Division of Public Health, Infectious Diseases, and Occupational Medicine, Department of Medicine, Mayo Clinic, Rochester, MN, USA.
Division of Public Health, Infectious Diseases, and Occupational Medicine, Department of Medicine, Mayo Clinic, Rochester, MN, USA; Department of Cardiovascular Diseases, Mayo Clinic College of Medicine and Science, Rochester, MN, USA.
Diagn Microbiol Infect Dis. 2022 Dec;104(4):115802. doi: 10.1016/j.diagmicrobio.2022.115802. Epub 2022 Aug 28.
Serial blood cultures (BCs) are integral in managing Staphylococcus aureus bacteremia (SAB) to determine complication risks and treatment response. Several studies recognized the skip phenomenon (SP)- the occurrence of intermittent negative BCs and recommend obtaining additional BCs to document clearance. We examined patients with SP to determine its clinical significance. Significant differences between those who did and did not manifest the SP included higher rates of injection drug use and community-onset SAB in the SP cohort. Longer SAB duration, high-grade SAB, and complicated bacteremia were more common in the SP group. In unadjusted outcome analyses, association of SP with hospital length of stay was not significant, although a higher risk of in-hospital mortality among SP patients approached significance. Analysis of hospital survivors revealed no significant differences in 90-day relapse or 1-year mortality. Clinical implications of patients with SAB and SP indicate that serial BCs are warranted to document bacterial clearance.
连续血培养（BCs）是管理金黄色葡萄球菌菌血症（SAB）的重要手段，可用于确定并发症风险和治疗反应。一些研究认识到了跳跃现象（SP）——间歇性阴性 BCs 的发生，并建议进行额外的 BCs 以记录清除情况。我们检查了有 SP 的患者，以确定其临床意义。在表现出 SP 和未表现出 SP 的患者之间，差异显著的包括：在 SP 队列中，注射毒品使用和社区获得性 SAB 的发生率更高。SP 组中 SAB 持续时间更长、严重程度更高和复杂性菌血症更为常见。在未调整的结果分析中，SP 与住院时间长短之间没有显著关联，尽管 SP 患者住院死亡率的风险更高，接近显著水平。对医院幸存者的分析显示，90 天复发或 1 年死亡率无显著差异。SAB 和 SP 患者的临床意义表明，连续进行 BCs 以记录细菌清除是有必要的。
