa (n ¼ 5), Acenitobacter lwoffii (n ¼ 4), and others (n ¼ 10). The median interval from the initiation of corticosteroids to the first positive cultures was 24 days (range, 1-70). At the first positive cultures, 15 patients with definitive BSI were afebrile. Four of them remained afebrile throughout the period of positive surveillance cultures. Patients with afebrile BSI tended to be older (P ¼ 0.063), and had indwelling central venous catheters less frequently than febrile patients (Po0.0001). Bloodstream pathogens were directly responsible for death in two patients with afebrile BSI. This study demonstrates that cortisosteroid frequently masks inflammatory reactions in allo-SCT recipients given conrticosteroids, and that surveillance blood culture is only diagnostic clue for 'occult' BSI.

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“…[4][5][6][7][8][23][24][25][26] Our study shows that routine surveillance cultures can predict the etiology of a bacteremia in 50% of cases. For coagulase-negative staphylococci, the predictive value of such cultures is, in fact, quite low because of the very high rate of colonization observed in our patients (77%).…”

Section: 11mentioning

confidence: 99%

Bacteremia after hematopoietic stem cell transplantation: incidence and predictive value of surveillance cultures

Frère

Hermanne

Debouge

et al. 2004

Bone Marrow Transplant

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Utility of obtaining blood cultures in febrile neutropenic patients undergoing bone marrow transplantation

Cited by 54 publications

References 28 publications

Utility of a Commercially Available Multiplex Real-Time PCR Assay To Detect Bacterial and Fungal Pathogens in Febrile Neutropenia

Utility of a Commercially Available Multiplex Real-Time PCR Assay To Detect Bacterial and Fungal Pathogens in Febrile Neutropenia

Value of surveillance blood culture for early diagnosis of occult bacteremia in patients on corticosteroid therapy following allogeneic hematopoietic stem cell transplantation

Bacteremia after hematopoietic stem cell transplantation: incidence and predictive value of surveillance cultures

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