Blood Culture Results Before and After Antimicrobial Administration in Patients With Severe Manifestations of Sepsis: A Diagnostic Study

Matthew P Cheng, Robert Stenstrom, Katryn Paquette, Sarah N Stabler, Murtaza Akhter, Adam C Davidson, Marko Gavric, Alexander Lawandi, Rehman Jinah, Zahid Saeed, Koray Demir, Kelly Huang, Amirali Mahpour, Chris Shamatutu, Chelsea Caya, Jean-Marc Troquet, Greg Clark, Cedric P Yansouni, David Sweet
Annals of Internal Medicine 2019 October 15, 171 (8): 547-554

Background: Administering antimicrobial agents before obtaining blood cultures could potentially decrease time to treatment and improve outcomes, but it is unclear how this strategy affects diagnostic sensitivity.

Objective: To determine the sensitivity of blood cultures obtained shortly after initiation of antimicrobial therapy in patients with severe manifestations of sepsis.

Design: Patient-level, single-group, diagnostic study. ( NCT01867905).

Setting: 7 emergency departments in North America.

Participants: Adults with severe manifestations of sepsis, including systolic blood pressure less than 90 mm Hg or a serum lactate level of 4 mmol/L or more.

Intervention: Blood cultures were obtained before and within 120 minutes after initiation of antimicrobial treatment.

Measurements: Sensitivity of blood cultures obtained after initiation of antimicrobial therapy.

Results: Of 3164 participants screened, 325 were included in the study (mean age, 65.6 years; 62.8% men) and had repeated blood cultures drawn after initiation of antimicrobial therapy (median time, 70 minutes [interquartile range, 50 to 110 minutes]). Preantimicrobial blood cultures were positive for 1 or more microbial pathogens in 102 of 325 (31.4%) patients. Postantimicrobial blood cultures were positive for 1 or more microbial pathogens in 63 of 325 (19.4%) patients. The absolute difference in the proportion of positive blood cultures between pre- and postantimicrobial testing was 12.0% (95% CI, 5.4% to 18.6%; P < 0.001). Sensitivity of postantimicrobial culture was 52.9% (CI, 42.8% to 62.9%). When the results of other microbiological cultures were included, microbial pathogens were found in 69 of 102 (67.6% [CI, 57.7% to 76.6%]) patients.

Limitation: Only a proportion of screened patients were recruited.

Conclusion: Among patients with severe manifestations of sepsis, initiation of empirical antimicrobial therapy significantly reduces the sensitivity of blood cultures drawn shortly after treatment initiation.

Primary Funding Source: Vancouver Coastal Health, St. Paul's Hospital Foundation Emergency Department Support Fund, the Fonds de recherche Santé-Québec, and the Maricopa Medical Foundation.

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