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    Follow-up blood cultures in Pseudomonas aeruginosa bacteremia: A potential target for diagnostic stewardship

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    Author
    Green, Alexis L.
    Liang, Yuanyuan
    O'Hara, Lyndsay M.
    Pineles, Lisa
    Sorongon, Scott
    Harris, Anthony D.
    Baghdadi, Jonathan D.
    Date
    2021-08-27
    Journal
    Antimicrobial Stewardship and Healthcare Epidemiology
    Publisher
    Cambridge University Press
    Type
    Article
    
    Metadata
    Show full item record
    See at
    https://doi.org/10.1017/ash.2021.184
    Abstract
    Objectives: Evidence supporting collection of follow-up blood cultures for Gram-negative bacteremia is mixed. We sought to understand why providers order follow-up blood cultures when managing P. aeruginosa bacteremia and whether follow-up blood cultures in this context are associated with short- and long-term survival. Methods: We conducted a retrospective cohort study of adult inpatients with P. aeruginosa bacteremia at the University of Maryland Medical Center in 2015-2020. Kaplan-Meier survival curves and Cox regression with time-varying covariates were used to evaluate the association between follow-up blood cultures and time to mortality within 30 days of first positive blood culture. Provider justifications for follow-up blood cultures were identified through chart review. Results: Of 159 eligible patients, 127 (80%) had follow-up blood cultures, including 9 (7%) that were positive for P. aeruginosa and 10 (8%) that were positive for other organisms. Follow-up blood cultures were typically collected to ensure clearance or to guide antibiotic therapy. Overall, 30-day mortality was 25.2%. After risk adjustment for patient characteristics, follow-up blood cultures were associated with a nonsignificant reduction in mortality risk (hazard ratio, 0.43; 95% confidence interval, 1.08; P =.071). In exploratory analyses, the potential mortality reduction from follow-up blood cultures was driven by their use in patients with Pitt bacteremia scores >0. Conclusions: Follow-up blood cultures are commonly collected for P. aeruginosa bacteremia but infrequently identify persistent bacteremia. Targeted use of follow-up blood cultures based on severity of illness may reduce unnecessary culturing. © The Author(s), 2021.
    Sponsors
    Infectious Diseases Society of America
    Keyword
    diagnostic stewardship
    follow-up blood cultures
    Pseudomonas aeruginosa
    Identifier to cite or link to this item
    http://hdl.handle.net/10713/18963
    ae974a485f413a2113503eed53cd6c53
    10.1017/ash.2021.184
    Scopus Count
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