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Yang YY, Tsai IT, Lai CH, Chen CP, Chen C, Hsu YC. Time to positivity of Klebsiella pneumoniae in blood cultures as prognostic marker in patients with intra-abdominal infection: A retrospective study. Virulence 2024; 15:2329397. [PMID: 38548677 PMCID: PMC10984124 DOI: 10.1080/21505594.2024.2329397] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2023] [Accepted: 03/06/2024] [Indexed: 04/02/2024] Open
Abstract
Klebsiella pneumoniae is a common causative pathogen of intra-abdominal infection with concomitant bacteraemia, leading to a significant mortality risk. The time to positivity (TTP) of blood culture is postulated to be a prognostic factor in bacteraemia caused by other species. Therefore, this study aimed to investigate the prognostic value of TTP in these patients. The single-centred, retrospective, observational cohort study was conducted between 1 July 2016 and 30 June 2021. All adult emergency department patients with diagnosis of intra-abdominal infection and underwent blood culture collection which yield K. pneumoniae during this period were enrolled. A total of 196 patients were included in the study. The overall 30-day mortality rate was 12.2% (24/196), and the median TTP of the studied cohort was 12.3 h (10.5-15.8 h). TTP revealed a moderate 30-day mortality discriminative ability (area under the curve 0.73, p < 0.001). Compared with the late TTP group (>12 h, N = 109), patients in the early TTP (≤12 h, N = 87) group had a significantly higher risk of 30-day morality (21.8% vs. 4.6%, p < 0.01) and other adverse outcomes. Furthermore, TTP (odds ratio [OR] = 0.79, p = 0.02), Pitt bacteraemia score (OR = 1.30, p = 0.03), and implementation of source control (OR = 0.06, p < 0.01) were identified as independent factors related to 30-day mortality risk in patients with intra-abdominal infection and K. pneumoniae bacteraemia. Therefore, physicians can use TTP for prognosis stratification in these patients.
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Affiliation(s)
- Yong-Ye Yang
- Department of Emergency Medicine, E-Da Hospital, I-Shou University, Kaohsiung, Taiwan
| | - I-Ting Tsai
- Department of Emergency Medicine, E-Da Hospital, I-Shou University, Kaohsiung, Taiwan
- School of Medicine, College of Medicine, I-Shou University, Kaohsiung, Taiwan
| | - Chung-Hsu Lai
- School of Medicine, College of Medicine, I-Shou University, Kaohsiung, Taiwan
- Division of Infectious Diseases, Department of Internal Medicine, E-Da Hospital, I-Shou University, Kaohsiung, Taiwan
| | - Chih-Ping Chen
- Department of Emergency Medicine, E-Da Hospital, I-Shou University, Kaohsiung, Taiwan
| | - Chia‐Chi Chen
- School of Medicine, College of Medicine, I-Shou University, Kaohsiung, Taiwan
- Department of Pathology, E-Da Hospital, I-Shou University, Kaohsiung, Taiwan
| | - Yin-Chou Hsu
- Department of Emergency Medicine, E-Da Hospital, I-Shou University, Kaohsiung, Taiwan
- School of Chinese Medicine for Post Baccalaureate, I-Shou University, Kaohsiung, Taiwan
- School of Medicine for International Student, I-Shou University, Kaohsiung, Taiwan
- Graduate Institute of Clinical Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
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2
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Comba IY, Go JR, Vaillant J, O’Horo JC, Stevens RW, Palraj R, Abu Saleh O. Sequential Time to Positivity as a Prognostic Indicator in Staphylococcus aureus Bacteremia. Open Forum Infect Dis 2024; 11:ofae173. [PMID: 38617074 PMCID: PMC11010313 DOI: 10.1093/ofid/ofae173] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Accepted: 03/19/2024] [Indexed: 04/16/2024] Open
Abstract
Background We aimed to determine the factors associated with sequential blood culture time to positivity (STTP) and validate the previously defined time to positivity (TTP) ratio threshold of 1.5 in predicting adverse disease outcomes and mortality of Staphylococcus aureus bacteremia (SAB). Methods We conducted an observational study of adult patients with SAB. The TTP ratio was calculated by dividing the TTP of the second blood culture by that of the first. Results Of 186 patients, 69 (37%) were female, with a mean age of 63.6 years. Median TTP was 12 hours (interquartile range [IQR], 10-15 hours) from the initial and 21 hours (17-29) from sequential blood cultures. Methicillin-resistant S aureus (MRSA)-infected patients had significantly shorter STTPs (P < .001) and lower TTP ratios (P < .001) compared to patients with methicillin-susceptible S aureus (MSSA). A significant correlation between initial and STTP was observed in patients with MRSA (r = 0.42, P = .002) but not in those with MSSA. A higher rate of native valve endocarditis (NVE) significantly correlated with a TTP ratio of ≤1.5 (odds ratio, 2.65 [95% confidence interval, 1.3-5.6]; P = .01). The subgroup having an initial TTP <12 hours combined with a TTP ratio ≤1.5 showed the highest prevalence of NVE. Conclusions The STTP varies based on methicillin susceptibility of S aureus isolate. This study suggests a potential clinical utility of the STTP to identify patients at a higher risk of NVE. However, prospective studies are required to validate these findings.
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Affiliation(s)
- Isin Y Comba
- Division of Public Health, Infectious Diseases, and Occupational Medicine, Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - John Raymond Go
- Division of Public Health, Infectious Diseases, and Occupational Medicine, Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - James Vaillant
- Division of Public Health, Infectious Diseases, and Occupational Medicine, Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - John C O’Horo
- Division of Public Health, Infectious Diseases, and Occupational Medicine, Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Ryan W Stevens
- Department of Pharmacy, Mayo Clinic, Rochester, Minnesota, USA
| | - Raj Palraj
- Division of Public Health, Infectious Diseases, and Occupational Medicine, Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Omar Abu Saleh
- Division of Public Health, Infectious Diseases, and Occupational Medicine, Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA
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Dufault SM, Crook AM, Rolfe K, Phillips PPJ. A flexible multi-metric Bayesian framework for decision-making in Phase II multi-arm multi-stage studies. Stat Med 2024; 43:501-513. [PMID: 38038137 DOI: 10.1002/sim.9961] [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: 02/15/2023] [Revised: 09/19/2023] [Accepted: 10/30/2023] [Indexed: 12/02/2023]
Abstract
We propose a multi-metric flexible Bayesian framework to support efficient interim decision-making in multi-arm multi-stage phase II clinical trials. Multi-arm multi-stage phase II studies increase the efficiency of drug development, but early decisions regarding the futility or desirability of a given arm carry considerable risk since sample sizes are often low and follow-up periods may be short. Further, since intermediate outcomes based on biomarkers of treatment response are rarely perfect surrogates for the primary outcome and different trial stakeholders may have different levels of risk tolerance, a single hypothesis test is insufficient for comprehensively summarizing the state of the collected evidence. We present a Bayesian framework comprised of multiple metrics based on point estimates, uncertainty, and evidence towards desired thresholds (a Target Product Profile) for (1) ranking of arms and (2) comparison of each arm against an internal control. Using a large public-private partnership targeting novel TB arms as a motivating example, we find via simulation study that our multi-metric framework provides sufficient confidence for decision-making with sample sizes as low as 30 patients per arm, even when intermediate outcomes have only moderate correlation with the primary outcome. Our reframing of trial design and the decision-making procedure has been well-received by research partners and is a practical approach to more efficient assessment of novel therapeutics.
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Affiliation(s)
- Suzanne M Dufault
- Division of Biostatistics, Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA, USA
- UCSF Center for Tuberculosis, University of California, San Francisco, CA, USA
| | - Angela M Crook
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials & Methodology, London, UK
| | | | - Patrick P J Phillips
- UCSF Center for Tuberculosis, University of California, San Francisco, CA, USA
- Division of Pulmonary and Critical Care Medicine, University of California, San Francisco, San Francisco, CA, USA
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4
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Keighley C, Pope A, Marriott D, Chen SCA, Slavin MA. Time-to-positivity in bloodstream infection for Candida species as a prognostic marker for mortality. Med Mycol 2023; 61:7109268. [PMID: 37019819 DOI: 10.1093/mmy/myad028] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Revised: 01/03/2023] [Accepted: 04/03/2023] [Indexed: 04/07/2023] Open
Abstract
Time-to-positivity (TTP) may assist in predicting outcome of candidaemia. We analysed a candidaemia dataset collected prospectively in Australia over 1 year (2014-2015). Time to positivity was defined as the period from blood culture sampling to the blood culture flagging positive. Of 415 candidaemia episodes, overall 30-day mortality was 29% (120/415); mortality with Candida albicans was 35% (59/169), C. glabrata complex, 37% (43/115), C. tropicalis, 43% (10/23), Pichia kudriavzevii 25% (3/12) and C. parapsilosis complex 7% (5/71). Each day of increased TTP multiplied the odds ratio (OR) of survival at 30 days by a factor of 1.32 (95%CI 1.06-1.69). Shorter TTP was associated with increased mortality, with 1 day TTP associated with 30-day mortality 37% (41/112) (95%CI: 28%-46%) and 5-day TTP 11% (2/18) (95%CI: 2%-36%).
