Follow-up blood cultures in Staphylococcus aureus bacteremia: a probability-based optimization.

Autor: Van Goethem S; Laboratory of Medical Microbiology, Antwerp University Hospital, Drie Eikenstraat 655, 2650, Edegem, Belgium. sam.vangoethem@icloud.com., Boogaerts H; Laboratory of Medical Microbiology, Antwerp University Hospital, Drie Eikenstraat 655, 2650, Edegem, Belgium., Cuykx M; Laboratory of Medical Microbiology, Antwerp University Hospital, Drie Eikenstraat 655, 2650, Edegem, Belgium., van den Bremen P; University of Antwerp, Edegem, Belgium., Wouters K; Clinical Trial Center (CTC), CRC Antwerp, Antwerp University Hospital, University of Antwerp, Edegem, Belgium., Goossens H; Laboratory of Medical Microbiology, Antwerp University Hospital, Drie Eikenstraat 655, 2650, Edegem, Belgium., Jansens H; Laboratory of Medical Microbiology, Antwerp University Hospital, Drie Eikenstraat 655, 2650, Edegem, Belgium., Ten Kate GL; Department of General Internal Medicine, Infectious Diseases and Tropical Medicine, Antwerp University Hospital, Drie Eikenstraat 655, 2650, Edegem, Belgium. Gerritluit.tenkate@uza.be.
Jazyk: angličtina
Zdroj: European journal of clinical microbiology & infectious diseases : official publication of the European Society of Clinical Microbiology [Eur J Clin Microbiol Infect Dis] 2022 Oct; Vol. 41 (10), pp. 1263-1268. Date of Electronic Publication: 2022 Sep 06.
DOI: 10.1007/s10096-022-04487-4
Abstrakt: Staphylococcus aureus bacteremia (SAB) is a relevant finding which prompts a thorough diagnostic work-up. Follow-up blood cultures (BC) are essential in this work-up. We investigate the probability of detecting an ongoing bacteremia after initiation of active therapy according to the number of BC taken at key time points. A retrospective analysis of all patients with SAB in a 6-year period was performed. Total number of BCs taken and the positivity was registered for each day after start of therapy. A positivity-rate was corrected using a logistic mixed effects model. Observed detection frequencies were applied to calculate detection probabilities using binomial distributions. Three hundred and seventeen cases were withheld for analysis. A BC bottle positivity rate of 66.7% was found 1 day after initiation of active therapy, which decreased to 48.5% on day 4. When using 1 set of FU-BC, 73.4% of persisting SABs are detected. To maintain a probability of detection of ≥ 90%, 2 BC sets should be taken on day 2 and day 4 after start of therapy. In 10 of 109 patients with positive FU-BC, skip phenomena were registered, with a significant higher proportion in patients with < 4 BC bottles taken (14%) than when ≥ 4 BC bottles were taken (4.1%). We recommend taking 2 BC sets on days 2 and 4 after start of therapy in order to detect ≥ 90% of persisting SABs, limiting skip phenomena and blood volume required. We strongly advice against taking a single BC set as follow-up for SAB.
(© 2022. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)
Databáze: MEDLINE
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