Time to blood culture positivity as a predictor of clinical outcome in patients with Candida albicans bloodstream infection

BMC Infectious Diseases

Carlos Alberto Pires Pereira¹  Elivane da Silva Victor³  Michael B Edmond²  Alexandre R Marra³  Cintia Zoya Nunes¹ 

[1] Infectious Diseases Division, Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil;Department of Internal Medicine, Virginia Commonwealth, University School of Medicine, Richmond, Virginia, USA;Division of Medical Practice, Hospital Israelita Albert Einstein, São Paulo, Brazil

关键词: Antifungal therapy;    Time to positivity;    Bloodstream infection;    Candida;   

Others  :  1145687
DOI  :  10.1186/1471-2334-13-486

 received in 2013-02-02, accepted in 2013-10-17,  发布年份 2013

【 摘 要 】

Background

Few studies have assessed the time to blood culture positivity as a predictor of clinical outcome in fungal bloodstream infections (BSIs). The purpose of this study was to evaluate the time to positivity (TTP) of blood cultures in patients with Candida albicans BSIs and to assess its impact on clinical outcome.

Methods

A historical cohort study with 89 adults patients with C. albicans BSIs. TTP was defined as the time between the start of incubation and the time that the automated alert signal indicating growth in the culture bottle sounded.

Results

Patients with BSIs and TTPs of culture of ≤36 h (n=39) and >36 h (n=50) were compared. Septic shock occurred in 46.2% of patients with TTPs of ≤36 h and in 40.0% of patients with TTP of >36 h (p=0.56). A central venous catheter source was more common with a BSI TTP of ≤36 h (p=0.04). Univariate analyis revealed that APACHE II score≥20 at BSI onset, the development of at least one organ system failure (respiratory, cardiovascular, renal, hematologic, or hepatic), SOFA at BSI onset, SAPS II at BSI onset, and time to positivity were associated with death. By using logistic regression analysis, the only independent predictor of death was time to positivity (1.04; 95% CI, 1.0-1.1, p=0.035), with the chance of the patient with C. albicans BSI dying increasing 4.0% every hour prior to culture positivity.

Conclusion

A longer time to positivity was associated with a higher mortality for Candida albicans BSIs; therefore, initiating empiric treatment with antifungals may improve outcomes.

【 授权许可】

   
2013 Nunes et al.; licensee BioMed Central Ltd.

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