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Affiliation(s)
- Caitlin Keighley
- Centre for Infectious Diseases and Microbiology Laboratory Services, Institute of Clinical Pathology and Medical Research, New South Wales Health Pathology, Westmead Hospital, Sydney, NSW 2145, Australia
- Marie Bashir Institute for Infectious Diseases and Biosecurity, The University of Sydney, Sydney, NSW and the Department of Infectious Diseases, Westmead Hospital, Westmead, Sydney, NSW 2145, Australia
- Southern.IML Pathology, 3 Bridge St, Coniston NSW 2500
| | - Alun Pope
- Eastern Health Clinical School, Monash University, Melbourne, Victoria 3124, Australia
- Analytical Insight, Unit 6e, 21 Park Avenue, Crawley 6009, WA, Australia
| | - Debbie Marriott
- Department of Microbiology and Infectious Diseases, St. Vincent's Hospital, Sydney 2010, NSW, Australia
| | - Sharon C-A Chen
- Centre for Infectious Diseases and Microbiology Laboratory Services, Institute of Clinical Pathology and Medical Research, New South Wales Health Pathology, Westmead Hospital, Sydney, NSW 2145, Australia
- Marie Bashir Institute for Infectious Diseases and Biosecurity, The University of Sydney, Sydney, NSW and the Department of Infectious Diseases, Westmead Hospital, Westmead, Sydney, NSW 2145, Australia
| | - Monica A Slavin
- Department of Infectious Diseases, Peter MacCallum Cancer Centre, National Centre for Infections in Cancer, Melbourne, VIC 3052, Australia
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5
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Hou W, Han T, Qu G, Sun Y, Yang D, Lin Y. Is early time to positivity of blood culture associated with clinical prognosis in patients with Klebsiella pneumoniae bloodstream infection? Epidemiol Infect 2023; 151:e43. [PMID: 36805070 PMCID: PMC10028975 DOI: 10.1017/s0950268823000262] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/23/2023] Open
Abstract
The association between time to positivity (TTP) of blood culture and the clinical prognosis of patients with Klebsiella pneumoniae bloodstream infection (BSI) remains unclear. A retrospective study of 148 inpatients with BSI caused by K. pneumoniae was performed at Shanghai Tongji Hospital, China, from October 2016-2020. The total in-hospital fatality rate was 32%. The median TTP was 11.0 (7.7-16.1) h and the optimal cutoff for prediction of in-hospital mortality was 9.4 h according to the ROC curve. Early TTP (<9.4 h) was a risk factor for in-hospital mortality by univariate analysis (OR = 2.5, 95% CI 1.2-5.0, P = 0.01), but not by multivariate analysis (OR = 2.7, 95% CI 1.0-7.4, P = 0.06). Old age, serum creatinine, white blood cells, and C-reactive protein values were risk factors for in-hospital mortality by multivariate analysis. Early TTP was not a risk factor for septic shock (OR = 1.8, 95% CI 0.6-5.1, P = 0.27) or ICU admission (OR = 1.0, 95% CI 1.0-1.0, P = 0.32). In conclusion, the in-hospital fatality rate of patients with K. pneumoniae BSI was relatively high and associated with an early TTP of blood cultures. However, no increased risk of mortality, septic shock or ICU admission was evident in early TTP patients.
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Affiliation(s)
- Weiwei Hou
- Department of Laboratory Medicine, Tongji Hospital, School of Medicine, Tongji University, Shanghai 200065, China
| | - Tiantian Han
- Department of Hospital Infection Control, Tongji Hospital, School of Medicine, Tongji University, Shanghai 200065, China
| | - Guangbo Qu
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Hefei, 230032, Anhui Province, China
| | - Yehuan Sun
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Hefei, 230032, Anhui Province, China
| | - Dianyu Yang
- Department of Laboratory Medicine, Tongji Hospital, School of Medicine, Tongji University, Shanghai 200065, China
| | - Yan Lin
- Department of Hospital Infection Control, Tongji Hospital, School of Medicine, Tongji University, Shanghai 200065, China
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Mazzulli T, Ratkov D, Guglielmin K, Gandhi B, Remington R, Birch R, Zimmer L, Garner CD. Impact of Implementation of BacT /Alert Virtuo on Blood Culture Time to Positivity in Sepsis Patients. Microbiol Spectr 2023; 11:e0500322. [PMID: 36749050 PMCID: PMC10101113 DOI: 10.1128/spectrum.05003-22] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Accepted: 01/23/2023] [Indexed: 02/08/2023] Open
Abstract
Time to positivity (TTP) for blood culture bottles incubated in the BacT/Alert Virtuo instrument was compared to the BacT/Alert 3D. TTP was significantly shorter with the Virtuo (median 16.2 h) than 3D (median 21.1 h; P < 0.001). Switching from 3D to Virtuo significantly improved TTP in this multicenter hospital setting study. IMPORTANCE Sepsis affects millions of people around the world each year, and accounts for a significant number of deaths in hospital intensive care units (ICU). Timely diagnosis is key to decreasing morbidity and mortality. One important element of sepsis diagnosis is organism detection using blood cultures. In this study, we examined the impact of implementing the BacT/Alert Virtuo automated blood culture detection system on time to positivity in an ICU patient population at a multicenter hospital setting.
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Affiliation(s)
- Tony Mazzulli
- Department of Microbiology, University Health Network/Mount Sinai Hospital, Toronto, Ontario, Canada
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada
| | - Dimitrije Ratkov
- Department of Microbiology, University Health Network/Mount Sinai Hospital, Toronto, Ontario, Canada
| | - Kristyn Guglielmin
- Department of Microbiology, University Health Network/Mount Sinai Hospital, Toronto, Ontario, Canada
| | - Bharat Gandhi
- Department of Microbiology, University Health Network/Mount Sinai Hospital, Toronto, Ontario, Canada
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7
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Arias-Felipe A, Ramírez-Berrios J, Recio-Martinez R, Orellana-Miguel MA, Fontiveros-Escalona D, Bergón-Sendín E, de Alba-Romero C. Determining Time to Positivity of Blood Cultures in a Neonatal Unit. J Pediatric Infect Dis Soc 2022; 11:510-513. [PMID: 36057109 DOI: 10.1093/jpids/piac084] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2022] [Accepted: 07/29/2022] [Indexed: 11/13/2022]
Abstract
Blood cultures are the gold standard for detecting bacteremia. We have studied the time to positivity of blood cultures in our neonatal unit to reduce antibiotic doses in patients with a negative blood culture. Empirical antibiotic treatment of neonatal sepsis could be withdrawn 24 hours after obtaining blood cultures.
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Affiliation(s)
- Ana Arias-Felipe
- Paediatrics Department, Hospital Universitario 12 de Octubre, Madrid, Spain
| | | | - Raúl Recio-Martinez
- Microbiology Department, Hospital Universitario 12 de Octubre, Madrid, Spain
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8
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Yang X, Liu M, Yu X, Wang Z, Xu Y. Time to Positivity Facilitates an Early Differential Diagnosis of Candida tropicalis from Other Candida species. Infect Drug Resist 2022; 15:5879-5886. [PMID: 36247739 PMCID: PMC9553502 DOI: 10.2147/idr.s383846] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Accepted: 09/28/2022] [Indexed: 11/05/2022] Open
Abstract
Background Candidemia caused by Candida tropicalis has more serious adverse consequences and an even higher mortality. Time to positivity (TTP) has been widely used to identify microbial species, resistant microorganisms and distinguish real pathogens and pollutants. However, few studies have demonstrated TTP as a presumptive diagnosis of C. tropicalis in patients with candidemia. Patients and Methods A retrospective study of 136 episodes of candidemia and simulated blood cultures with 314 episodes of confirmed Candida strains were applied to explore the role of TTPs in diagnosing C. tropicalis. TTPs were recorded as the shorter one if both aerobic and anaerobic vials were positive. Lastly, relationships were tested between TTPs and resistance and initial inocula concentration. Results For the retrospective study, the mean of TTPs for C. tropicalis from 136 patients with candidemia was significantly shorter than other Candida species. The area under the receiver operating characteristics (ROC) curve was 0.8896 ± 0.030 with a sensitivity of 92.86% and a specificity of 77.87%, respectively, indicating TTPs with a cut-off value of <25.50 h had a strong diagnostic power for C. tropicalis in patients with candidemia. Moreover, TTPs from 314 simulated blood cultures showed similar results as the retrospective study, demonstrating TTP is a powerful diagnostic tool in early diagnosing C. tropicalis in patients with candidemia. Additionally, our results showed no statistical significance between TTPs and initial inocula concentration and resistance of Candida species, suggesting initial inocula concentration does not impact TTPs, and TTPs may not be promising in predicting the resistance of all Candida species. Conclusion TTP can be employed to early distinguish C. tropicalis from other Candida species in patients with candidemia, which is extremely helpful to initiate empiric antifungal treatments to improve clinical outcomes.
