ESRD, treatment resistance tied to persistent bacteraemia | Latest ... - MIMS

Stephen Padilla

4 hours ago

In patients with Gram-negative bloodstream infection (BSI), factors such as end-stage renal disease (ESRD), central venous catheter (CVC), infections due to extended-spectrum beta-lactamase (ESBL)-producing or carbapenemase-producing Enterobacterales (CPE), resistance to empirical treatment, and unfavourable response within 48 hours each correlate with a positive follow-up blood culture (FUBC).

The utility of FUBC remains controversial because while it results in better survival, it also leads to longer hospital stay and treatment duration, according to the researchers, led by Cecilia Bonazzetti, Infectious Diseases Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna in Bologna, Italy, who presented the findings at the recent ECCMID 2023 in Copenhagen, Denmark.

"In addition, positive FUBCs have shown to be a prognostic marker. Thus, to identify Gram-negative BSI patients for whom FUBCs are useful is key," they noted.

Bonazzetti and her team performed a systematic review with meta-analysis to gauge the impact of FUBC on the outcome and management of patients with Gram-negative BSI, as well as to determine the risk factors associated with persistent bacteraemia.

An independent search was carried out on the databases of Pubmed-Medline, Scopus, and Cochrane Library until 24 June 2022 for randomized controlled trials (RCTs) and observational studies. Those that did not provide a comparator group, did not perform adjustment for confounders, or lacked quantitative target outcome results for the intervention or comparator group were excluded.

The research team extracted the data using a prespecified form and evaluated the quality of included studies using ROB 2.0 tools for RCTs and ROBINS-I tool for observational studies. Finally, they conducted a meta-analysis by pooling all adjusted odds ratios (ORs) using a random-effect model with inverse variance method.

A total of 3,747 articles had been identified, of which 11 met the eligibility criteria. Bonazzetti and colleagues found that overall execution of FUBCs resulted in a significantly lower risk of death (OR, 0.58, 95 percent confidence interval [CI], 0.49‒0.70), without heterogeneity (p=0.68; I², 0.0 percent) and publication bias. [ECCMID 2023, abstract O0041]

In addition, although carrying out FUBCs led to a longer duration of treatment (standardized mean difference [SMD], 0.65, 95 percent CI, 0.45‒0.84) and longer hospital stay (SMD, 0.75, 95 percent CI, 0.19‒1.31), it also resulted in effective source control (OR, 1.38, 95 percent CI, 1.07‒1.78).

The following risk factors were found to have a significant and independent association with positive FUBCs: ESRD (n=3; OR, 2.99, 95 percent CI, 1.77‒5.05), CVD (n=4; OR, 3.30, 95 percent CI, 1.82‒5.95), infections due to ESBL-producing or CPE (n=4; OR, 3.24, 95 percent CI, 2.01‒5.23), resistance to empirical treatment (n=3; OR, 2.70, 95 percent CI, 1.65‒4.41), and unfavourable response within 48 hours (n=2; OR, 2.99, 95 percent CI, 1.44‒6.24).

Notably, neither heterogeneity nor publication bias was detected for each risk factor.

"Our analysis could be useful to stratify patients at low (0 point) or high (>1 point) risk for persistent bacteraemia to optimize the use of FUBCs in Gram-negative BSI," the researchers said. "It should be validated in further studies."

Wait Loading...