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

Link to article at PubMed

Clin Microbiol Infect. 2023 Mar 7:S1198-743X(23)00114-3. doi: 10.1016/j.cmi.2023.02.024. Online ahead of print.


BACKGROUND: The clinical usefulness of follow-up blood cultures (FUBCs) in Gram-negative bloodstream infections (GN-BSIs) represents a debated issue.

OBJECTIVE: To assess the impact on clinical outcome of FUBCs in patient with GN-BSI and to predict risk factors for persistent bacteremia.

DATA SOURCE: PubMed-MEDLINE, Scopus, and Cochrane Library Database were independently searched until 24 June 2022.

STUDY ELIGIBILITY CRITERIA: Randomized controlled trials or prospective/retrospective observational studies including patients affected by GN-BSIs. Primary endpoints were in-hospital mortality rate, and persistent BSI defined as FUBC positive for the same pathogen isolated from index BCs.

PARTICIPANTS: Hospitalized patients with documented GN-BSIs.

INTERVENTION: Performance of FUBCs (defined as subsequent BCs collected at least 24 hours after index BCs).

ASSESSMENT OF RISK OF BIAS: Quality of included studies was independently assessed according to ROB 2.0 and ROBINS-I tools.

METHODS: Of data synthesis: Meta-analysis was performed by pooling odds ratio (OR) retrieved from studies providing adjustment for confounders using random-effect model with inverse variance method. Risk factors for persistent BSIs were also assessed.

RESULTS: 3,747 articles were screened, and eleven observational studies (six assessing impact on outcome [N=4,631], and five investigating risk factors for persistent GN-BSI [N=2,566]), conducted between 2002-2020 were included. Execution of FUBCs were associated with significant lower risk of mortality (OR 0.58; 95%CI 0.49-0.70; I2=0.0%). Presence of end-stage renal disease (OR 2.99; 95%CI 1.77-5.05), central venous catheter (OR 3.30; 95%CI 1.82-5.95), infections due to ESBL-producing strains (OR 2.25; 95%CI 1.18-4.28), resistance to empirical treatment (OR 2.70; 95%CI 1.65-4.41), and unfavourable response at 48 hours (OR 2.99; 95%CI 1.44-6.24) emerged as independent risk factors for persistent bacteremia.

CONCLUSIONS: The execution of FUBCs is associated with a significant lower risk of mortality in patients with GN-BSIs. Our analysis could be useful to stratify patients at high-risk for persistent bacteraemia to optimize the use of FUBCs.

PMID:36894053 | DOI:10.1016/j.cmi.2023.02.024

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