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Affiliation(s)
- Xianggui Yang
- Department of Laboratory Medicine, Clinical Medical College and the First Affiliated Hospital of Chengdu Medical College, Chengdu, Sichuan, People’s Republic of China,Correspondence: Xianggui Yang; Ying Xu, Tel/Fax +86-17358631230; +86-28-83016723, Email ;
| | - Mingquan Liu
- Department of Laboratory Medicine, Clinical Medical College and the First Affiliated Hospital of Chengdu Medical College, Chengdu, Sichuan, People’s Republic of China
| | - Xuejing Yu
- Department of Internal Medicine, Division of Cardiology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Zhenguo Wang
- Department of Stomatology, Clinical Medical College and the First Affiliated Hospital of Chengdu Medical College, Chengdu, Sichuan, People’s Republic of China
| | - Ying Xu
- Department of Laboratory Medicine, Clinical Medical College and the First Affiliated Hospital of Chengdu Medical College, Chengdu, Sichuan, People’s Republic of China
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Ransom EM, Burnham CD. Routine Use of Anaerobic Blood Culture Bottles for Specimens Collected from Adults and Children Enhances Microorganism Recovery and Improves Time to Positivity. J Clin Microbiol 2022; 60:e0050022. [PMID: 36040158 DOI: 10.1128/jcm.00500-22] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
The utility of anaerobic blood culture bottles remains controversial, especially for specimens from children. Data are limited on the inclusion of an anaerobic bottle as part of a blood culture "set" when using contemporary blood culture instruments and media. Here, we evaluated the clinical utility of anaerobic blood culture bottles (FN Plus) and aerobic bottles (FA Plus) for the BacT/Alert Virtuo blood culture system (bioMérieux). A total of 158,710 bottles collected between November 2018 and October 2019 were evaluated. There were 6,652 positive anaerobic bottles, of which 384 (5.8%) contained 403 obligate anaerobes. In patients <19 years old, there were 389 positive anaerobic bottles, with 15 (1.8%) containing 16 obligate anaerobes. If not for anaerobic bottles, all but 8 obligate anaerobes would have gone undetected. Furthermore, anaerobic bottles were advantageous for some facultative anaerobes. Staphylococcus aureus from anaerobic bottles demonstrated statistically significant increased recovery (1,992 anaerobic versus 1,901 aerobic bottles, P = 0.009) and faster mean time to positivity (1,138 versus 1,174 min, P = 0.027). Only 25 microorganisms had statistically significant improved recovery and/or faster time to positivity from aerobic versus anaerobic bottles, suggesting anaerobic bottles offer comparable growth for most species. Finally, if only an aerobic bottle had been collected, 2,027 fewer positive cultures would have been detected and 7,452 fewer isolates would have been reported, including cultures with S. aureus (413 isolates, 10.6% less), Pseudomonas aeruginosa (9 isolates, 3.1% less) and Escherichia coli (193 isolates, 14.0% less). Taken together, these findings support the practice of routinely including an anaerobic bottle for blood culture collection.
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Hsu JE, Bumgarner RE, Bourassa LA, Budge MD, Duquin TR, Garrigues GE, Green A, Iannotti JP, Khazzam MS, Koh JL, Matsen FA, Namdari S, Nicholson TA, Richter SS, Sabesan VJ, Virk MS, Whitson AJ, Yian EH, Ricchetti ET. What do positive and negative Cutibacterium culture results in periprosthetic shoulder infection mean? A multi-institutional control study. J Shoulder Elbow Surg 2022; 31:1713-1720. [PMID: 35176494 DOI: 10.1016/j.jse.2022.01.127] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Revised: 01/06/2022] [Accepted: 01/09/2022] [Indexed: 02/01/2023]
Abstract
BACKGROUND Deep tissue culture specimens obtained at the time of revision shoulder arthroplasty are commonly positive for Cutibacterium. Clinical interpretation of positive cultures can be difficult. This was a multi-institutional study evaluating the accuracy of cultures for Cutibacterium using positive control (PC) and negative control (NC) samples. The relationship between time to culture positivity and strength of culture positivity was also studied. METHODS Eleven different institutions were each sent 12 blinded samples (10 PC and 2 NC samples). The 10 PC samples included 2 sets of 5 different dilutions of a Cutibacterium isolate from a failed total shoulder arthroplasty with a probable periprosthetic infection. At each institution, the samples were handled as if they were received from the operating room. Specimen growth, time to culture positivity, and strength of culture positivity (based on semiquantitative assessment) were reported. RESULTS A total of 110 PC samples and 22 NC samples were tested. One hundred percent of specimens at the 4 highest dilutions were positive for Cutibacterium. At the lowest dilution, 91% of samples showed positive findings. Cutibacterium grew in 14% of NC samples. Cutibacterium grew in PC samples at an average of 4.0 ± 1.3 days, and all of these samples showed growth within 7 days. The time to positivity was significantly shorter (P < .001) and the strength of positivity was significantly higher (P < .001) in true-positive cultures compared with false-positive cultures. CONCLUSIONS This multi-institutional study suggests that different institutions may report highly consistent rates of culture positivity for revision shoulder arthroplasty samples with higher bacterial loads. In contrast, with lower bacterial loads, the results are somewhat less consistent. Clinicians should consider using a shorter time to positivity and a higher strength of positivity as adjuncts in determining whether a tissue culture sample is a true positive.
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Affiliation(s)
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- ASES PJI Multicenter Research Group
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11
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Ulrich PS, Bastian IN, Chen DJ. Clinical Significance of BD Bactec FX Blood Culture Incubation Beyond 96 Hours (4 Days). J Clin Microbiol 2022; 60:e0054922. [PMID: 35758670 DOI: 10.1128/jcm.00549-22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Blood cultures (BC) for bacteria and yeast have traditionally been incubated for 5 days using modern instruments. Many organisms may grow sooner, and the need for the full 5-day incubation period has been questioned. This study evaluated the clinical significance of isolates recovered beyond 96 h. A retrospective chart review was conducted on all positive BC (+BC) performed via BD Bactec FX with >96 h of incubation from 5/2019 to 1/2022 at the UW Health University Hospital clinical microbiology laboratory. A total of 59,958 BC were performed; 6,031 (10%) were +BC. Of +BC, 104 (2%) demonstrated growth >96 h. The 104 cultures were from 89 patients and included 12 (12%) Staphylococcus aureus (1 MRSA), 9 (9%) yeast (8 Candida sp.), 8 (8%) Escherichia coli and 7 (7%) Enterococcus sp. (1 VRE) isolates. Fifty-six percent (n = 50) of the 89 +BC >96 h cases were clinically significant, and 26% (n = 13) resulted in antibiotic adjustments based on the +BC; 4 of these had previous positive cultures. Of the remaining 37 clinically significant +BC >96 h for which no antibiotic changes were made, 32 patients had previous positive cultures. The majority (98%) of BC bottles were positive before 96 h. For isolates that required >96 h, most (56%) were considered clinically significant, including S. aureus and E. coli cultures. Changes to antibiotic therapy were made in a minority (26%) of clinically significant cases. Based on these findings, under routine conditions, laboratories using BD Bactec FX should maintain a 120 h incubation period.
