Impact on clinical outcome of follow-up blood cultures and risk factors for persistent bacteraemia in patients with gram-negative bloodstream infections: a systematic review with meta-analysis.
Follow-up blood culture(s)
Gram-negative bloodstream infections
Mortality rate
Persistent bacteraemia
Risk score for persistent GN-BSI
Journal
Clinical microbiology and infection : the official publication of the European Society of Clinical Microbiology and Infectious Diseases
ISSN: 1469-0691
Titre abrégé: Clin Microbiol Infect
Pays: England
ID NLM: 9516420
Informations de publication
Date de publication:
Sep 2023
Sep 2023
Historique:
received:
23
12
2022
revised:
17
02
2023
accepted:
28
02
2023
medline:
22
8
2023
pubmed:
10
3
2023
entrez:
9
3
2023
Statut:
ppublish
Résumé
The clinical usefulness of follow-up blood cultures (FUBCs) in gram-negative bloodstream infections (GN-BSIs) represents a debated issue. To assess the impact on the clinical outcome of FUBCs in patients with GN-BSI and to predict risk factors for persistent bacteraemia. PubMed-MEDLINE, Scopus, and the Cochrane Library Database were independently searched until 24 June, 2022. Randomized controlled trials, prospective, or retrospective observational studies, including patients affected by GN-BSIs. Primary endpoints were in-hospital mortality rate, and persistent blood stream infections were defined as FUBC-positive for the same pathogen isolated from index blood cultures (BCs). Hospitalized patients with documented GN-BSIs. Performance of FUBCs (defined as subsequent BCs collected at least 24 hours after index BCs). Quality of included studies was independently assessed according to the Cochrane Risk of Bias Tool and the Risk Of Bias In Non-randomized Studies of Interventions. Meta-analysis was performed by pooling odds ratio (OR) retrieved from studies providing adjustment for confounders using random-effect model with the inverse variance method. Risk factors for persistent blood stream infections were also assessed. A total of 3747 articles were screened, and 11 observational studies (6 assessing impact on outcome (N = 4631), and 5 investigating risk factors for persistent GN-BSI (N = 2566)), conducted between 2002 and 2020 were included. The execution of FUBCs was associated with a significantly lower risk of mortality (OR, 0.58; 95% CI, 0.49-0.70; I The execution of FUBCs is associated with a significantly low risk of mortality in patients with GN-BSIs. Our analysis could be useful to stratify patients at a high risk of persistent bacteraemia to optimize the use of FUBCs.
Sections du résumé
BACKGROUND
BACKGROUND
The clinical usefulness of follow-up blood cultures (FUBCs) in gram-negative bloodstream infections (GN-BSIs) represents a debated issue.
OBJECTIVE
OBJECTIVE
To assess the impact on the clinical outcome of FUBCs in patients with GN-BSI and to predict risk factors for persistent bacteraemia.
DATA SOURCES
METHODS
PubMed-MEDLINE, Scopus, and the Cochrane Library Database were independently searched until 24 June, 2022.
STUDY ELIGIBILITY CRITERIA
METHODS
Randomized controlled trials, prospective, or retrospective observational studies, including patients affected by GN-BSIs. Primary endpoints were in-hospital mortality rate, and persistent blood stream infections were defined as FUBC-positive for the same pathogen isolated from index blood cultures (BCs).
PARTICIPANTS
METHODS
Hospitalized patients with documented GN-BSIs.
INTERVENTION
METHODS
Performance of FUBCs (defined as subsequent BCs collected at least 24 hours after index BCs).
ASSESSMENT OF RISK OF BIAS
UNASSIGNED
Quality of included studies was independently assessed according to the Cochrane Risk of Bias Tool and the Risk Of Bias In Non-randomized Studies of Interventions.
METHODS OF DATA SYNTHESIS
UNASSIGNED
Meta-analysis was performed by pooling odds ratio (OR) retrieved from studies providing adjustment for confounders using random-effect model with the inverse variance method. Risk factors for persistent blood stream infections were also assessed.
RESULTS
RESULTS
A total of 3747 articles were screened, and 11 observational studies (6 assessing impact on outcome (N = 4631), and 5 investigating risk factors for persistent GN-BSI (N = 2566)), conducted between 2002 and 2020 were included. The execution of FUBCs was associated with a significantly lower risk of mortality (OR, 0.58; 95% CI, 0.49-0.70; I
CONCLUSIONS
CONCLUSIONS
The execution of FUBCs is associated with a significantly low risk of mortality in patients with GN-BSIs. Our analysis could be useful to stratify patients at a high risk of persistent bacteraemia to optimize the use of FUBCs.
Identifiants
pubmed: 36894053
pii: S1198-743X(23)00114-3
doi: 10.1016/j.cmi.2023.02.024
pii:
doi:
Types de publication
Meta-Analysis
Systematic Review
Journal Article
Review
Langues
eng
Sous-ensembles de citation
IM
Pagination
1150-1158Informations de copyright
Copyright © 2023 European Society of Clinical Microbiology and Infectious Diseases. Published by Elsevier Ltd. All rights reserved.
Déclaration de conflit d'intérêts
Transparency declaration The authors declare that they have no conflicts of interest.