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Distribution and clinical determinants of time‐to‐positivity of blood cultures in patients with neutropenia
Author(s) -
Lambregts Merel M.C.,
Warreman Eva B.,
Bernards Alexandra T.,
Veelken Hendrik,
von dem Borne Peter A.,
Dekkers Olaf M.,
Visser Leo G.,
de Boer Mark G.
Publication year - 2018
Publication title -
european journal of haematology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.904
H-Index - 84
eISSN - 1600-0609
pISSN - 0902-4441
DOI - 10.1111/ejh.13001
Subject(s) - neutropenia , medicine , bacteremia , blood culture , sepsis , bloodstream infection , cohort , febrile neutropenia , pediatrics , antibiotics , toxicity , biology , microbiology and biotechnology
Objectives Blood cultures ( BC s) are essential in the evaluation of neutropenic fever. Modern BC systems have significantly reduced the time‐to‐positivity ( TTP ) of BC . This study explores the probability of bacteraemia when BC s have remained negative for different periods of time. Methods All adult patients with neutropenia and bacteraemia were included (January 2012‐February 2016). Predictive clinical factors for short (≤16 hours) and long (>24 hours) TTP were determined. The residual probability of bacteraemia was estimated for the scenario of negative BC 24 hours after collection. Results The cohort consisted of 154 patients, accounting for 190 episodes of bacteraemia. Median age of 61 years, 60.5% were male. In 123 (64.7%) episodes, BC yielded a single Gram‐positive micro‐organism and in 49 (25.8%) a Gram‐negative micro‐organism (median TTP 16.7, 14.5 hours respectively, P < .01). TTP was ≤24 hours in 91.6% of episodes. Central line‐associated bacteraemia was associated with long TTP . The probability of bacteraemia if BC had remained negative for 24 hours was 1%‐3%. Conclusions The expected TTP offers guidance in the management of patients with neutropenia and suspected bacteraemia. The knowledge of negative BC can support a change in working diagnosis, and impact clinical decisions as soon as 24 hours after BC collection.