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12
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Church D, Somayaji R, Viczko J, Gregson D, Naugler C. A longitudinal population-based study of predictors of mortality from bloodstream infections in Calgary, Alberta, Canada. Future Microbiol 2021; 17:17-25. [PMID: 34874184 DOI: 10.2217/fmb-2021-0004] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Aim: To study the predictors of mortality from nine major pathogens causing approximately 70% of cases over a 7-year period. Materials & methods: A population-based surveillance cohort of all adult and pediatric patients in the Calgary Zone with an initial episode of bloodstream infections (BSI). Results: The 1-year mortality was 29.2% among 9524 patients (5164 males [54%]). Incidence rates for BSI increased annually to 119.7/100,000 persons by 2016. Distinct survival curves were found for each specific pathogen. Age, comorbidity burden and infecting organism were significantly associated with increased hazard of death. No relationship occurred between the time to positivity for blood cultures and overall mortality. Conclusion: BSI has a high mortality, but overall survival depends on underlying host health and the type of pathogen acquired.
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Affiliation(s)
- Deirdre Church
- Department of Pathology & Laboratory Medicine, Calgary, AB T2N 4N1, Canada.,Department of Medicine, Cumming School of Medicine, Calgary, AB T2N 4N1, Canada.,Department of the Clinical Section of Microbiology, Calgary Laboratory Services, Calgary, AB T2N 4N1, Canada
| | - Ranjani Somayaji
- Department of Medicine, Cumming School of Medicine, Calgary, AB T2N 4N1, Canada.,Department of Microbiology, Immunology & Infectious Disease, Calgary, AB T2N 4N1, Canada.,Department of Community Health Sciences, University of Calgary, Calgary, AB T2N 4N1, Canada
| | - Jeannine Viczko
- Department of Pathology & Laboratory Medicine, Calgary, AB T2N 4N1, Canada.,Department of the Clinical Section of Microbiology, Calgary Laboratory Services, Calgary, AB T2N 4N1, Canada
| | - Dan Gregson
- Department of Pathology & Laboratory Medicine, Calgary, AB T2N 4N1, Canada.,Department of Medicine, Cumming School of Medicine, Calgary, AB T2N 4N1, Canada.,Department of the Clinical Section of Microbiology, Calgary Laboratory Services, Calgary, AB T2N 4N1, Canada
| | - Christopher Naugler
- Department of Pathology & Laboratory Medicine, Calgary, AB T2N 4N1, Canada.,Department of Community Health Sciences, University of Calgary, Calgary, AB T2N 4N1, Canada
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13
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Sellers LA, Fitton KM, Segovia MF, Forehand CC, Dobbin KK, Newsome AS. Time to blood, respiratory and urine culture positivity in the intensive care unit: Implications for de-escalation. SAGE Open Med 2021; 9:20503121211040702. [PMID: 34434557 PMCID: PMC8381457 DOI: 10.1177/20503121211040702] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Accepted: 08/02/2021] [Indexed: 11/15/2022] Open
Abstract
Objectives Concern for late detection of bacterial pathogens is a barrier to early de-escalation efforts. The purpose of this study was to assess blood, respiratory and urine culture results at 72 h to test the hypothesis that early negative culture results have a clinically meaningful negative predictive value. Methods We retrospectively reviewed all patients admitted to the medical intensive care unit between March 2012 and July 2018 with blood cultures obtained. Blood, respiratory and urine culture results were assessed for time to positivity, defined as the time between culture collection and preliminary species identification. The primary outcome was the negative predictive value of negative blood culture results at 72 h. Secondary outcomes included sensitivity, specificity, positive predictive value and negative predictive value of blood, respiratory and urine culture results. Results The analysis included 1567 blood, 514 respiratory and 1059 urine cultures. Of the blood, respiratory and urine cultures ultimately positive, 90.3%, 76.2% and 90.4% were positive at 72 h. The negative predictive value of negative 72-h blood, respiratory and urine cultures were 0.99, 0.82 and 0.97, respectively. Antibiotic de-escalation had good specificity, positive predictive value and negative predictive value for finalized negative cultures. Conclusion Negative blood and urine culture results at 72 h had a high negative predictive value. These findings have important ramifications for antimicrobial stewardship efforts and support protocolized re-evaluation of empiric antibiotic therapy at 72 h. Caution should be used in patients with clinically suspected pneumonia, since negative respiratory culture results at 72 h were weakly predictive of finalized negative cultures.
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Affiliation(s)
- Lindsey A Sellers
- Department of Pharmacy, Augusta University Medical Center, Augusta, GA, USA
| | | | | | - Christy C Forehand
- Department of Pharmacy, Augusta University Medical Center, Augusta, GA, USA.,Department of Clinical and Administrative Pharmacy, College of Pharmacy, University of Georgia, Athens, GA, USA
| | - Kevin K Dobbin
- Department of Epidemiology and Biostatistics, College of Public Health, University of Georgia, Athens, GA, USA
| | - Andrea Sikora Newsome
- Department of Pharmacy, Augusta University Medical Center, Augusta, GA, USA.,Department of Clinical and Administrative Pharmacy, College of Pharmacy, University of Georgia, Athens, GA, USA
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Ransom EM, Alipour Z, Wallace MA, Burnham CA. Evaluation of Optimal Blood Culture Incubation Time To Maximize Clinically Relevant Results from a Contemporary Blood Culture Instrument and Media System. J Clin Microbiol 2021; 59:e02459-20. [PMID: 33239377 DOI: 10.1128/JCM.02459-20] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Accepted: 11/23/2020] [Indexed: 12/11/2022] Open
Abstract
Timely diagnosis of microorganisms in blood cultures is necessary to optimize therapy. Although blood culture media and systems have evolved for decades, the standard interval for incubation prior to being discarded as negative has remained 5 days. Here, we evaluated the optimal incubation time for the BacT/Alert Virtuo blood culture detection system (bioMérieux) using FA Plus (aerobic) and FN Plus (anaerobic) resin culture bottles in routine clinical use. Timely diagnosis of microorganisms in blood cultures is necessary to optimize therapy. Although blood culture media and systems have evolved for decades, the standard interval for incubation prior to being discarded as negative has remained 5 days. Here, we evaluated the optimal incubation time for the BacT/Alert Virtuo blood culture detection system (bioMérieux) using FA Plus (aerobic) and FN Plus (anaerobic) resin culture bottles in routine clinical use. Following institutional review board (IRB) approval, a retrospective review evaluated the outcomes of 158,710 bottles collected between November 2018 and October 2019. The number of positive blood bottles was 13,592 (8.6%); 99% of positive aerobic and anaerobic bottles flagged positive by 91.5 and 108 h, respectively. The mean (median) times to positivity were 18.4 h (15.6 h) for Staphylococcus aureus, 12.3 h (9.5 h) for Escherichia coli, 22.2 h (15.9 h) for Pseudomonas aeruginosa, and 48.9 h (42.9 h) for Candida spp. Only 175 bottles (0.1% of all bottles) flagged positive after 4 days of incubation; 89 (51%) of these bottles grew Cutibacterium (Propionibacterium) species. Chart review of blood cultures positive after 4 days (96 h) rarely had a clinical impact and sometimes had a negative impact on patient care. Finally, a seeded study of the HACEK group (i.e., Haemophilus, Aggregatibacter, Cardiobacterium, Eikenella, and Kingella), historically associated with delayed blood culture positivity, demonstrated no benefit to extended incubation beyond 4 days. Collectively, these findings demonstrated that a 4-day incubation time was sufficient for the Virtuo system and media. Implementation of the 4-day incubation time could enhance clinically relevant results by reducing recovery of contaminants and finalizing blood cultures 1 day earlier.
