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Correlation between time to positivity of blood cultures with clinical presentation and outcomes in patients with Klebsiella pneumoniae bacteraemia: prospective cohort study.
Clin Microbiol Infect. 2009 Apr 15;
Authors: Liao CH, Lai CC, Hsu MS, Huang YT, Chu FY, Hsu HS, Hsueh PR
Clin Microbiol InfectAbstract Time to positivity (TTP) of blood cultures in patients with bacteraemia is considered to be a predictor of outcome for some bacterial species. Two hundred and thirty-one patients with Klebsiella pneumoniae monomicrobial bacteraemia at a hospital from 1 January to 31 December 2007 were prospectively enrolled. TTP <7 h (46 patients, 19.9%) was associated with a higher Pittsburg bacteraemia score (6.2 +/- 5.5 vs. 3.7 +/- 4.3, p 0.002), fewer non-fatal diseases by the McCabe classification (39.1% vs. 64.9%, p 0.002), a higher percentage of patients with liver cirrhosis, active malignancy, and chemotherapy within 3 months (28.3% vs. 11.9%, p 0.007; 28.3% vs. 14.6%, p 0.031; 23.9% vs. 5.4%, p <0.001), more primary bacteraemia (45.7% vs. 22.2%, p 0.002), and a higher 30-day mortality rate (47.8% vs. 21.1%, p <0.001). Risk factors for 30-day mortality in the univariate analysis included higher Pittsburg bacteraemia score (5.8 +/- 5.3 vs. 3.7 +/- 4.3, p 0.002), primary bacteraemia (41.0% vs. 21.8%, p 0.004), TTP <7 h (36.1% vs. 14.1%, p <0.001), and the presence of active malignancy (29.5% vs. 12.9%, p 0.004). In the multivariate analysis, higher Pittsburg bacteraemia score (OR 1.07; 95% CI 1.01-1.14), TTP <7 h (OR 2.46; 95% CI 1.20-5.05) and active malignancy (OR 2.21; 95% CI 1.03-4.73) were the significant factors associated with 30-day mortality. In the Kaplan-Meier survival curve, short TTP was significantly associated with mortality at all time-points after admission. TTP of blood cultures, interpreted with a cut-off point of <7 h, in patients with K. pneumoniae bacteraemia can provide useful prognostic information.
PMID: 19392886 [PubMed - as supplied by publisher]