Antibiotics and the Yield of Blood Cultures: Sequence Matters
Authors: Jacqueline H. Geer, Mark D. Siegel
Journal: Annals of Internal Medicine (2019)

Editorials15 October 2019Antibiotics and the Yield of Blood Cultures: Sequence MattersJacqueline H. Geer, MD and Mark D. Siegel, MDJacqueline H. Geer, MDYale School of Medicine, New Haven, Connecticut (J.H.G., M.D.S.) and Mark D. Siegel, MDYale School of Medicine, New Haven, Connecticut (J.H.G., M.D.S.)Author, Article, and Disclosure Informationhttps://doi.org/10.7326/M19-2489 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail Sepsis, defined as "life-threatening organ dysfunction caused by a dysregulated host response to infection" (1), is a common, deadly syndrome that affects millions of people globally each year (2). Septic shock is the most severe subset of sepsis and is associated with the highest risk for death (1). Patients with sepsis frequently present to emergency departments for initial management. The timing of antibiotic administration tracks closely with survival, with the odds of death increasing by as much as 10% per hour of delayed treatment (3). Efforts at mitigation have led to a growing focus on care "bundles," which emphasize prompt ...References1. Singer M, Deutschman CS, Seymour CW, et al. The Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3). JAMA. 2016;315:801-10. [PMID: 26903338] doi:10.1001/jama.2016.0287 CrossrefMedlineGoogle Scholar2. Rhodes A, Evans LE, Alhazzani W, et al. Surviving Sepsis Campaign: international guidelines for management of sepsis and septic shock: 2016. Intensive Care Med. 2017;43:304-77. [PMID: 28101605] doi:10.1007/s00134-017-4683-6 CrossrefMedlineGoogle Scholar3. Peltan ID, Brown SM, Bledsoe JR, et al. ED door-to-antibiotic time and long-term mortality in sepsis. Chest. 2019;155:938-46. [PMID: 30779916] doi:10.1016/j.chest.2019.02.008 CrossrefMedlineGoogle Scholar4. Seymour CW, Gesten F, Prescott HC, et al. Time to treatment and mortality during mandated emergency care for sepsis. N Engl J Med. 2017;376:2235-44. [PMID: 28528569] doi:10.1056/NEJMoa1703058 CrossrefMedlineGoogle Scholar5. Rhodes A, Phillips G, Beale R, et al. The surviving Sepsis Campaign bundles and outcome: results from the International Multicentre Prevalence Study on Sepsis (the IMPreSS study). Intensive Care Med. 2015;41:1620-8. [PMID: 26109396] doi:10.1007/s00134-015-3906-y CrossrefMedlineGoogle Scholar6. Coburn B, Morris AM, Tomlinson G, et al. Does this adult patient with suspected bacteremia require blood cultures? JAMA. 2012;308:502-11. [PMID: 22851117] doi:10.1001/jama.2012.8262 CrossrefMedlineGoogle Scholar7. Cheng MP, Stenstrom R, Paquette K, et al. Blood culture results before and after antimicrobial administration in patients with severe manifestations of sepsis. A diagnostic study. Ann Intern Med. 2019;171:547-54. doi:10.7326/M19-1696 LinkGoogle Scholar8. Lee A, Mirrett S, Reller LB, et al. Detection of bloodstream infections in adults: how many blood cultures are needed? J Clin Microbiol. 2007;45:3546-8. [PMID: 17881544] CrossrefMedlineGoogle Scholar9. Gupta S, Sakhuja A, Kumar G, et al. Culture-negative severe sepsis: nationwide trends and outcomes. Chest. 2016;150:1251-9. [PMID: 27615024] doi:10.1016/j.chest.2016.08.1460 CrossrefMedlineGoogle Scholar Author, Article, and Disclosure InformationAffiliations: Yale School of Medicine, New Haven, Connecticut (J.H.G., M.D.S.)Disclosures: Disclosures can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M19-2489.Corresponding Author: Mark D. Siegel, MD, Yale School of Medicine, 333 Cedar Street, LCI 105, PO Box 208057, New Haven, CT 06520-8057; e-mail, mark.[email protected]edu.Current Author Addresses: Drs. Geer and Siegel: Yale School of Medicine, 333 Cedar Street, LCI 105, PO Box 208057, New Haven, CT 06520-8057.This article was published at Annals.org on 17 September 2019. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoBlood Culture Results Before and After Antimicrobial Administration in Patients With Severe Manifestations of Sepsis Matthew P. Cheng , Robert Stenstrom , Katryn Paquette , Sarah N. Stabler , Murtaza Akhter , Adam C. Davidson , Marko Gavric , Alexander Lawandi , Rehman Jinah , Zahid Saeed , Koray Demir , Kelly Huang , Amirali Mahpour , Chris Shamatutu , Chelsea Caya , Jean-Marc Troquet , Greg Clark , Cedric P. Yansouni , David Sweet , and Metrics Cited byPatterns, price and predictors of successful empiric antibiotic therapy in a real‐world settingThink Twice before Prescribing Antibiotics for That Swollen Knee: The Influence of Antibiotics on the Diagnosis of Periprosthetic Joint Infection 15 October 2019Volume 171, Issue 8Page: 587-588KeywordsAntibioticsAntimicrobialsBloodComputed axial tomographyDisclosureEmergency departmentForecastingPathogensSepsisShock ePublished: 17 September 2019 Issue Published: 15 October 2019 Copyright & PermissionsCopyright © 2019 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...