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De Rose DU, Perri A, Auriti C, Gallini F, Maggio L, Fiori B, D’Inzeo T, Spanu T, Vento G. Time to Positivity of Blood Cultures Could Inform Decisions on Antibiotics Administration in Neonatal Early-Onset Sepsis. Antibiotics (Basel) 2021; 10:antibiotics10020123. [PMID: 33525647 PMCID: PMC7910918 DOI: 10.3390/antibiotics10020123] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2021] [Revised: 01/25/2021] [Accepted: 01/26/2021] [Indexed: 11/30/2022] Open
Abstract
(1) Background: Empirical antibiotics for suspected neonatal early-onset sepsis are often prolonged administered, even in the absence of clinical signs of infection, while awaiting the blood cultures results. The C-reactive protein is widely used to guide antibiotic therapy, although its increase in the first hours of life is not always evidence of infection. The aim of this study was to evaluate the time to positivity (TTP) of blood cultures (BC) that develop pathogens in our population of neonates and determine whether TTP could safely inform the decisions on empirical antibiotic discontinuation in neonatal early-onset sepsis and reduce the use of unnecessary antibiotics. (2) Methods: We retrospectively collected data of all newborns ≥ 34 weeks admitted to the Neonatal Intermediate-Care Unit at Policlinico “A. Gemelli” University Hospital (Rome, Italy) from 2014 to 2018, with suspected early-onset sepsis (EOS). The TTP was the time in hours from the first BC inoculation to the bacterial growth. We defined as positive BC only those with a pathogenic organism. (3) Results: In total, 103 out of 20,528 infants born in the five-year study period were admitted to our Neonatal Intermediate-Care Unit because of a suspected EOS and enrolled into the study. The mean TTP of pathogenic organisms was 17.7 ± 12.5 h versus 80.5 ± 55.8 h of contaminants (p = 0.003). We found ten positive BCs. The TTP of BC was lower than 12, 36, and 48 h in 80%, 90%, and 100% of cases, respectively. CRP levels on admission were similar in infants with a positive and negative BC (p = 0.067). The discontinuation of therapy in asymptomatic infants 48 h after initiation would have resulted in a saving of 217 days of antibiotics (31.1% of total days administered). (4) Conclusion: From our data, the TTP of blood cultures that develop pathogens is less than 48 h in 100% of cases. Therefore, in late preterm and full-term infants with suspected EOS, stopping empiric antibiotics 48 h after initiation may be a safe practice to reduce unnecessary antibiotic use, when blood cultures are negative and infants asymptomatic.
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Affiliation(s)
- Domenico Umberto De Rose
- Neonatal Intensive Care Unit, Medical and Surgical Department of Fetus, Newborn and Infant—“Bambino Gesù” Children’s Hospital IRCCS, 00165 Rome, Italy;
- Correspondence: ; Tel.: +39-06-68592427; Fax: +39-06-68593916
| | - Alessandro Perri
- Neonatology Unit, Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario “Agostino Gemelli” IRCCS, 00168 Rome, Italy; (A.P.); (F.G.); (L.M.); (G.V.)
| | - Cinzia Auriti
- Neonatal Intensive Care Unit, Medical and Surgical Department of Fetus, Newborn and Infant—“Bambino Gesù” Children’s Hospital IRCCS, 00165 Rome, Italy;
| | - Francesca Gallini
- Neonatology Unit, Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario “Agostino Gemelli” IRCCS, 00168 Rome, Italy; (A.P.); (F.G.); (L.M.); (G.V.)
- Dipartimento di Scienze della Vita e Sanità Pubblica, Facoltà di Medicina e Chirurgia, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Luca Maggio
- Neonatology Unit, Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario “Agostino Gemelli” IRCCS, 00168 Rome, Italy; (A.P.); (F.G.); (L.M.); (G.V.)
- Dipartimento di Scienze della Vita e Sanità Pubblica, Facoltà di Medicina e Chirurgia, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Barbara Fiori
- Department of Laboratory and Infectious Sciences, Fondazione Policlinico Universitario “Agostino Gemelli” IRCCS, 00168 Rome, Italy; (B.F.); (T.D.); (T.S.)
| | - Tiziana D’Inzeo
- Department of Laboratory and Infectious Sciences, Fondazione Policlinico Universitario “Agostino Gemelli” IRCCS, 00168 Rome, Italy; (B.F.); (T.D.); (T.S.)
| | - Teresa Spanu
- Department of Laboratory and Infectious Sciences, Fondazione Policlinico Universitario “Agostino Gemelli” IRCCS, 00168 Rome, Italy; (B.F.); (T.D.); (T.S.)
- Dipartimento di Scienze Biotecnologiche di Base, Cliniche Intensivologiche e Perioperatorie, Facoltà di Medicina e Chirurgia, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Giovanni Vento
- Neonatology Unit, Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario “Agostino Gemelli” IRCCS, 00168 Rome, Italy; (A.P.); (F.G.); (L.M.); (G.V.)
- Dipartimento di Scienze della Vita e Sanità Pubblica, Facoltà di Medicina e Chirurgia, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
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16
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Zeng L, Wang S, Lin M, Chen Y, Deng Q, Zhong H, Guan X, Yao S, Liu H. Evaluation of time to positivity for blood culture combined with immature granulocytes, neutrophil-to-lymphocyte ratio, and CRP in identifying bloodstream coagulase-negative Staphylococci infection in pediatric patients. J Clin Lab Anal 2020; 34:e23473. [PMID: 33463771 PMCID: PMC7676180 DOI: 10.1002/jcla.23473] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 06/13/2020] [Accepted: 06/13/2020] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVE To evaluate the application value of time to positivity (TTP) for blood culture combined with inflammatory parameters that included immature granulocyte percentage (IG%), immature granulocyte count (IG#), C-reactive protein (CRP), white blood cells (WBC) neutrophil percentage (NE%), and neutrophil-to-lymphocyte ratio (NLR), and to identify bloodstream infections from contamination with coagulase-negative staphylococci (CoNS) in pediatric patients. METHODS Data of 12 897 inpatients with blood culture CoNS were retrospectively collected and analyzed from January-December 2019 at our hospital. According to pre-defined criteria, they were divided into a CoNS infection group (132 cases) and a CoNS contamination group (124 cases). Infection with Staphylococcus aureus (SA, 27 cases) at the same period was considered a positive control group. ROC curve analysis assisted in determining the value of applying TTP combined with the above-mentioned inflammatory parameters to distinguish CoNS infection from contamination. RESULTS Among the 256 strains of CoNS, Staphylococcus hominis (55.1%), Staphylococcus epidermidis (32.0%), and Staphylococcus capitis (7.0%) were common. There was no significant difference in the subspecies distribution between the infection and contamination groups. The TTP of the CoNS infection group was significantly lower than the contamination group (P < .05). IG%, IG#, CRP, NE%, and NLR were all higher in the infected group as compared to the contaminated group (P < .05), while WBC was similar among groups. There was also no statistical difference in those parameters when comparing the CoNS infection and SA groups. ROC analysis showed that TTP value in identifying CoNS infection from contamination was the highest with area under the curve (AUC) of 0.913, and the sensitivity and specificity were 0.827 and 0.852, respectively, at the optimal cutoff value of 23.9 hours. This was followed by IG% (AUC = 0.712), with an optimal critical value of 0.55%, and a sensitivity of 0.519 and specificity of 0.797. All the AUC values of IG#, CRP, NE%, and NLR were <0.7. A combination of TTP with IG%, CRP, and NLR improved the AUC, sensitivity, specificity, accuracy, PPV, and NPV values to 0.977, 0.922, 0.957, 91.8%, 92.2%, and 91.3%, respectively. CONCLUSIONS TTP within 24 hours indicates likelihood of CoNS as the pathogenic agent in pediatric patient blood culture. The combination of TTP with IG% CRP and NLR might improve the diagnostic accuracy.
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Affiliation(s)
- Lanlan Zeng
- Guangzhou Women and Children's Medical CenterGuangzhou Medical UniversityGuangzhouChina
| | - Shuhui Wang
- Guangzhou Women and Children's Medical CenterGuangzhou Medical UniversityGuangzhouChina
| | - Minchun Lin
- Guangzhou Women and Children's Medical CenterGuangzhou Medical UniversityGuangzhouChina
| | - Yaxing Chen
- Guangzhou Women and Children's Medical CenterGuangzhou Medical UniversityGuangzhouChina
| | - Qiulian Deng
- Guangzhou Women and Children's Medical CenterGuangzhou Medical UniversityGuangzhouChina
| | - Huamin Zhong
- Guangzhou Women and Children's Medical CenterGuangzhou Medical UniversityGuangzhouChina
| | - Xiaoshan Guan
- Guangzhou Women and Children's Medical CenterGuangzhou Medical UniversityGuangzhouChina
| | - Shuwen Yao
- Guangzhou Women and Children's Medical CenterGuangzhou Medical UniversityGuangzhouChina
| | - Haiying Liu
- Guangzhou Women and Children's Medical CenterGuangzhou Medical UniversityGuangzhouChina
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17
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Butler-Laporte G, Yansouni CP, Paquette K, Lawandi A, Stabler SN, Akhter M, Davidson AC, Gavric M, Jinah R, Saeed Z, Demir K, Sangsari S, Huang K, Mahpour A, Shamatutu C, Caya C, Troquet JM, Clark G, Wong T, Lee TC, Stenstrom R, Sweet D, Cheng MP. Real-world Time to Positivity of 2 Widely Used Commercial Blood Culture Systems in Patients With Severe Manifestations of Sepsis: An Analysis of the FABLED Study. Open Forum Infect Dis 2020; 7:ofaa371. [PMID: 33005699 PMCID: PMC7518368 DOI: 10.1093/ofid/ofaa371] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Accepted: 08/14/2020] [Indexed: 01/22/2023] Open
Abstract
Background Of all microbiological tests performed, blood cultures have the most impact on patient care. Timely results are essential, especially in the management of sepsis. While there are multiple available blood culture systems on the market, they have never been compared in a prospective study in a critically ill population. Methods We performed an analysis of the FABLED study cohort to compare culture results and time to positivity (TTP) of 2 widely used blood culture systems: BacT/Alert and BACTEC. In this multisite prospective study, patients with severe manifestations of sepsis had cultures drawn before antibiotics using systematic enrollment criteria and blood drawing methodology allowing for minimization of pre-analytical biases. Results We enrolled 315 patients; 144 had blood cultures (47 positive) with BacT/Alert and 171 with BACTEC (53 positive). Patients whose blood cultures were processed using the BacT/Alert system were younger (median, 64 vs 70 years; P = .003), had a higher proportion of HIV (9.03% vs 1.75%; P = .008) and a lower qSOFA (P = .003). There were no statistically significant differences in the most commonly identified bacterial species. TTP was shorter for BACTEC (median [interquartile range {IQR}], 12.5 [10-14] hours) compared with BacT/Alert (median [IQR], 17 [14-21] hours; P < .0001). Conclusions In this large prospective multi-centre study comparing the two blood culture systems among patients with severe manifestations of sepsis, and using a rigorous pre-analytical methodology, the BACTEC system yielded positive culture results 4.5 hours earlier than BacT/Alert. These results apply to commonly isolated bacteria. However, our study design did not allow direct comparison of TTP for unusual pathogens nor of clinical sensitivity between systems. More research is needed to determine the clinical implications of this finding.
