Timing of follow-up blood cultures for community-onset bacteremia

Ching-Chi Lee,Wen-Chien Ko,Chung-Hsun Lee,Ming-Yuan Hong,Chao-Yung Yang,Hung-Jen Tang,Chih-Chia Hsieh

doi:10.1038/s41598-019-51032-z

Abstract

Bacteremia is associated with high morbidity and mortality, but the utility and optimal timing of follow-up blood cultures (FUBCs) remain undefined. To assess the optimal timing of FUBCs related to appropriate antibiotic therapy (AAT), adults with community-onset bacteremia and FUBCs after bacteremia onset were retrospectively studied during the 6-year period in two hospitals. Based on the time gap between the initiation of AAT and FUBC sampling, 1,247 eligible patients were categorized as FUBCs prior to AAT (65 patients, 5.2%), 0–3 days (202, 16.2%), 3.1–6 days (470, 37.7%), 6.1–9 days (299, 24.0%), and ≥9 days (211, 16.9%) after AAT. The prognostic impact of the growth of the same bacteria in FUBCs on 30-day mortality was evidenced only in patients with FUBCs at 3.1–6 days after AAT (adjusted odds ratio [AOR], 3.75; P < 0.001), not in those with FUBCs prior to AAT (AOR, 2.86; P = 0.25), 0–3 days (AOR, 0.39; P = 0.08), 6.1–9 days (AOR, 2.19; P = 0.32), and ≥9 days (AOR, 0.41; P = 0.41) of AAT, after adjusting independent factors of 30-day mortality recognized by the multivariable regression in each category. Conclusively, persistent bacteremia in FUBCs added prognostic significance in the management of adults with community-onset bacteremia after 3.1–6 days of AAT.

Highlights

Bloodstream infections are associated with high morbidity and mortality despite the availability of potential antimicrobial therapy and advances in supportive care[1]
The question of “When should follow-up blood cultures (FUBCs) be sampled after the administration of appropriate antibiotic therapy (AAT)?” has been debated
Clinicians agree that the best way to achieve a rapid onset of antibacterial action in antimicrobial therapy is through intravenous administration of antibiotics

Summary

Introduction

Bloodstream infections are associated with high morbidity and mortality despite the availability of potential antimicrobial therapy and advances in supportive care[1]. The principle of follow-up blood culture (FUBC) sampling was not “one-size-fits-all” in the literature. It has been considered as a standard of care for patients with Staphylococcus aureus bacteremia[2,3], but Gram-negative bacillary bacteremia was usually regarded to be transient or intermittent, and FUBCs were not routinely recommended[4,5]. Bacteremia may persist in FUBCs among patients with unresolved infections or receiving ineffective antimicrobial therapy[6,7]. The aim was to determine the impact of the growth of FUBCs on patient outcomes at various time gaps between the FUBC sampling and AAT administration

Methods

Results

Conclusion