Sepsis: study supports blood cultures before empirical antibiotics

  • Cheng MP & al.
  • Ann Intern Med
  • 17 Sep 2019

  • International Clinical Digest
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Takeaway

  • Obtaining blood culture after initiating empirical antimicrobials for severe manifestations of sepsis results in ~50% reduced culture sensitivity.

Why this matters

  • Among patients with severe manifestations of sepsis, draw blood culture as quickly as possible under aseptic technique, followed immediately by antimicrobial infusion.

Key results

  • 325 intent-to-treat patients; mean age, 65.6 years (standard deviation, 17.7); 62.8% men.
  • Median time to repeating post-antimicrobial blood culture, 70 (interquartile range [IQR], 50-110) minutes.
  • 31.4% (102/325) vs 19.4% (63/325) had pre-antimicrobial, post-antimicrobial blood culture, respectively, positive for ≥1 microbial pathogen; absolute difference, 12.0% (P<.001>
  • Post-antimicrobial blood culture sensitivity for the entire study population, 52.9% (95% CI, 42.8%-62.9%); per-protocol (PP) population, 56.3% (95% CI, 44.7%-67.3%).
  • Overall sensitivity increased with addition of cultures from other anatomical sites, 67.6% (95% CI, 57.7%-76.6%), but remained consistent in PP population.

Study design

  • Patient-level, single-group, 7-centre FABLED diagnostic study to determine if blood culture sensitivity (drawn, 30-120 minutes) declined after administration of antimicrobial agents among patients with severe manifestations of sepsis.
  • Funding: Vancouver Coastal Health, others.

Limitations

  • Low proportion of bacteraemic patients.
  • Variable blood culture quantity.
  • Limited generalisability.

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