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Current time-to-positivity of blood cultures in febrile neutropenia: a tool to be used in stewardship de-escalation strategies.
- Source :
-
Clinical microbiology and infection : the official publication of the European Society of Clinical Microbiology and Infectious Diseases [Clin Microbiol Infect] 2019 Apr; Vol. 25 (4), pp. 447-453. Date of Electronic Publication: 2018 Aug 07. - Publication Year :
- 2019
-
Abstract
- Objectives: We aimed to describe the current time-to-positivity (TTP) of blood cultures in individuals with onco-haematological diseases with febrile neutropenia. We assessed the probability of having a multidrug-resistant Gram-negative bacilli (MDR-GNB) bloodstream infection (BSI) 24 h after cultures were taken, to use this information for antibiotic de-escalation strategies.<br />Methods: BSI episodes were prospectively collected (2003-2017). When a patient experienced more than one BSI, only one episode was randomly chosen. Time elapsed from the beginning of incubation to a positive reading was observed; TTP was recorded when the first bottle had a positive result.<br />Results: Of the 850 patient-unique episodes, 323 (38%) occurred in acute leukaemia, 185 (21.8%) in non-Hodgkin's lymphoma and 144 (16.9%) in solid neoplasms. Coagulase-negative staphylococci (225; 26.5%), Escherichia coli (207; 26.1%), Pseudomonas aeruginosa (136; 16%), Enterococcus spp. (81; 9.5%) and Klebsiella pneumoniae (67; 7.9%), were the most frequent microorganisms isolated. MDR-GNB were documented in 126 (14.8%) episodes. Median TTP was 12 h (interquartile range 9-16.5 h). Within the first 24 h, 92.1% of blood cultures were positive (783/850). No MDR-GNB was positive over 24 h. Of the 67 (7.9%) episodes with a TTP ≥24 h, 25 (37.3%) occurred in patients who were already receiving active antibiotics against the isolated pathogen. Most common isolations with TTP ≥24 h were coagulase-negative staphylococci, candidaemia and a group of anaerobic GNB.<br />Conclusions: Currently, the vast majority of BSI in individuals with onco-haematological diseases with febrile neutropenia have a TTP <24 h, including all episodes caused by MDR-GNB. Our results support reassessing empiric antibiotic treatment in neutropenic patients at 24 h, to apply antibiotic stewardship de-escalation strategies.<br /> (Copyright © 2018. Published by Elsevier Ltd.)
- Subjects :
- Aged
Bacteremia blood
Bacteremia diagnosis
Bacteremia microbiology
Blood Culture
Febrile Neutropenia blood
Febrile Neutropenia microbiology
Female
Gram-Negative Bacterial Infections blood
Gram-Negative Bacterial Infections microbiology
Gram-Positive Bacterial Infections blood
Gram-Positive Bacterial Infections microbiology
Humans
Male
Middle Aged
Prospective Studies
Anti-Bacterial Agents therapeutic use
Antimicrobial Stewardship methods
Bacteremia drug therapy
Drug Resistance, Multiple, Bacterial physiology
Febrile Neutropenia drug therapy
Gram-Negative Bacterial Infections drug therapy
Gram-Positive Bacterial Infections drug therapy
Neoplasms complications
Subjects
Details
- Language :
- English
- ISSN :
- 1469-0691
- Volume :
- 25
- Issue :
- 4
- Database :
- MEDLINE
- Journal :
- Clinical microbiology and infection : the official publication of the European Society of Clinical Microbiology and Infectious Diseases
- Publication Type :
- Academic Journal
- Accession number :
- 30096417
- Full Text :
- https://doi.org/10.1016/j.cmi.2018.07.026