Jang Sukbin, Jeon Minji, Kim Si-Ho, Mun Seok Jun
Division of Infectious Diseases, Department of Medicine, Dankook University Hospital, Dankook University College of Medicine, Cheonan, Republic of Korea.
Division of Infectious Diseases, Department of Internal Medicine, Kosin University Gospel Hospital, Kosin University College of Medicine, Busan, Republic of Korea.
Microb Drug Resist. 2025 Jan;31(1):21-25. doi: 10.1089/mdr.2024.0107. Epub 2024 Dec 5.
Intermittent negative blood cultures, known as the skip phenomenon (SP), frequently occur in patients with bacteremia (SAB), yet the clinical implications of SP in persistent SAB are not well understood. In this retrospective cohort study conducted at four university hospitals, SP was observed in 25 (11.3%) of 221 patients with persistent SAB. Infections involving methicillin-resistant (MRSA) were more prevalent in patients with SP, who also experienced longer durations of bacteremia and delayed active antibiotic therapy compared with those without SP. The 30-day in-hospital mortality was lower in patients with SP than in those without SP (12.0% vs. 30.6%, respectively, = 0.052). The median time from the initiation of active antibiotic therapy to the occurrence of SP was 6 days, and from SP to the last positive blood culture was 7 days. The duration of bacteremia and MRSA were independent predictors of SP. These findings suggest that SP can cause the duration of bacteremia to be underestimated by more than 1 week, indicating that confirmation of serial negative blood cultures might be necessary to reliably rule out SP in patients with prolonged MRSA bacteremia.
间歇性血培养阴性，即所谓的“跳跃现象”（SP），在血流感染（SAB）患者中经常出现，但SP在持续性SAB中的临床意义尚未得到充分理解。在四家大学医院进行的这项回顾性队列研究中，221例持续性SAB患者中有25例（11.3%）观察到SP。与无SP的患者相比，SP患者中耐甲氧西林金黄色葡萄球菌（MRSA）感染更为普遍，其菌血症持续时间更长，积极抗生素治疗延迟。SP患者的30天院内死亡率低于无SP的患者（分别为12.0%和30.6%，P = 0.052）。从开始积极抗生素治疗到出现SP的中位时间为6天，从SP到最后一次血培养阳性的时间为7天。菌血症持续时间和MRSA是SP的独立预测因素。这些发现表明，SP可导致菌血症持续时间被低估超过1周，这表明对于长期MRSA菌血症患者，可能需要连续进行血培养阴性确认才能可靠排除SP。
