Should we treat patients with only one set of positive blood cultures for extensively drug-resistant Acinetobacter baumannii the same as multiple sets?
Acinetobacter species are not considered skin commensals and under-treatment is an overriding concern when caring for critically-ill patients who are mostly at risk of extensively drug-resistant Acinetobacter baumannii (XDRAB) infections. Hence even a single blood culture yielding XDRAB will tend to...
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| Format: | Article |
| Language: | English |
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Public Library of Science (PLoS)
2017-01-01
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| Series: | PLoS ONE |
| Online Access: | http://europepmc.org/articles/PMC5501650?pdf=render |
| _version_ | 1818520025267437568 |
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| author | Aristine Cheng Yu-Chung Chuang Hsin-Yun Sun Chia-Jui Yang Hou-Tai Chang Jia-Ling Yang Wang-Huei Sheng Yee-Chun Chen Shan-Chwen Chang |
| author_facet | Aristine Cheng Yu-Chung Chuang Hsin-Yun Sun Chia-Jui Yang Hou-Tai Chang Jia-Ling Yang Wang-Huei Sheng Yee-Chun Chen Shan-Chwen Chang |
| author_sort | Aristine Cheng |
| collection | DOAJ |
| description | Acinetobacter species are not considered skin commensals and under-treatment is an overriding concern when caring for critically-ill patients who are mostly at risk of extensively drug-resistant Acinetobacter baumannii (XDRAB) infections. Hence even a single blood culture yielding XDRAB will tend to prompt intervention. However, field observations suggest that patients with single-positive blood cultures had milder disease and were more likely to be recruited in interventional studies than those with multiple-positive blood cultures, yet no distinction is made in current clinical or trial recruitment practices. To our knowledge, this is the first study to compare the clinical characteristics and outcomes of patients with single-positive versus multiple-positive blood cultures for XDRAB. In this multicenter prospective cohort study of XDRAB bacteremic patients from July 2010 to June 2015, only patients with at least two simultaneously drawn blood cultures were included. The patients were classified as having single-positive or multiple-positive blood cultures according to the number of positive blood cultures yielding XDRAB. The primary end-point was the 28-day mortality. Of a total of 155 patients enrolled, 69 had a single-positive and 86 had multiple-positive blood cultures. Leukopenia (37.2% vs. 16.2%; P = 0.004), thrombocytopenia (56.0% vs. 26.5%; P < 0.001), higher Pitt bacteremia scores (6.6 vs. 5.5, P = 0.03) and higher 28-day mortality rates (70.9% vs. 43.5%; P = 0.001) distinguished patients with multiple-positive from those with single-positive cultures. Multivariate logistic regression showed that multi-positivity independently predicted 28-day mortality (adjusted odds ratio, 2.34; 95% confidence interval (CI), 1.03-5.28; P = 0.04) and the Cox regression confirmed that multi-positivity (adjusted hazard ratio, 1.80; 95% CI, 1.13-2.85; P = 0.01) predicted rapid mortality. Patients with multiple versus single positive blood cultures yielding XDRAB had greater morbidity and mortality. Investigators and clinicians should be aware that the blood culture positivity rate impacts outcomes of XDRAB bacteremia. |
| first_indexed | 2024-12-11T01:31:53Z |
| format | Article |
| id | doaj.art-77ce9b574aeb474bb06211232458b827 |
| institution | Directory Open Access Journal |
| issn | 1932-6203 |
| language | English |
| last_indexed | 2024-12-11T01:31:53Z |
| publishDate | 2017-01-01 |
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| series | PLoS ONE |
| spelling | doaj.art-77ce9b574aeb474bb06211232458b8272022-12-22T01:25:21ZengPublic Library of Science (PLoS)PLoS ONE1932-62032017-01-01127e018096710.1371/journal.pone.0180967Should we treat patients with only one set of positive blood cultures for extensively drug-resistant Acinetobacter baumannii the same as multiple sets?Aristine ChengYu-Chung ChuangHsin-Yun SunChia-Jui YangHou-Tai ChangJia-Ling YangWang-Huei ShengYee-Chun ChenShan-Chwen ChangAcinetobacter species are not considered skin commensals and under-treatment is an overriding concern when caring for critically-ill patients who are mostly at risk of extensively drug-resistant Acinetobacter baumannii (XDRAB) infections. Hence even a single blood culture yielding XDRAB will tend to prompt intervention. However, field observations suggest that patients with single-positive blood cultures had milder disease and were more likely to be recruited in interventional studies than those with multiple-positive blood cultures, yet no distinction is made in current clinical or trial recruitment practices. To our knowledge, this is the first study to compare the clinical characteristics and outcomes of patients with single-positive versus multiple-positive blood cultures for XDRAB. In this multicenter prospective cohort study of XDRAB bacteremic patients from July 2010 to June 2015, only patients with at least two simultaneously drawn blood cultures were included. The patients were classified as having single-positive or multiple-positive blood cultures according to the number of positive blood cultures yielding XDRAB. The primary end-point was the 28-day mortality. Of a total of 155 patients enrolled, 69 had a single-positive and 86 had multiple-positive blood cultures. Leukopenia (37.2% vs. 16.2%; P = 0.004), thrombocytopenia (56.0% vs. 26.5%; P < 0.001), higher Pitt bacteremia scores (6.6 vs. 5.5, P = 0.03) and higher 28-day mortality rates (70.9% vs. 43.5%; P = 0.001) distinguished patients with multiple-positive from those with single-positive cultures. Multivariate logistic regression showed that multi-positivity independently predicted 28-day mortality (adjusted odds ratio, 2.34; 95% confidence interval (CI), 1.03-5.28; P = 0.04) and the Cox regression confirmed that multi-positivity (adjusted hazard ratio, 1.80; 95% CI, 1.13-2.85; P = 0.01) predicted rapid mortality. Patients with multiple versus single positive blood cultures yielding XDRAB had greater morbidity and mortality. Investigators and clinicians should be aware that the blood culture positivity rate impacts outcomes of XDRAB bacteremia.http://europepmc.org/articles/PMC5501650?pdf=render |
| spellingShingle | Aristine Cheng Yu-Chung Chuang Hsin-Yun Sun Chia-Jui Yang Hou-Tai Chang Jia-Ling Yang Wang-Huei Sheng Yee-Chun Chen Shan-Chwen Chang Should we treat patients with only one set of positive blood cultures for extensively drug-resistant Acinetobacter baumannii the same as multiple sets? PLoS ONE |
| title | Should we treat patients with only one set of positive blood cultures for extensively drug-resistant Acinetobacter baumannii the same as multiple sets? |
| title_full | Should we treat patients with only one set of positive blood cultures for extensively drug-resistant Acinetobacter baumannii the same as multiple sets? |
| title_fullStr | Should we treat patients with only one set of positive blood cultures for extensively drug-resistant Acinetobacter baumannii the same as multiple sets? |
| title_full_unstemmed | Should we treat patients with only one set of positive blood cultures for extensively drug-resistant Acinetobacter baumannii the same as multiple sets? |
| title_short | Should we treat patients with only one set of positive blood cultures for extensively drug-resistant Acinetobacter baumannii the same as multiple sets? |
| title_sort | should we treat patients with only one set of positive blood cultures for extensively drug resistant acinetobacter baumannii the same as multiple sets |
| url | http://europepmc.org/articles/PMC5501650?pdf=render |
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