RESEARCH SUPPORT, NON-U.S. GOV'T
Blood Culture Results Before and After Antimicrobial Administration in Patients With Severe Manifestations of Sepsis: A Diagnostic Study.
Annals of Internal Medicine 2019 October 16
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. (ClinicalTrials.gov: 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.
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. (ClinicalTrials.gov: 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.
Full text links
Trending Papers
Management of heart failure in patients with kidney disease - updates from the 2021 ESC guidelines.Nephrology, Dialysis, Transplantation 2023 January 24
2023 American Society of Anesthesiologists Practice Guidelines for Preoperative Fasting: Carbohydrate-containing Clear Liquids with or without Protein, Chewing Gum, and Pediatric Fasting Duration-A Modular Update of the 2017 American Society of Anesthesiologists Practice Guidelines for Preoperative Fasting.Anesthesiology 2023 Februrary 2
Chronic Kidney Disease, Urinary Tract Infections and Antibiotic Nephrotoxicity: Are There Any Relationships?Medicina 2022 December 28
Guidelines to the Practice of Anesthesia: Revised Edition 2023.Canadian Journal of Anaesthesia 2023 January 24
How I Treat Multiple myeloma in the geriatric patient.Blood 2023 January 25
Management of Latent Tuberculosis Infection.JAMA 2023 January 20
Get seemless 1-tap access through your institution/university
For the best experience, use the Read mobile app
Read by QxMD is copyright © 2021 QxMD Software Inc. All rights reserved. By using this service, you agree to our terms of use and privacy policy.
Get seemless 1-tap access through your institution/university
For the best experience, use the Read mobile app