Positive follow-up blood cultures identify high mortality risk among patients with Gram-negative bacteraemia.
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Issue Date
2020-07
Authors
Maskarinec, S A
Park, L P
Ruffin, F
Turner, N A
Patel, Nimish
Eichenberger, E M
van Duin, D
Lodise, Thomas P
Fowler, Vance G Jr
Thaden, Joshua T
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Abstract
OBJECTIVES: The role of follow-up blood cultures (FUBCs) in the management of Gram-negative bacteraemia (GNB) is poorly understood. We aimed to determine the utility of FUBCs in identifying patients with increased mortality risk.
METHODS: An observational study with a prospectively enrolled cohort of adult inpatients with GNB was conducted at Duke University Health System from 2002 to 2015. FUBCs were defined as blood cultures performed from 24 hours to 7 days from initial positive blood culture.
RESULTS: Among 1702 patients with GNB, 1164 (68%) had FUBCs performed. When performed, FUBCs were positive in 20% (228/1113) of cases. FUBC acquisition was associated with lower all-cause in-hospital mortality (108/538, 20%, vs. 176/1164, 15%; p 0.01) and attributable in-hospital mortality (78/538, 15%, vs. 98/1164, 8%; p < 0.0001). Propensity score-weighted Cox proportional hazards models revealed that obtaining FUBCs was associated with reductions in all-cause (hazard ratio (HR) 0.629; 95% confidence interval (CI), 0.511-0.772; p < 0.0001) and attributable mortality (HR 0.628; 95% CI, 0.480-0.820; p 0.0007). Positive FUBCs were associated with increased all-cause mortality (49/228, 21%, vs. 110/885, 11%; p 0.0005) and attributable mortality (27/228, 12%, vs. 61/885, 7%; p 0.01) relative to negative FUBCs. Propensity score-weighted Cox proportional hazards models revealed that positive FUBCs were associated with increased all-cause (HR 2.099; 95% CI, 1.567-2.811; p < 0.0001) and attributable mortality (HR 1.800; 95% CI, 1.245-2.603; p 0.002). In a calibration analysis, a scoring system accurately identified patients at high risk of positive FUBCs.
CONCLUSIONS: Rates of positive FUBCs were high and identified patients at increased risk for mortality. Clinical variables can identify patients at high risk for positive FUBCs. FUBCs should be considered in the management of GNB.
Citation
Maskarinec SA, Park LP, Ruffin F, Turner NA, Patel N, Eichenberger EM, van Duin D, Lodise T, Fowler VG Jr, Thaden JT. Positive follow-up blood cultures identify high mortality risk among patients with Gram-negative bacteraemia. Clin Microbiol Infect. 2020 Jul;26(7):904-910. doi: 10.1016/j.cmi.2020.01.025. Epub 2020 Feb 28. PMID: 32114010; PMCID: PMC7311251.
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K24 AI093969/AI/NIAID NIH HHS/United States , KL2 TR002554/TR/NCATS NIH HHS/United States , R01 AI068804/AI/NIAID NIH HHS/United States , T32 AI100851/AI/NIAID NIH HHS/United States