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Minerva Anestesiologica 2020 Feb 25

DOI: 10.23736/S0375-9393.20.14040-9


lingua: Inglese

Follow up blood cultures in Gram-negative bacilli bacteremia: are they needed for critically ill patients?

Martina SPAZIANTE 1, Alessandra OLIVA 1, 2, Giancarlo CECCARELLI 1, Francesco ALESSANDRI 3, Francesco PUGLIESE 3, Mario VENDITTI 1

1 Department of Public Health and Infectious Diseases, “Sapienza” University of Rome, Rome, Italy; 2 IRCCS INM Neuromed, Pozzilli, Isernia, Italy; 3 Department of Anesthesia and Intensive Care Medicine, “Sapienza” University of Rome, Rome, Italy


BACKGROUND: Gram-negative bacilli bacteremias (GNB-Bs) represent a major cause of morbidity and mortality in Intensive Care Unit (ICU) patients. Aim of this study was to investigate the role of follow-up blood cultures (FUBCs) and the clinical significance of persistent bacteremia (PB) in these settings.
METHODS: We retrospectively analyzed clinical data and outcome of GNB-Bs that occurred in ICU patients over a span of 1 year. In particular we sought information on development and clinical details of PB, defined as repeatedly positive FUBCs after ≥96h of appropriate antibiotic treatment and ≥48h after removal of endovascular devices.
RESULTS: Among 307 ICU patients, 69 (22.4%) developed 107 GNB-Bs. Out of these, 78 (73%) could be eventually analysed: 50/78 (64.1%) were non-PBs from 26 patients and 28/78 (35.9%) were PBs from 23 patients. Duration of fever and bacteremia, time to procalcitonin normalization and weaning from vasopressors were longer in episodes of PBs than non-PBs (p=0.04, p<0.001, p=0.02 and p=0.004 respectively). Primary bacteremia was more frequent in non-PBs than in PBs (29/50, 58% vs 3/28, 10.7%, p=0.0001), whereas septic thrombus infection (STI) was the source of infection in 14/28 (50%). Finally, clinical features and 30-day mortality did not differ between patients with PB and those who developed only non-PB episodes.
CONCLUSIONS: Among our ICU patients, more than one third of GNB-Bs for which FUBCs were performed resulted PB. This condition is often associated with the presence of STI; therefore, FUBCs seem useful for the optimal management of GNB in this clinical setting.

KEY WORDS: Gram-negative bloodstream infections; Follow-up blood cultures; Persistent bacteremia; Septic thrombus infection; ICU

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