PMID- 23397233
OWN - NLM
STAT- MEDLINE
DCOM- 20131223
LR  - 20211021
IS  - 1435-4373 (Electronic)
IS  - 0934-9723 (Linking)
VI  - 32
IP  - 7
DP  - 2013 Jul
TI  - Clinical and microbiological implications of time-to-positivity of blood cultures 
      in patients with Gram-negative bacilli bacteremia.
PG  - 955-9
LID - 10.1007/s10096-013-1833-9 [doi]
AB  - Time-to-positivity (TTP) is defined as the length of time from the beginning of 
      culture incubation to the detection of bacterial growth by an automated system. 
      The objective of this study was to assess the clinical and microbiological 
      implications of TTP among patients with Gram-negative bacilli (GNB) bacteremia. 
      This was a prospective, single-center, observational study. Patients aged 18 
      years or older with one or more blood cultures growing GNB were included and 
      followed until hospital discharge or death. Patients were excluded if they were 
      without symptoms of infection, if they had polymicrobial culture, or if the 
      culture was positive with an obligate anaerobe. A multivariate logistic 
      regression analysis was performed to determine the predictors of in-hospital 
      mortality, including TTP (primary endpoint), demographics, disease severity, 
      comorbidities, pathogen type, source of infection, time to symptom resolution, 
      hospital/intensive care unit (ICU) length of stay, adequacy of empiric 
      antibiotics, and presence of an extended-spectrum beta-lactamase (ESBL)-producing 
      bacteria. One hundred consecutive patients with GNB bacteremia were enrolled. TTP 
      was an independent predictor of mortality; for every hour that TTP was shorter, 
      the risk of mortality increased by 10% [odds ratio (OR) 1.10, 95% confidence 
      interval (CI) 1.00-1.21, p = 0.049]. Other predictors of mortality included 
      severity of illness, ESBL-producing GNB, and ICU admission within 24 h before 
      culture. Mortality was highest among patients with inadequate empiric therapy 
      (56% vs. 14%, p < 0.001) and TTP <11 h (23.1% vs. 8.3%, p = 0.18). 
      Lactose-fermenting GNB had a shorter mean TTP than non-lactose fermenters (11.4 
      vs. 17.9 h, p = 0.001). Among patients with bacteremia due to GNB, TTP values are 
      inversely associated with mortality risk.
FAU - Palmer, H R
AU  - Palmer HR
AD  - Department of Pharmacy, St. Luke's Episcopal Hospital, Houston, TX, USA.
FAU - Palavecino, E L
AU  - Palavecino EL
FAU - Johnson, J W
AU  - Johnson JW
FAU - Ohl, C A
AU  - Ohl CA
FAU - Williamson, J C
AU  - Williamson JC
LA  - eng
PT  - Journal Article
DEP - 20130209
PL  - Germany
TA  - Eur J Clin Microbiol Infect Dis
JT  - European journal of clinical microbiology & infectious diseases : official 
      publication of the European Society of Clinical Microbiology
JID - 8804297
RN  - 0 (Anti-Bacterial Agents)
SB  - IM
MH  - Adolescent
MH  - Adult
MH  - Aged
MH  - Aged, 80 and over
MH  - Anti-Bacterial Agents/therapeutic use
MH  - Bacteremia/*diagnosis/drug therapy/microbiology
MH  - Bacteriological Techniques/*methods
MH  - Female
MH  - Gram-Negative Bacteria/*isolation & purification
MH  - Gram-Negative Bacterial Infections/*diagnosis/drug therapy/microbiology
MH  - Humans
MH  - Length of Stay
MH  - Male
MH  - Middle Aged
MH  - Prospective Studies
MH  - Survival Analysis
MH  - Time Factors
MH  - Treatment Outcome
MH  - Young Adult
EDAT- 2013/02/12 06:00
MHDA- 2013/12/24 06:00
CRDT- 2013/02/12 06:00
PHST- 2012/12/03 00:00 [received]
PHST- 2013/01/24 00:00 [accepted]
PHST- 2013/02/12 06:00 [entrez]
PHST- 2013/02/12 06:00 [pubmed]
PHST- 2013/12/24 06:00 [medline]
AID - 10.1007/s10096-013-1833-9 [doi]
PST - ppublish
SO  - Eur J Clin Microbiol Infect Dis. 2013 Jul;32(7):955-9. doi: 
      10.1007/s10096-013-1833-9. Epub 2013 Feb 9.