Can a routine follow-up blood culture be justified in Klebsiella pneumoniae bacteremia? a retrospective case–control study

BMC Infectious Diseases

Myoung-don Oh²  Eui-Chong Kim²  Nam-Joong Kim²  Sang Won Park²  Kyoung Un Park¹  Wan Beom Park²  Ji-Hwan Bang²  Pyoeng Gyun Choe²  Chung-Jong Kim¹  Nak-Hyun Kim²  Taek Soo Kim¹  Hong Bin Kim¹  Kyoung-Ho Song¹  Eu Suk Kim¹  Chang Kyung Kang² 

[1]Department of Internal Medicine, Seoul National University Bundang Hospital, 173-gil 82 Gumi-ro, Bundang-gu, Seongnam, Republic of Korea 463-707

[2]Seoul National University College of Medicine, 103 Daehak-ro, Jongro-gu, Seoul, Republic of Korea 110-460

关键词: Blood culture;    Follow-up;    Risk factor;    Bacteremia;    Klebsiella pneumoniae;   

Others  :  1146501
DOI  :  10.1186/1471-2334-13-365

 received in 2013-03-23, accepted in 2013-07-25,  发布年份 2013

【 摘 要 】

Background

The need for mandatory confirmation of negative conversion in Klebsiella pneumoniae bacteremia (KpB) has not been adequately addressed. We conducted a retrospective case–control study of adult patients with KpB over a 5-year period in two tertiary-care hospitals to determine the risk factors for persistent bacteremia and to reevaluate the necessity of follow-up blood culture in KpB.

Methods

Persistent KpB is defined as the finding of K. pneumoniae in more than two separate blood-culture samples for longer than a two-day period in a single episode. The case- and control-groups were patients with persistent and non-persistent KpB, respectively, and they were matched 1-to-3 according to age and gender.

Results

Among 1068 KpB episodes analyzed after excluding polymicrobial infection and repeated KpB, follow-up blood cultures were performed in 862 cases (80.7%), 62 of which (7.2%) were persistent. Independent risk factors for persistence were intra-abdominal infection, higher Charlson’s comorbidity weighted index score, prior solid organ transplantation, and unfavorable treatment response, which was defined as positivity for at least two parameters among fever, leukocytosis, and no decrease of C-reactive protein on the second day after initial culture. A proposed scoring system using four variables, namely, intra-abdominal infection, nosocomial KpB, fever and lack of C-reactive protein decrease, the last two being assessed on the second day after the initial blood culture, showed that only 4.9% of the patients with no risk factors or with only intra-abdominal infection had persistent KpB.

Conclusions

Though persistent KpB is uncommon, follow-up blood culture was performed in as many as 80% of the cases in this study. A more careful clinical assessment is warranted to reduce the cost and patient inconvenience involved in follow-up blood culture.

【 授权许可】

   
2013 Kang et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

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