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Follow-up blood cultures in Pseudomonas aeruginosa bacteremia: A potential target for diagnostic stewardship
OBJECTIVES: Evidence supporting collection of follow-up blood cultures for Gram-negative bacteremia is mixed. We sought to understand why providers order follow-up blood cultures when managing P. aeruginosa bacteremia and whether follow-up blood cultures in this context are associated with short- an...
Autores principales: | , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Cambridge University Press
2021
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9495539/ https://www.ncbi.nlm.nih.gov/pubmed/36168473 http://dx.doi.org/10.1017/ash.2021.184 |
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author | Green, Alexis L. Liang, Yuanyuan O’Hara, Lyndsay M. Pineles, Lisa Sorongon, Scott Harris, Anthony D. Baghdadi, Jonathan D. |
author_facet | Green, Alexis L. Liang, Yuanyuan O’Hara, Lyndsay M. Pineles, Lisa Sorongon, Scott Harris, Anthony D. Baghdadi, Jonathan D. |
author_sort | Green, Alexis L. |
collection | PubMed |
description | OBJECTIVES: Evidence supporting collection of follow-up blood cultures for Gram-negative bacteremia is mixed. We sought to understand why providers order follow-up blood cultures when managing P. aeruginosa bacteremia and whether follow-up blood cultures in this context are associated with short- and long-term survival. METHODS: We conducted a retrospective cohort study of adult inpatients with P. aeruginosa bacteremia at the University of Maryland Medical Center in 2015–2020. Kaplan-Meier survival curves and Cox regression with time-varying covariates were used to evaluate the association between follow-up blood cultures and time to mortality within 30 days of first positive blood culture. Provider justifications for follow-up blood cultures were identified through chart review. RESULTS: Of 159 eligible patients, 127 (80%) had follow-up blood cultures, including 9 (7%) that were positive for P. aeruginosa and 10 (8%) that were positive for other organisms. Follow-up blood cultures were typically collected “to ensure clearance” or “to guide antibiotic therapy.” Overall, 30-day mortality was 25.2%. After risk adjustment for patient characteristics, follow-up blood cultures were associated with a nonsignificant reduction in mortality risk (hazard ratio, 0.43; 95% confidence interval, 1.08; P = .071). In exploratory analyses, the potential mortality reduction from follow-up blood cultures was driven by their use in patients with Pitt bacteremia scores >0. CONCLUSIONS: Follow-up blood cultures are commonly collected for P. aeruginosa bacteremia but infrequently identify persistent bacteremia. Targeted use of follow-up blood cultures based on severity of illness may reduce unnecessary culturing. |
format | Online Article Text |
id | pubmed-9495539 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2021 |
publisher | Cambridge University Press |
record_format | MEDLINE/PubMed |
spelling | pubmed-94955392022-09-26 Follow-up blood cultures in Pseudomonas aeruginosa bacteremia: A potential target for diagnostic stewardship Green, Alexis L. Liang, Yuanyuan O’Hara, Lyndsay M. Pineles, Lisa Sorongon, Scott Harris, Anthony D. Baghdadi, Jonathan D. Antimicrob Steward Healthc Epidemiol Original Article OBJECTIVES: Evidence supporting collection of follow-up blood cultures for Gram-negative bacteremia is mixed. We sought to understand why providers order follow-up blood cultures when managing P. aeruginosa bacteremia and whether follow-up blood cultures in this context are associated with short- and long-term survival. METHODS: We conducted a retrospective cohort study of adult inpatients with P. aeruginosa bacteremia at the University of Maryland Medical Center in 2015–2020. Kaplan-Meier survival curves and Cox regression with time-varying covariates were used to evaluate the association between follow-up blood cultures and time to mortality within 30 days of first positive blood culture. Provider justifications for follow-up blood cultures were identified through chart review. RESULTS: Of 159 eligible patients, 127 (80%) had follow-up blood cultures, including 9 (7%) that were positive for P. aeruginosa and 10 (8%) that were positive for other organisms. Follow-up blood cultures were typically collected “to ensure clearance” or “to guide antibiotic therapy.” Overall, 30-day mortality was 25.2%. After risk adjustment for patient characteristics, follow-up blood cultures were associated with a nonsignificant reduction in mortality risk (hazard ratio, 0.43; 95% confidence interval, 1.08; P = .071). In exploratory analyses, the potential mortality reduction from follow-up blood cultures was driven by their use in patients with Pitt bacteremia scores >0. CONCLUSIONS: Follow-up blood cultures are commonly collected for P. aeruginosa bacteremia but infrequently identify persistent bacteremia. Targeted use of follow-up blood cultures based on severity of illness may reduce unnecessary culturing. Cambridge University Press 2021-08-27 /pmc/articles/PMC9495539/ /pubmed/36168473 http://dx.doi.org/10.1017/ash.2021.184 Text en © The Author(s) 2021 https://creativecommons.org/licenses/by/4.0/This is an Open Access article, distributed under the terms of the Creative Commons Attribution licence (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted re-use, distribution, and reproduction in any medium, provided the original work is properly cited. |
spellingShingle | Original Article Green, Alexis L. Liang, Yuanyuan O’Hara, Lyndsay M. Pineles, Lisa Sorongon, Scott Harris, Anthony D. Baghdadi, Jonathan D. Follow-up blood cultures in Pseudomonas aeruginosa bacteremia: A potential target for diagnostic stewardship |
title | Follow-up blood cultures in Pseudomonas aeruginosa bacteremia: A potential target for diagnostic stewardship |
title_full | Follow-up blood cultures in Pseudomonas aeruginosa bacteremia: A potential target for diagnostic stewardship |
title_fullStr | Follow-up blood cultures in Pseudomonas aeruginosa bacteremia: A potential target for diagnostic stewardship |
title_full_unstemmed | Follow-up blood cultures in Pseudomonas aeruginosa bacteremia: A potential target for diagnostic stewardship |
title_short | Follow-up blood cultures in Pseudomonas aeruginosa bacteremia: A potential target for diagnostic stewardship |
title_sort | follow-up blood cultures in pseudomonas aeruginosa bacteremia: a potential target for diagnostic stewardship |
topic | Original Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9495539/ https://www.ncbi.nlm.nih.gov/pubmed/36168473 http://dx.doi.org/10.1017/ash.2021.184 |
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