Amipara Rajiv, Winders Hana Rac, Justo Julie Ann, Bookstaver P Brandon, Kohn Joseph, Al-Hasan Majdi N
Department of Medicine, Division of Infectious Diseases, University of South Carolina School of Medicine, Columbia, SC, USA.
Department of Medicine, Division of Infectious Diseases, Prisma Health-Midlands, Columbia, SC, USA.
EClinicalMedicine. 2021 Mar 30;34:100811. doi: 10.1016/j.eclinm.2021.100811. eCollection 2021 Apr.
The role of follow up blood cultures (FUBC) in the management of gram-negative bloodstream infection (GN-BSI) remains controversial. This retrospective cohort study examines the association between obtaining FUBC and mortality in GN-BSI.
Hospitalized adults with community-onset GN-BSI at Prisma Health-Midlands hospitals in South Carolina, USA from January 1, 2010 to June 30, 2015 were identified. Patients who died or were discharged from hospital within 72 h were excluded to minimize impact of survival and selection biases on results, respectively. Multivariate Cox proportional hazards regression was used to examine association between obtaining FUBC and 28-day all-cause mortality after adjustment for the propensity to obtain FUBC.
Among 766 patients with GN-BSI, 219 (28.6%) had FUBC obtained and 15 of 219 (6.8%) FUBC were persistently positive. Overall, median age was 67 years, 438 (57%) were women, 457 (60%) had urinary source of infection, and 426 (56%) had BSI due to . Mortality was significantly lower in patients who had FUBC obtained than in those who did not have FUBC (6.3% vs. 11.7%, log-rank = 0.03). Obtaining FUBC was independently associated with reduced mortality (hazards ratio 0.47, 95% confidence intervals: 0.23-0.87; 0.02) after adjustments for age, chronic comorbidities, acute severity of illness, appropriateness of empirical antimicrobial therapy, and propensity to obtain FUBC.
Improved survival in hospitalized patients with GN-BSI who had FUBC is consistent with the results of recent publications from Italy and North Carolina supporting utilization of FUBC in management of GN-BSI.
This study had no funding source.
血培养复查（FUBC）在革兰氏阴性菌血流感染（GN-BSI）管理中的作用仍存在争议。这项回顾性队列研究探讨了进行FUBC与GN-BSI患者死亡率之间的关联。
确定2010年1月1日至2015年6月30日期间在美国南卡罗来纳州Prisma Health-Midlands医院住院的社区获得性GN-BSI成年患者。分别排除在72小时内死亡或出院的患者，以尽量减少生存和选择偏倚对结果的影响。多变量Cox比例风险回归用于在调整进行FUBC的倾向后，检验进行FUBC与28天全因死亡率之间的关联。
在766例GN-BSI患者中，219例（28.6%）进行了FUBC，其中15例（6.8%）FUBC持续呈阳性。总体而言，中位年龄为67岁，438例（57%）为女性，457例（60%）感染源为泌尿系统，426例（56%）的血流感染由……引起。进行FUBC的患者死亡率显著低于未进行FUBC的患者（6.3%对11.7%，对数秩检验P = 0.03）。在调整年龄、慢性合并症、疾病急性严重程度、经验性抗菌治疗的恰当性以及进行FUBC的倾向后，进行FUBC与死亡率降低独立相关（风险比0.47，95%置信区间：0.23 - 0.87；P = 0.02）。
进行FUBC的住院GN-BSI患者生存率提高，这与意大利和北卡罗来纳州近期支持在GN-BSI管理中使用FUBC的出版物结果一致。
本研究无资金来源。
