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Peri AM, O’Callaghan K, Rafiei N, Graves B, Sinclair H, Brischetto A, Lim K, Parkes-Smith J, Eustace M, Davidson N, Tabah A, Stewart A, Chatfield MD, Harris PNA, Paterson DL. Persistence of Detectable Pathogens by Culture-Independent Systems (T2 Magnetic Resonance) in Patients With Bloodstream Infection: Prognostic Role and Possible Clinical Implications. Clin Infect Dis 2024; 78:283-291. [PMID: 37890109 PMCID: PMC10874273 DOI: 10.1093/cid/ciad663] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Revised: 10/13/2023] [Accepted: 10/25/2023] [Indexed: 10/29/2023] Open
Abstract
BACKGROUND Persistent Staphylococcus aureus bacteremia is associated with metastatic infection and adverse outcomes, whereas gram-negative bacteremia is normally transient and shorter course therapy is increasingly advocated for affected patients. Whether the prolonged detection of pathogen DNA in blood by culture-independent systems could have prognostic value and guide management decisions is unknown. METHODS We performed a multicenter, prospective, observational study on 102 patients with bloodstream infection (BSI) to compare time to bloodstream clearance according to T2 magnetic resonance and blood cultures over a 4-day follow-up. We also explored the association between duration of detectable pathogens according to T2 magnetic resonance (magnetic resonance-DNAemia [MR-DNAemia]) and clinical outcomes. RESULTS Time to bloodstream clearance according to T2 magnetic resonance was significantly longer than blood culture clearance (HR, .54; 95% CI, .39-.75) and did not differ according to the causative pathogen (P = .5). Each additional day of MR-DNAemia increased the odds of persistent infection (defined as metastatic infection or delayed source control) both in the overall population (OR, 1.98; 95% CI, 1.45-2.70) and in S. aureus (OR, 1.92; 95% CI, 1.12-3.29) and gram-negative bacteremia (OR, 2.21; 95% CI, 1.35-3.60). MR-DNAemia duration was also associated with no improvement in Sequential Organ Failure Assessment score at day 7 from infection onset (OR, 1.76; 95% CI, 1.21-2.56). CONCLUSIONS T2 magnetic resonance may help diagnose BSI in patients on antimicrobials with negative blood cultures as well as to identify patients with metastatic infection, source control failure, or adverse short-term outcome. Future studies may inform its usefulness within the setting of antimicrobial stewardship programs.
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Affiliation(s)
- Anna Maria Peri
- UQ Centre for Clinical Research, The University of Queensland, Brisbane, Queensland, Australia
| | - Kevin O’Callaghan
- Infectious Diseases Unit, Redcliffe Hospital, Redcliffe, Queensland, Australia
| | - Nastaran Rafiei
- Infectious Diseases Unit, Caboolture Hospital, Caboolture, Queensland, Australia
| | - Bianca Graves
- Herston Infectious Diseases Institute, Herston, Brisbane, Queensland, Australia
| | - Holly Sinclair
- Infectious Diseases Unit, Royal Brisbane and Women’s Hospital, Brisbane, Queensland, Australia
| | - Anna Brischetto
- Infectious Diseases Unit, Redcliffe Hospital, Redcliffe, Queensland, Australia
| | - Karen Lim
- Infectious Diseases Unit, Redcliffe Hospital, Redcliffe, Queensland, Australia
| | - Jill Parkes-Smith
- Infectious Diseases Unit, Redcliffe Hospital, Redcliffe, Queensland, Australia
| | - Matthew Eustace
- Infectious Diseases Unit, Redcliffe Hospital, Redcliffe, Queensland, Australia
| | - Natalie Davidson
- Infectious Diseases Unit, Redcliffe Hospital, Redcliffe, Queensland, Australia
| | - Alexis Tabah
- Intensive Care Unit, Redcliffe Hospital, Redcliffe, Queensland, Australia
| | - Adam Stewart
- Central Microbiology, Pathology Queensland, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
| | - Mark D Chatfield
- UQ Centre for Clinical Research, The University of Queensland, Brisbane, Queensland, Australia
| | - Patrick N A Harris
- UQ Centre for Clinical Research, The University of Queensland, Brisbane, Queensland, Australia
- Herston Infectious Diseases Institute, Herston, Brisbane, Queensland, Australia
- Central Microbiology, Pathology Queensland, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
| | - David L Paterson
- UQ Centre for Clinical Research, The University of Queensland, Brisbane, Queensland, Australia
- Infectious Diseases Unit, Royal Brisbane and Women’s Hospital, Brisbane, Queensland, Australia
- ADVANCE-ID, Saw Swee Hock School of Public Health, National University of Singapore, Singapore
- Infectious Diseases Translational Research Program, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
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