At #IDWeek2022
Role of follow-up blood cultures for Gram positives
Valeria Fabre
Detection of bacteria depends on:
Volume of blood and number of sets - should aim 40ml in 4 bottles (2 sets)
Role of follow-up blood cultures for Gram positives
Valeria Fabre
Detection of bacteria depends on:
Volume of blood and number of sets - should aim 40ml in 4 bottles (2 sets)
About 20% of GP bactermia are persistent. Mostly S. aureus. Strep not persistent. Wiggers BMC ID 2016
Persistance in SAB may occur in up to 40% of cases
Persistance in SAB may occur in up to 40% of cases
Minejima CID 2020 mentioned again. @BradSpellberg
Risk factors for prolonged SAB - MRSA, endovascular source, ICU
Bacteremia of ≥3 days independent predictor of 30-day mortality
Risk factors for prolonged SAB - MRSA, endovascular source, ICU
Bacteremia of ≥3 days independent predictor of 30-day mortality
Delay in initiation of effective therapy NOT associated with prolongation. But delay in source control was. Delay in source control assoc with higher mortality
Kuhel Lancet ID 2020
Also found assoc with bacteremia duration and mortality
Lack of source control increased 90d mortality. Even then, pSAB despite removal of suspected focus had increased mortality (17 to 34%)
Also found assoc with bacteremia duration and mortality
Lack of source control increased 90d mortality. Even then, pSAB despite removal of suspected focus had increased mortality (17 to 34%)
2nd day of bacteremia after active therapy best distinguished those who died vs survivors
Skip phenomenon - BC intermittently positive
More common in immunocompromised, those with cardiac devices, no diff in mortality
Australian study (Jim Stewart) of 1017 cases. Skip occurred in 13%. SP assoc with relapse. More common with MRSA. 2 sets of BC increased sens
More common in immunocompromised, those with cardiac devices, no diff in mortality
Australian study (Jim Stewart) of 1017 cases. Skip occurred in 13%. SP assoc with relapse. More common with MRSA. 2 sets of BC increased sens
New topic:
Persistent Strep bacteremia
159 non-staph IE, all strep. NO cases persistent bacteremia
314 cases Strep. 12% with IE. Follow-up BC+ in 3%. No difference in outcomes
Persistent Strep bacteremia
159 non-staph IE, all strep. NO cases persistent bacteremia
314 cases Strep. 12% with IE. Follow-up BC+ in 3%. No difference in outcomes
20% of Enterococcus BSI persistent
Especially if on prostehtic valves
DENOVA scare to determine risk of IE
Especially if on prostehtic valves
DENOVA scare to determine risk of IE
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