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Affiliation(s)
- Guillaume Butler-Laporte
- Divisions of Infectious Diseases and Medical Microbiology, McGill University Health Centre, Montréal, Québec, Canada
| | - Cedric P Yansouni
- Divisions of Infectious Diseases and Medical Microbiology, McGill University Health Centre, Montréal, Québec, Canada.,McGill Interdisciplinary Initiative in Infection and Immunity, McGill University, Montréal, Québec, Canada
| | - Katryn Paquette
- Division of Neonatology, McGill University Health Centre, Montréal, Québec, Canada
| | - Alexander Lawandi
- Divisions of Infectious Diseases and Medical Microbiology, McGill University Health Centre, Montréal, Québec, Canada
| | - Sarah N Stabler
- Department of Pharmacy Services, Surrey Memorial Hospital, Surrey, British Columbia, Canada
| | - Murtaza Akhter
- Department of Emergency Medicine, Maricopa Integrated Health Center, Phoenix, Arizona, USA
| | - Adam C Davidson
- Department of Emergency Medicine, Lion's Gate Hospital, Vancouver, British Columbia, Canada
| | - Marko Gavric
- University of British Columbia, Vancouver, British Columbia, Canada
| | - Rehman Jinah
- University of British Columbia, Vancouver, British Columbia, Canada
| | - Zahid Saeed
- Department of Pulmonary and Critical Care Medicine, University of Arizona College of Medicine, Phoenix, Arizona, USA
| | - Koray Demir
- Department of Medicine, McGill University, Montréal, Québec, Canada
| | - Sassan Sangsari
- Department of Emergency Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Kelly Huang
- Department of Emergency Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Amirali Mahpour
- Division of Respirology, University of Western Ontario, London, Ontario, Canada
| | - Chris Shamatutu
- University of British Columbia, Vancouver, British Columbia, Canada
| | | | - Jean-Marc Troquet
- Department of Emergency Medicine, McGill University Health Centre, Montréal, Québec, Canada
| | - Greg Clark
- Department of Emergency Medicine, McGill University Health Centre, Montréal, Québec, Canada
| | - Titus Wong
- Department of Medical Microbiology, Vancouver Coastal Health, Vancouver, British Columbia, Canada
| | - Todd C Lee
- Divisions of Infectious Diseases and Medical Microbiology, McGill University Health Centre, Montréal, Québec, Canada.,McGill Interdisciplinary Initiative in Infection and Immunity, McGill University, Montréal, Québec, Canada.,Department of Medicine, McGill University, Montréal, Québec, Canada
| | - Robert Stenstrom
- Department of Emergency Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - David Sweet
- Department of Emergency Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Matthew P Cheng
- Divisions of Infectious Diseases, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
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Pieterman ED, Sarink MJ, Sala C, Cole ST, de Steenwinkel JEM, Bax HI. Advanced Quantification Methods To Improve the 18b Dormancy Model for Assessing the Activity of Tuberculosis Drugs In Vitro. Antimicrob Agents Chemother 2020; 64:e00280-20. [PMID: 32340993 DOI: 10.1128/AAC.00280-20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Accepted: 04/21/2020] [Indexed: 01/03/2023] Open
Abstract
One of the reasons for the lengthy tuberculosis (TB) treatment is the difficulty to treat the nonmultiplying mycobacterial subpopulation. In order to assess the ability of (new) TB drugs to target this subpopulation, we need to incorporate dormancy models in our preclinical drug development pipeline. In most available dormancy models, it takes a long time to create a dormant state, and it is difficult to identify and quantify this nonmultiplying condition. The Mycobacterium tuberculosis 18b strain might overcome some of these problems, because it is dependent on streptomycin for growth and becomes nonmultiplying after 10 days of streptomycin starvation but still can be cultured on streptomycin-supplemented culture plates. We developed our 18b dormancy time-kill kinetics model to assess the difference in the activity of isoniazid, rifampin, moxifloxacin, and bedaquiline against log-phase growth compared to the nonmultiplying M. tuberculosis subpopulation by CFU counting, including a novel area under the curve (AUC)-based approach as well as time-to-positivity (TTP) measurements. We observed that isoniazid and moxifloxacin were relatively more potent against replicating bacteria, while rifampin and high-dose bedaquiline were equally effective against both subpopulations. Moreover, the TTP data suggest that including a liquid culture-based method could be of additional value, as it identifies a specific mycobacterial subpopulation that is nonculturable on solid media. In conclusion, the results of our study underline that the time-kill kinetics 18b dormancy model in its current form is a useful tool to assess TB drug potency and thus has its place in the TB drug development pipeline.
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Chen Y, Huang X, Wu A, Lin X, Zhou P, Liu Y, Wu Y, Fu C, Dou Q, Jiang H. Prognostic roles of time to positivity of blood cultures in patients with Escherichia coli bacteremia. Epidemiol Infect 2020; 148:e101. [PMID: 32381131 DOI: 10.1017/S0950268820000941] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
The time to positivity (TTP) of blood cultures has been considered a predictor of clinical outcomes for bacteremia. This retrospective study aimed to determine the clinical value of TTP for the prognostic assessment of patients with Escherichia coli bacteremia. A total of 167 adult patients with E.coli bacteremia identified over a 22-month period in a 3500-bed university teaching hospital in China were studied. The standard cut-off TTP was 11 h in the patient cohort. The septic shock occurred in 27.9% of patients with early TTP (⩽11 h) and in 7.1% of those with a prolonged TTP (>11 h) (P = 0.003). The mortality rate was significantly higher for patients in the early than in the late group (17.7% vs. 4.0%, P < 0.001). Multivariate analysis showed that an early TTP (OR 4.50, 95% CI 1.70–11.93), intensive care unit admission (OR 8.39, 95% CI 2.01–35.14) and neutropenia (OR 4.20, 95% CI 1.55–11.40) were independently associated with septic shock. Likewise, the independent risk factors for mortality of patients were an early TTP (OR 3.80, 95% CI 1.04–12.90), intensive care unit admission (OR 6.45; 95% CI 1.14–36.53), a Pittsburgh bacteremia score ⩾2 (OR 4.34, 95% CI 1.22–15.47) and a Charlson Comorbidity Index ⩾3 (OR 11.29, 95% CI 2.81–45.39). Overall, a TTP for blood cultures within 11 h appears to be associated with worse outcomes for patients with E.coli bacteremia.
