Division of Infectious Diseases, Samsung Medical Center, Sungkyunkwan University School of Medicine, (06351) 81 Irwon-ro, Gangnam-gu, Seoul, South Korea.
Division of Infectious Diseases, Kangdong Sacred Heart Hospital, Hallym University School of Medicine, Seoul, Republic of Korea.
Eur J Clin Microbiol Infect Dis. 2019 Apr;38(4):695-702. doi: 10.1007/s10096-019-03484-4. Epub 2019 Jan 28.
The need for mandatory confirmation of negative conversion in bacteremic urinary tract infection (UTI) has not been adequately addressed, even though follow-up blood cultures (FUBCs) are still prescribed liberally. The purpose of this study was to identify possible risk factors associated with positive FUBCs. We retrospectively collected data on adult cases of bacteremic UTI with at least one FUBC. Patients were divided into the negative FUBCs and the positive FUBC group, and data of both groups were compared. Of 306 cases of bacteremic UTI, 251 had a negative result from an FUBC and 55 had a positive result. Diabetes mellitus, malignancy, complicated UTI, and initial intensive care unit (ICU) admission were significantly more common in the positive FUBC group than in the negative group (all-P < 0.05). Time to defervescence was significantly longer in the positive FUBC group than in the negative group (52.2 h vs. 25.3 h, P < 0.05). A multivariate analysis showed that malignancy, initial ICU admission, CRP > 16 (mg/dL), and a time to defervescence of more than 48 h were significant factors associated with a positive FUBC. No subsequent cases of bacteremia developed in patients without risk factors associated with a positive FUBC. In bacteremic UTIs, patients with positive FUBCs usually present with higher initial inflammatory markers, longer time to defervescence, more frequent ICU admission rates, and an elevated chance of having cancer. More careful clinical assessment before drawing FUBCs would reduce costs and inconvenience to patients.
血培养阴性转换的强制性确认需求尚未得到充分解决，尽管仍广泛开具随访血培养（FUBC）。本研究的目的是确定与 FUBC 阳性相关的可能危险因素。我们回顾性收集了至少有一次 FUBC 的成人菌血症性尿路感染（UTI）病例数据。将患者分为 FUBC 阴性和 FUBC 阳性组，并比较两组数据。在 306 例菌血症性 UTI 患者中，251 例 FUBC 结果为阴性，55 例 FUBC 结果为阳性。与 FUBC 阴性组相比，FUBC 阳性组的糖尿病、恶性肿瘤、复杂 UTI 和初始重症监护病房（ICU）入住的比例显著更高（均 P < 0.05）。FUBC 阳性组退热时间明显长于 FUBC 阴性组（52.2 小时 vs. 25.3 小时，P < 0.05）。多因素分析显示，恶性肿瘤、初始 ICU 入住、C 反应蛋白（CRP）>16（mg/dL）和退热时间超过 48 小时是与 FUBC 阳性相关的显著因素。无 FUBC 阳性相关危险因素的患者均未发生后续菌血症。在菌血症性 UTI 中，FUBC 阳性患者通常具有更高的初始炎症标志物、更长的退热时间、更高的 ICU 入住率和更高的癌症发生几率。在进行 FUBC 检查前进行更仔细的临床评估，将降低成本并减少患者的不便。
