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Can a routine follow-up blood culture be justified in Klebsiella pneumoniae bacteremia? a retrospective case–control study

BACKGROUND: The need for mandatory confirmation of negative conversion in Klebsiella pneumoniae bacteremia (KpB) has not been adequately addressed. We conducted a retrospective case–control study of adult patients with KpB over a 5-year period in two tertiary-care hospitals to determine the risk fac...

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Autores principales: Kang, Chang Kyung, Kim, Eu Suk, Song, Kyoung-Ho, Kim, Hong Bin, Kim, Taek Soo, Kim, Nak-Hyun, Kim, Chung-Jong, Choe, Pyoeng Gyun, Bang, Ji-Hwan, Park, Wan Beom, Park, Kyoung Un, Park, Sang Won, Kim, Nam-Joong, Kim, Eui-Chong, Oh, Myoung-don
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2013
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3734211/
https://www.ncbi.nlm.nih.gov/pubmed/23914899
http://dx.doi.org/10.1186/1471-2334-13-365
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author Kang, Chang Kyung
Kim, Eu Suk
Song, Kyoung-Ho
Kim, Hong Bin
Kim, Taek Soo
Kim, Nak-Hyun
Kim, Chung-Jong
Choe, Pyoeng Gyun
Bang, Ji-Hwan
Park, Wan Beom
Park, Kyoung Un
Park, Sang Won
Kim, Nam-Joong
Kim, Eui-Chong
Oh, Myoung-don
author_facet Kang, Chang Kyung
Kim, Eu Suk
Song, Kyoung-Ho
Kim, Hong Bin
Kim, Taek Soo
Kim, Nak-Hyun
Kim, Chung-Jong
Choe, Pyoeng Gyun
Bang, Ji-Hwan
Park, Wan Beom
Park, Kyoung Un
Park, Sang Won
Kim, Nam-Joong
Kim, Eui-Chong
Oh, Myoung-don
author_sort Kang, Chang Kyung
collection PubMed
description BACKGROUND: The need for mandatory confirmation of negative conversion in Klebsiella pneumoniae bacteremia (KpB) has not been adequately addressed. We conducted a retrospective case–control study of adult patients with KpB over a 5-year period in two tertiary-care hospitals to determine the risk factors for persistent bacteremia and to reevaluate the necessity of follow-up blood culture in KpB. METHODS: Persistent KpB is defined as the finding of K. pneumoniae in more than two separate blood-culture samples for longer than a two-day period in a single episode. The case- and control-groups were patients with persistent and non-persistent KpB, respectively, and they were matched 1-to-3 according to age and gender. RESULTS: Among 1068 KpB episodes analyzed after excluding polymicrobial infection and repeated KpB, follow-up blood cultures were performed in 862 cases (80.7%), 62 of which (7.2%) were persistent. Independent risk factors for persistence were intra-abdominal infection, higher Charlson’s comorbidity weighted index score, prior solid organ transplantation, and unfavorable treatment response, which was defined as positivity for at least two parameters among fever, leukocytosis, and no decrease of C-reactive protein on the second day after initial culture. A proposed scoring system using four variables, namely, intra-abdominal infection, nosocomial KpB, fever and lack of C-reactive protein decrease, the last two being assessed on the second day after the initial blood culture, showed that only 4.9% of the patients with no risk factors or with only intra-abdominal infection had persistent KpB. CONCLUSIONS: Though persistent KpB is uncommon, follow-up blood culture was performed in as many as 80% of the cases in this study. A more careful clinical assessment is warranted to reduce the cost and patient inconvenience involved in follow-up blood culture.
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spelling pubmed-37342112013-08-06 Can a routine follow-up blood culture be justified in Klebsiella pneumoniae bacteremia? a retrospective case–control study Kang, Chang Kyung Kim, Eu Suk Song, Kyoung-Ho Kim, Hong Bin Kim, Taek Soo Kim, Nak-Hyun Kim, Chung-Jong Choe, Pyoeng Gyun Bang, Ji-Hwan Park, Wan Beom Park, Kyoung Un Park, Sang Won Kim, Nam-Joong Kim, Eui-Chong Oh, Myoung-don BMC Infect Dis Research Article BACKGROUND: The need for mandatory confirmation of negative conversion in Klebsiella pneumoniae bacteremia (KpB) has not been adequately addressed. We conducted a retrospective case–control study of adult patients with KpB over a 5-year period in two tertiary-care hospitals to determine the risk factors for persistent bacteremia and to reevaluate the necessity of follow-up blood culture in KpB. METHODS: Persistent KpB is defined as the finding of K. pneumoniae in more than two separate blood-culture samples for longer than a two-day period in a single episode. The case- and control-groups were patients with persistent and non-persistent KpB, respectively, and they were matched 1-to-3 according to age and gender. RESULTS: Among 1068 KpB episodes analyzed after excluding polymicrobial infection and repeated KpB, follow-up blood cultures were performed in 862 cases (80.7%), 62 of which (7.2%) were persistent. Independent risk factors for persistence were intra-abdominal infection, higher Charlson’s comorbidity weighted index score, prior solid organ transplantation, and unfavorable treatment response, which was defined as positivity for at least two parameters among fever, leukocytosis, and no decrease of C-reactive protein on the second day after initial culture. A proposed scoring system using four variables, namely, intra-abdominal infection, nosocomial KpB, fever and lack of C-reactive protein decrease, the last two being assessed on the second day after the initial blood culture, showed that only 4.9% of the patients with no risk factors or with only intra-abdominal infection had persistent KpB. CONCLUSIONS: Though persistent KpB is uncommon, follow-up blood culture was performed in as many as 80% of the cases in this study. A more careful clinical assessment is warranted to reduce the cost and patient inconvenience involved in follow-up blood culture. BioMed Central 2013-08-02 /pmc/articles/PMC3734211/ /pubmed/23914899 http://dx.doi.org/10.1186/1471-2334-13-365 Text en Copyright © 2013 Kang et al.; licensee BioMed Central Ltd. http://creativecommons.org/licenses/by/2.0 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Research Article
Kang, Chang Kyung
Kim, Eu Suk
Song, Kyoung-Ho
Kim, Hong Bin
Kim, Taek Soo
Kim, Nak-Hyun
Kim, Chung-Jong
Choe, Pyoeng Gyun
Bang, Ji-Hwan
Park, Wan Beom
Park, Kyoung Un
Park, Sang Won
Kim, Nam-Joong
Kim, Eui-Chong
Oh, Myoung-don
Can a routine follow-up blood culture be justified in Klebsiella pneumoniae bacteremia? a retrospective case–control study
title Can a routine follow-up blood culture be justified in Klebsiella pneumoniae bacteremia? a retrospective case–control study
title_full Can a routine follow-up blood culture be justified in Klebsiella pneumoniae bacteremia? a retrospective case–control study
title_fullStr Can a routine follow-up blood culture be justified in Klebsiella pneumoniae bacteremia? a retrospective case–control study
title_full_unstemmed Can a routine follow-up blood culture be justified in Klebsiella pneumoniae bacteremia? a retrospective case–control study
title_short Can a routine follow-up blood culture be justified in Klebsiella pneumoniae bacteremia? a retrospective case–control study
title_sort can a routine follow-up blood culture be justified in klebsiella pneumoniae bacteremia? a retrospective case–control study
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3734211/
https://www.ncbi.nlm.nih.gov/pubmed/23914899
http://dx.doi.org/10.1186/1471-2334-13-365
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