Blood Culture Results Before and After Antimicrobial Administration in Patients With Severe Manifestations of Sepsis A Diagnostic Study
Blood Culture Results Before and After Antimicrobial Administration in Patients With Severe Manifestations of Sepsis A Diagnostic Study
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DOI：
10.7326/m19-1696
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发表时间：
2019-10-15
影响因子：
39.2
通讯作者：
Osati, Farzaneh
中科院分区：
文献类型：
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作者：
Cheng, Matthew P.;Stenstrom, Robert;Osati, Farzaneh
背景：在获得血培养前使用抗菌药物可能会缩短治疗时间并改善结果，但尚不清楚该策略如何影响诊断敏感性。目的：测定严重脓毒症患者开始抗菌治疗后不久血培养物的敏感性。设计：患者水平、单组、诊断研究。（临床试验。gov: NCT01867905）设置：北美的7个急诊科。参与者：有严重脓毒症表现的成年人，包括收缩压低于90mmhg或血清乳酸水平为4mmol /L或更高。干预措施：在抗菌药物治疗开始前和开始后120分钟内进行血培养。测量：抗菌素治疗开始后获得的血培养物的敏感性。结果：在筛选的3164名参与者中，325人被纳入研究（平均年龄65.6岁，62.8%为男性），并在开始抗菌治疗后重复进行血培养（中位时间为70分钟[四分位数范围为50至110分钟]）。325例患者中有102例（31.4%）抗微生物前血培养阳性。325例患者中有63例（19.4%）抗菌后血培养呈1种或1种以上微生物病原体阳性。微生物检测前后血培养阳性比例的绝对差异为12.0% （95% CI, 5.4% ~ 18.6%; P < 0.001）。微生物后培养敏感性为52.9% （CI, 42.8% ~ 62.9%）。当包括其他微生物培养结果时，102例患者中有69例（67.6% [CI， 57.7%至76.6%]）发现微生物病原体。局限性：只招募了一部分筛选过的患者。结论：在有严重脓毒症表现的患者中，开始经验性抗菌药物治疗可显著降低治疗开始后不久血培养的敏感性。
Background: Administering antimicrobial agents before obtaining blood cultures could potentially decrease time to treatment and improve outcomes, but it is unclear how this strategy affects diagnostic sensitivity.Objective: To determine the sensitivity of blood cultures obtained shortly after initiation of antimicrobial therapy in patients with severe manifestations of sepsis.Design: Patient-level, single-group, diagnostic study. (Clinical Trials.gov: NCT01867905)Setting: 7 emergency departments in North America.Participants: Adults with severe manifestations of sepsis, including systolic blood pressure less than 90 mm Hg or a serum lactate level of 4 mmol/L or more.Intervention: Blood cultures were obtained before and within 120 minutes after initiation of antimicrobial treatment.Measurements: Sensitivity of blood cultures obtained after initiation of antimicrobial therapy.Results: Of 3164 participants screened, 325 were included in the study (mean age, 65.6 years; 62.8% men) and had repeated blood cultures drawn after initiation of antimicrobial therapy (median time, 70 minutes [interquartile range, 50 to 110 minutes]). Preantimicrobial blood cultures were positive for 1 or more microbial pathogens in 102 of 325 (31.4%) patients. Post-antimicrobial blood cultures were positive for 1 or more microbial pathogens in 63 of 325 (19.4%) patients. The absolute difference in the proportion of positive blood cultures between pre- and postantimicrobial testing was 12.0% (95% CI, 5.4% to 18.6%; P < 0.001). Sensitivity of postantimicrobial culture was 52.9% (CI, 42.8% to 62.9%). When the results of other microbiological cultures were included, microbial pathogens were found in 69 of 102 (67.6% [CI, 57.7% to 76.6%]) patients.Limitation: Only a proportion of screened patients were recruited.Conclusion: Among patients with severe manifestations of sepsis, initiation of empirical antimicrobial therapy significantly reduces the sensitivity of blood cultures drawn shortly after treatment initiation.