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20
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Deroche L, Bémer P, Valentin AS, Jolivet-Gougeon A, Tandé D, Héry-Arnaud G, Lemarié C, Kempf M, Bret L, Burucoa C, Corvec S, Plouzeau C. The Right Time to Safely Re-Evaluate Empirical Antimicrobial Treatment of Hip or Knee Prosthetic Joint Infections. J Clin Med 2019; 8:jcm8122113. [PMID: 31810267 PMCID: PMC6947470 DOI: 10.3390/jcm8122113] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2019] [Revised: 11/28/2019] [Accepted: 11/29/2019] [Indexed: 12/12/2022] Open
Abstract
Currently, no guideline provides recommendations on the duration of empirical antimicrobial treatment (EAT) in prosthetic joint infection (PJI). The aim of our study was to describe the time to growth of bacteria involved in PJI, rendering possible decreased duration of EAT. Based on a French multicentre prospective cohort study, culture data from patients with confirmed hip or knee PJI were analysed. For each patient, five samples were processed. Time to positivity was defined as the first positive medium in at least one sample for virulent pathogens and as the first positive medium in at least two samples for commensals. Definitive diagnosis of polymicrobial infections was considered the day the last bacteria were identified. Among the 183 PJIs, including 28 polymicrobial infections, microbiological diagnosis was carried out between Day 1 (D1) and D5 for 96.7% of cases. There was no difference in the average time to positivity between acute and chronic PJI (p = 0.8871). Microbiological diagnosis was given earlier for monomicrobial than for polymicrobial infections (p = 0.0034). When an optimized culture of peroperative samples was carried out, almost all cases of PJI were diagnosed within five days, including polymicrobial infections. EAT can be re-evaluated at D5 according to microbiological documentation.
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Affiliation(s)
- Luc Deroche
- Bacteriology-Hospital Hygiene Department, University Hospital of Poitiers, Poitiers Universiy, F-86000 Poitiers, France; (C.B.); (C.P.)
- Correspondence: or
| | - Pascale Bémer
- Bacteriology-Hospital Hygiene Department, University Hospital of Nantes, Nantes University, F-44000 Nantes, France; (P.B.); (S.C.)
| | - Anne-Sophie Valentin
- Bacteriology-Hospital Hygiene Department, University Hospital of Tours, Tours University, F-37000 Tours, France;
| | - Anne Jolivet-Gougeon
- Univ Rennes, INSERM, University Hospital of Rennes, NUMECAN Institute (Nutrition Metabolisms and Cancer), F-35000 Rennes, France;
| | - Didier Tandé
- Bacteriology-Hospital Hygiene Department, University Hospital of Brest, Brest University, F-29000 Brest, France; (D.T.); (G.H.-A.)
| | - Geneviève Héry-Arnaud
- Bacteriology-Hospital Hygiene Department, University Hospital of Brest, Brest University, F-29000 Brest, France; (D.T.); (G.H.-A.)
| | - Carole Lemarié
- Bacteriology-Hospital Hygiene Department, University Hospital of Angers, Angers University, F-49000 Angers, France; (C.L.); (M.K.)
| | - Marie Kempf
- Bacteriology-Hospital Hygiene Department, University Hospital of Angers, Angers University, F-49000 Angers, France; (C.L.); (M.K.)
| | - Laurent Bret
- Bacteriology-Hospital Hygiene Department, Hospital of Orléans, F-45000 Orléans, France;
| | - Christophe Burucoa
- Bacteriology-Hospital Hygiene Department, University Hospital of Poitiers, Poitiers Universiy, F-86000 Poitiers, France; (C.B.); (C.P.)
| | - Stéphane Corvec
- Bacteriology-Hospital Hygiene Department, University Hospital of Nantes, Nantes University, F-44000 Nantes, France; (P.B.); (S.C.)
| | - Chloé Plouzeau
- Bacteriology-Hospital Hygiene Department, University Hospital of Poitiers, Poitiers Universiy, F-86000 Poitiers, France; (C.B.); (C.P.)
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Gits-Muselli M, Villiers S, Hamane S, Berçot B, Donay JL, Denis B, Guigue N, Alanio A, Bretagne S. Time to and differential time to blood culture positivity for assessing catheter-related yeast fungaemia: A longitudinal, 7-year study in a single university hospital. Mycoses 2019; 63:95-103. [PMID: 31630462 DOI: 10.1111/myc.13024] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2019] [Revised: 10/04/2019] [Accepted: 10/10/2019] [Indexed: 01/05/2023]
Abstract
BACKGROUND Time to positivity (TTP) and differential time to positivity (DTTP) between central and peripheral blood cultures are commonly used for bacteraemia to evaluate the likelihood of central venous catheter (CVC)-related bloodstream infection. Few studies have addressed these approaches to yeast fungaemia. OBJECTIVES This study aimed to evaluate TTP and DTTP to assess CVC-related yeast fungaemia (CVC-RYF). PATIENTS/METHODS We retrospectively analysed the results from 105 adult patients with incident fungaemia, with CVC removed and cultured, collected from 2010 to 2017. The bottles were incubated in a BioMérieux BacT/ALERT 3D and kept for at least 5 days. RESULTS Of the 105 patients included, most were oncology patients (85.7%) and had of long-term CVC (79.6%); 32 (30.5%) had a culture-positive CVC (defined as CVC-RYF) with the same species as in blood culture, and 69.5% had culture-negative CVC (defined as non-CVC-RYF, NCVC-RYF). Candida albicans represented 46% of the episodes. The median TTP was statistically different between CVC-RYF and NCVC-RYF (16.8 hours interquartile range (IQR) [9.7-28.6] vs 29.4 hours [IQR 20.7-41.3]; P = .001). A TTP <10 hours had the best positive likelihood ratio (21.5) for CVC-RYF, although the sensitivity was only 28%. DTTP was available for 52 patients. A DTTP >5 hours had a sensitivity of 100% and a specificity of 71% for CVC-RYF. CONCLUSIONS Since the median TTP was 17 hours and the most performing DTTP >5 hours, these delays are too long to take a decision in the same operational day. More rapid methods for detecting infected catheters should be tested to avoid unnecessary CVC withdrawal.
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Affiliation(s)
- Maud Gits-Muselli
- Parasitology-Mycology Laboratory, Lariboisière Saint-Louis Fernand Widal Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France.,Paris-Diderot, Sorbonne Paris Cité University, Paris, France.,Molecular Mycology Unit, Institut Pasteur, Reference National Center of Invasive Mycoses and Antifungals, CNRS UMR2000, Paris, France
| | - Stéphane Villiers
- Anesthesiology Department, Lariboisière Saint-Louis Fernand Widal Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France
| | - Samia Hamane
- Parasitology-Mycology Laboratory, Lariboisière Saint-Louis Fernand Widal Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France
| | - Béatrice Berçot
- Microbiology Department, Lariboisière Saint-Louis Fernand Widal Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France.,Paris-Diderot, IAME UMR-1137, Sorbonne Paris Cité University, Paris, France
| | - Jean-Luc Donay
- Microbiology Department, Lariboisière Saint-Louis Fernand Widal Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France
| | - Blandine Denis
- Tropical and Infectious Diseases Department, Lariboisière Saint-Louis Fernand Widal Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France
| | - Nicolas Guigue
- Parasitology-Mycology Laboratory, Lariboisière Saint-Louis Fernand Widal Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France
| | - Alexandre Alanio
- Parasitology-Mycology Laboratory, Lariboisière Saint-Louis Fernand Widal Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France.,Paris-Diderot, Sorbonne Paris Cité University, Paris, France.,Molecular Mycology Unit, Institut Pasteur, Reference National Center of Invasive Mycoses and Antifungals, CNRS UMR2000, Paris, France
| | - Stéphane Bretagne
- Parasitology-Mycology Laboratory, Lariboisière Saint-Louis Fernand Widal Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France.,Paris-Diderot, Sorbonne Paris Cité University, Paris, France.,Molecular Mycology Unit, Institut Pasteur, Reference National Center of Invasive Mycoses and Antifungals, CNRS UMR2000, Paris, France
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Srivastava S, Deshpande D, Nuermberger E, Lee PS, Cirrincione K, Dheda K, Gumbo T. The Sterilizing Effect of Intermittent Tedizolid for Pulmonary Tuberculosis. Clin Infect Dis 2018; 67:S336-S341. [PMID: 30496463 PMCID: PMC6260152 DOI: 10.1093/cid/ciy626] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [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] [Indexed: 02/03/2023] Open
Abstract
Background Linezolid exhibits remarkable sterilizing effect in tuberculosis; however, a large proportion of patients develop serious adverse events. The congener tedizolid could have a better side-effect profile, but its sterilizing effect potential is unknown. Methods We performed a 42-day tedizolid exposure-effect and dose-fractionation study in the hollow fiber system model of tuberculosis for sterilizing effect, using human-like intrapulmonary pharmacokinetics. Bacterial burden was examined using time to positivity (TTP) and colony-forming units (CFUs). Exposure-effect was examined using the inhibitory sigmoid maximal kill model. The exposure mediating 80% of maximal kill (EC80) was defined as the target exposure, and the lowest dose to achieve EC80 was identified in 10000-patient Monte Carlo experiments. The dose was also examined for probability of attaining concentrations associated with mitochondrial enzyme inhibition. Results At maximal effect, tedizolid monotherapy totally eliminated 7.1 log10 CFU/mL Mycobacterium tuberculosis over 42 days; however, TTP still demonstrated some growth. Once-weekly tedizolid regimens killed as effectively as daily regimens, with an EC80 free drug 0- to 24-hour area under the concentration-time curve-to-minimum inhibitory concentration (MIC) ratio of 200. An oral tedizolid of 200 mg/day achieved the EC80 in 92% of 10000 patients. The susceptibility breakpoint was an MIC of 0.5 mg/L. The 200 mg/day dose did not achieve concentrations associated with mitochondrial enzyme inhibition. Conclusions Tedizolid exhibits dramatic sterilizing effect and should be examined for pulmonary tuberculosis. A tedizolid dose of 200 mg/day or 700 mg twice a week is recommended for testing in patients; the intermittent tedizolid dosing schedule could be much safer than daily linezolid.
