Infectious Diseases Unit, Department of Medical and Surgical Sciences, Policlinico Sant'Orsola Malpighi, University of Bologna, Bologna, Italy.
Infectious Diseases Unit, Department of Medical and Surgical Sciences, Policlinico Sant'Orsola Malpighi, University of Bologna, Bologna, Italy.
Clin Microbiol Infect. 2020 Jul;26(7):897-903. doi: 10.1016/j.cmi.2020.01.023. Epub 2020 Jan 30.
We examined factors associated with follow-up blood cultures (FUBCs) in patients with monomicrobial Gram-negative (GN) bloodstream infection (BSI) and investigated the impact of FUBCs on therapeutic management and patient outcome.
A retrospective cohort analysis was conducted of adult patients diagnosed with GN-BSI at a tertiary-care university hospital during 2013-2016. FUBCs performed between 24 hours and 7 days after index BCs was the exposure variable. Risk factors for 30-day mortality were analysed by multivariate Cox analysis on the overall cohort, including FUBCs as a time-varying covariate and on 1:1 matched patients according to Sequential Organ Failure Assessment (SOFA) score and time to FUBC.
In 278 (17.6%) of 1576 patients, FUBCs were performed within a median of 3 and 2 days after index BCs and active antibiotic therapy initiation. Persistent BSI was found in 107 (38.5%) of 278 patients. FUBCs were performed in more severely ill patients, with nonurinary sources, difficult-to-treat pathogens and receipt of initial inappropriate therapy. Source control and infectious disease consultation rates were higher among patients with preceding FUBCs and was associated with longer treatment duration. Thirty-day mortality was 10.4%. Independent risk factors for mortality were Charlson comorbidity index (hazard ratio (HR) 1.12) SOFA (HR 1.11), septic shock (HR 2.64), urinary source (HR 0.60), central venous catheter source (HR 2.30), complicated BSI (HR 2.10), carbapenem resistance (HR 2.34), active empiric therapy (HR 0.68), source control (HR 0.34) and FUBCs (HR 0.48). Association between FUBCs and lower mortality was confirmed in the 274 matched pairs.
FUBCs were performed in more severe GN-BSIs, yielding a high rate of persistent BSI. In this context, FUBCs were associated with lower mortality.
我们研究了单一致病菌革兰氏阴性（GN）血流感染（BSI）患者进行随访血培养（FUBC）的相关因素，并探讨了 FUBC 对治疗管理和患者预后的影响。
对 2013 年至 2016 年期间在一家三级保健大学医院确诊为 GN-BSI 的成年患者进行回顾性队列分析。FUBC 是在指数 BC 后 24 小时至 7 天之间进行的暴露变量。对整个队列进行多变量 Cox 分析，包括 FUBC 作为时变协变量，并根据序贯器官衰竭评估（SOFA）评分和 FUBC 时间对 1:1 匹配的患者进行分析，以确定 30 天死亡率的危险因素。
在 1576 例患者中，278 例（17.6%）在指数 BC 后中位数 3 天和 2 天内进行了 FUBC，并开始了积极的抗生素治疗。在 278 例患者中，有 107 例（38.5%）发现持续性 BSI。FUBC 是在病情更严重的患者中进行的，这些患者有非尿源性来源、难以治疗的病原体和初始不适当的治疗。在有 FUBC 史的患者中，进行了更高的源控制和传染病咨询，且治疗时间更长。30 天死亡率为 10.4%。死亡率的独立危险因素为 Charlson 合并症指数（风险比（HR）1.12）SOFA（HR 1.11）、败血症性休克（HR 2.64）、尿源（HR 0.60）、中心静脉导管源（HR 2.30）、复杂 BSI（HR 2.10）、碳青霉烯耐药（HR 2.34）、积极经验性治疗（HR 0.68）、源控制（HR 0.34）和 FUBC（HR 0.48）。在 274 对匹配的患者中，FUBC 与较低的死亡率之间的关联得到了证实。
FUBC 是在病情更严重的 GN-BSI 中进行的，持续性 BSI 发生率较高。在这种情况下，FUBC 与较低的死亡率相关。
