Cheng, Matthew P., Stenstrom, Robert, Paquette, Katryn, Stabler, Sarah N., Akhter, Murtaza, Davidson, Adam C., Gavric, Marko, Lawandi, Alexander, Jinah, Rehman, Saeed, Zahid, Demir, Koray, Huang, Kelly, Mahpour, Amirali, Shamatutu, Chris, Caya, Chelsea, Troquet, Jean-Marc, Clark, Greg, Yansouni, Cedric P., Sweet, David, Cheng, Matthew P., Stenstrom, Robert, Paquette, Katryn, Stabler, Sarah N., Akhter, Murtaza, Davidson, Adam, Gavric, Marko, Lawandi, Alexander, Jinah, Rehman, Saeed, Zahid, Demir, Koray, Huang, Kelly, Mahpour, Amirali, Shamatutu, Chris, Caya, Chelsea, Troquet, Jean-Marc, Clark, Greg, Yansouni, Cedric, Sweet, David, Ryan, Emily, Kadatz, Matthew J., Sekhon, Myphinder, Sangsari, Sassan and Osati, Farzaneh (2019). Blood Culture Results Before and After Antimicrobial Administration in Patients With Severe Manifestations of Sepsis A Diagnostic Study. Ann. Intern. Med., 171 (8). S. 547 - 556. PHILADELPHIA: AMER COLL PHYSICIANS. ISSN 1539-3704

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Abstract

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. (Clinical Trials.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. Post-antimicrobial 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.

Item Type: Journal Article
Creators:
CreatorsEmailORCIDORCID Put Code
Cheng, Matthew P.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Stenstrom, RobertUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Paquette, KatrynUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Stabler, Sarah N.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Akhter, MurtazaUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Davidson, Adam C.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Gavric, MarkoUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Lawandi, AlexanderUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Jinah, RehmanUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Saeed, ZahidUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Demir, KorayUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Huang, KellyUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Mahpour, AmiraliUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Shamatutu, ChrisUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Caya, ChelseaUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Troquet, Jean-MarcUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Clark, GregUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Yansouni, Cedric P.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Sweet, DavidUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Cheng, Matthew P.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Stenstrom, RobertUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Paquette, KatrynUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Stabler, Sarah N.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Akhter, MurtazaUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Davidson, AdamUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Gavric, MarkoUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Lawandi, AlexanderUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Jinah, RehmanUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Saeed, ZahidUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Demir, KorayUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Huang, KellyUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Mahpour, AmiraliUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Shamatutu, ChrisUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Caya, ChelseaUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Troquet, Jean-MarcUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Clark, GregUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Yansouni, CedricUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Sweet, DavidUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Ryan, EmilyUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Kadatz, Matthew J.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Sekhon, MyphinderUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Sangsari, SassanUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Osati, FarzanehUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
URN: urn:nbn:de:hbz:38-130882
DOI: 10.7326/M19-1696
Journal or Publication Title: Ann. Intern. Med.
Volume: 171
Number: 8
Page Range: S. 547 - 556
Date: 2019
Publisher: AMER COLL PHYSICIANS
Place of Publication: PHILADELPHIA
ISSN: 1539-3704
Language: English
Faculty: Unspecified
Divisions: Unspecified
Subjects: no entry
Uncontrolled Keywords:
KeywordsLanguage
GOAL-DIRECTED RESUSCITATION; SEPTIC SHOCK; ANTIBIOTIC-THERAPY; ORGAN FAILURE; MORTALITY; LACTATE; DEFINITIONS; GUIDELINES; SURVIVAL; IMPACTMultiple languages
Medicine, General & InternalMultiple languages
Refereed: Yes
URI: http://kups.ub.uni-koeln.de/id/eprint/13088

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