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Affiliation(s)
- Shashikant Srivastava
- Center for Infectious Diseases Research and Experimental Therapeutics, Baylor Research Institute, Baylor University Medical Center, Dallas, Texas
| | - Devyani Deshpande
- Center for Infectious Diseases Research and Experimental Therapeutics, Baylor Research Institute, Baylor University Medical Center, Dallas, Texas
| | - Eric Nuermberger
- Center for Tuberculosis Research, Department of Medicine
- Department of International Health, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Pooi S Lee
- Center for Infectious Diseases Research and Experimental Therapeutics, Baylor Research Institute, Baylor University Medical Center, Dallas, Texas
| | - Kayle Cirrincione
- Center for Infectious Diseases Research and Experimental Therapeutics, Baylor Research Institute, Baylor University Medical Center, Dallas, Texas
| | - Keertan Dheda
- Lung Infection and Immunity Unit, Division of Pulmonology and University of Cape Town Lung Institute, Department of Medicine, Observatory, South Africa
| | - Tawanda Gumbo
- Center for Infectious Diseases Research and Experimental Therapeutics, Baylor Research Institute, Baylor University Medical Center, Dallas, Texas
- Lung Infection and Immunity Unit, Division of Pulmonology and University of Cape Town Lung Institute, Department of Medicine, Observatory, South Africa
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Burger DA, Schall R, Chen DG. Robust Bayesian nonlinear mixed-effects modeling of time to positivity in tuberculosis trials. Pharm Stat 2018; 17:615-628. [PMID: 30027676 DOI: 10.1002/pst.1877] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2017] [Revised: 05/15/2018] [Accepted: 05/23/2018] [Indexed: 11/08/2022]
Abstract
Early phase 2 tuberculosis (TB) trials are conducted to characterize the early bactericidal activity (EBA) of anti-TB drugs. The EBA of anti-TB drugs has conventionally been calculated as the rate of decline in colony forming unit (CFU) count during the first 14 days of treatment. The measurement of CFU count, however, is expensive and prone to contamination. Alternatively to CFU count, time to positivity (TTP), which is a potential biomarker for long-term efficacy of anti-TB drugs, can be used to characterize EBA. The current Bayesian nonlinear mixed-effects (NLME) regression model for TTP data, however, lacks robustness to gross outliers that often are present in the data. The conventional way of handling such outliers involves their identification by visual inspection and subsequent exclusion from the analysis. However, this process can be questioned because of its subjective nature. For this reason, we fitted robust versions of the Bayesian nonlinear mixed-effects regression model to a wide range of TTP datasets. The performance of the explored models was assessed through model comparison statistics and a simulation study. We conclude that fitting a robust model to TTP data obviates the need for explicit identification and subsequent "deletion" of outliers but ensures that gross outliers exert no undue influence on model fits. We recommend that the current practice of fitting conventional normal theory models be abandoned in favor of fitting robust models to TTP data.
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Affiliation(s)
| | - Robert Schall
- Department of Mathematical Statistics and Actuarial Science, University of the Free State, Bloemfontein, South Africa.,IQVIA, Biostatistics, Bloemfontein, South Africa
| | - Ding-Geng Chen
- Department of Statistics, University of Pretoria, Pretoria, South Africa
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Lin HW, Hsu HS, Huang YT, Yang CJ, Hsu MS, Liao CH. Time to positivity in blood cultures of adults with nontyphoidal Salmonella bacteremia. J Microbiol Immunol Infect 2016; 49:417-23. [PMID: 25311404 DOI: 10.1016/j.jmii.2014.08.004] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/08/2014] [Revised: 07/23/2014] [Accepted: 08/07/2014] [Indexed: 11/21/2022]
Abstract
BACKGROUND Nontyphoidal Salmonella (NTS) is an important bacterial etiology of diarrheal disease, and it causes invasive diseases in immunocompromised hosts. For bacteremia from some species, blood culture with a rapid time to positivity (TTP) is associated with greater mortality. This study investigated TTP of NTS bacteremia and its relationship to clinical parameters and prognosis. METHODS Adult patients with NTS bacteremia who were admitted to a tertiary care facility in northern Taiwan from January 2010 to December 2012 were enrolled. Demographics, clinical and microbiological characteristics, and treatment response were reviewed. The TTP for each patient was retrieved from the automated machine. RESULTS Sixty-six adult patients (mean age, 66.1 years; range, 27-96 years) with NTS bacteremia were identified by the following serogroup distributions: serogroup B (23.4%), serogroup C1 (1.6%), serogroup C2 (6.3%), and serogroup D (68.8%). The in-hospital mortality, 14-day mortality, and 30-day mortality were 15.2%, 7.6%, and 12.1%, respectively. The TTP ranged 6.5-41.7 hours (median: 11.5 hours). Patients with rapid TTP (less than 10 hours), compared to patients without rapid TTP, were more likely to have liver cirrhosis (31.6% vs. 6.4%, p = 0.013), endovascular lesions (21.1% vs. 4.3%, p = 0.05), higher bacteremia score, intensive care unit admission (57.9% vs. 25.5%, p = 0.021), and septic shock (63.2% vs. 12.8%, p < 0.001). There were no significant differences in the in-hospital mortality and 14-day mortality between patients with TTP <10 hours and patients with TTP ≥10 hours. CONCLUSION The TTP of blood cultures, interpreted with a cut-off point of <10 hours, in patients with NTS bacteremia may provide useful diagnostic and prognostic information.
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Pardo J, Klinker KP, Borgert SJ, Trikha G, Rand KH, Ramphal R. Time to positivity of blood cultures supports antibiotic de-escalation at 48 hours. Ann Pharmacother 2013; 48:33-40. [PMID: 24259644 DOI: 10.1177/1060028013511229] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Appropriate de-escalation of empirical antimicrobial therapy is a fundamental component of antimicrobial stewardship. Concern for the late detection of bloodstream pathogens may undermine early streamlining efforts and subject patients to protracted courses of nonessential therapy. OBJECTIVE To quantify the prevalence of bacterial bloodstream infection (BSI) detection after more than 48 hours of culture incubation. We also assessed the impact of antimicrobial therapy delivered prior to blood sample collection. METHODS We retrospectively evaluated time to blood culture positivity (TTP) in adult patients at an academic tertiary care hospital. Microbiology reports were reviewed to identify the TTP for the first positive blood culture bottle for each episode of BSI occurring from February 1, 2011, to July 31, 2011. Isolates were classified as true pathogens or contaminants. Blood culture results after 48 hours of incubation were compared with results after 120 hours of incubation. RESULTS The median TTP of 416 monomicrobial BSIs and 210 contamination episodes was 13.7 and 24.4 hours, respectively (P < .001). The median TTPs in those who received and did not receive prior antibiotics were 17.0 and 12.8 hours, respectively (P < .001). By 48 hours, 98% of aerobic Gram-positive and Gram-negative BSIs were detected. Culture results at 48 hours were 97% sensitive and had a negative predictive value of 99.8%. CONCLUSION Few true BSIs are detected after more than 48 hours of culture incubation. Clinicians may adjust empirical antibiotic coverage at this time with little risk for subsequent bacterial pathogen detection.
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Affiliation(s)
- Joe Pardo
- UF Health Shands Hospital, Gainesville, FL, USA
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