Blood Culture Results Before and After Antimicrobial Administration
Authors: Matthew P. Cheng, Robert Stenstrom, Katryn Paquette, Cedric Yansouni, David Sweet
Journal: Annals of Internal Medicine (2020)

Letters17 March 2020Blood Culture Results Before and After Antimicrobial AdministrationMatthew P. Cheng, MD, Robert Stenstrom, MD, PhD, Katryn Paquette, MD, Cedric Yansouni, MD, and David Sweet, MDMatthew P. Cheng, MDBrigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts (M.P.C.)Search for more papers by this author, Robert Stenstrom, MD, PhDUniversity of British Columbia, St. Paul's Hospital, and the Centre for Health Evaluation and Outcome Sciences, Vancouver, British Columbia, Canada (R.S.)Search for more papers by this author, Katryn Paquette, MDMontreal Children's Hospital, McGill University, Montreal, Quebec, Canada (K.P.)Search for more papers by this author, Cedric Yansouni, MDMcGill University Health Centre, McGill University, Montreal, Quebec, Canada (C.Y.)Search for more papers by this author, and David Sweet, MDUniversity of British Columbia and Vancouver General Hospital, Vancouver, British Columbia, Canada (D.S.)Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/L19-0796 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail IN RESPONSE:We agree with Dr. Schinkel and colleagues that antimicrobial therapy should be initiated as early as possible in patients with severe manifestations of sepsis and that this practice should not be generalized to patients who are less ill. However, their assertion that postantimicrobial blood cultures would identify resistant pathogens with similar sensitivity to preantimicrobial ones is neither supported by our data nor a reasonable assumption. Our study showed that postantimicrobial blood cultures were more likely to identify resistant organisms than susceptible ones (Supplement Table 4 in our article), but these cultures were still less sensitive than preantimicrobial cultures. ...References1. Clinical and Laboratory Standards Institute. Development of In Vitro Susceptibility Test in Criteria and Quality Control Parameters. 4th ed. CLSI Guideline no. M23. Wayne, PA: Clinical and Laboratory Standards Institute; 2016. Google Scholar2. 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 Scholar3. Garnacho-Montero J, Gutiérrez-Pizarraya A, Escoresca-Ortega A, et al. De-escalation of empirical therapy is associated with lower mortality in patients with severe sepsis and septic shock. Intensive Care Med. 2014;40:32-40. [PMID: 24026297] doi:10.1007/s00134-013-3077-7 CrossrefMedlineGoogle Scholar Author, Article, and Disclosure InformationAffiliations: Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts (M.P.C.)University of British Columbia, St. Paul's Hospital, and the Centre for Health Evaluation and Outcome Sciences, Vancouver, British Columbia, Canada (R.S.)Montreal Children's Hospital, McGill University, Montreal, Quebec, Canada (K.P.)McGill University Health Centre, McGill University, Montreal, Quebec, Canada (C.Y.)University of British Columbia and Vancouver General Hospital, Vancouver, British Columbia, Canada (D.S.)Acknowledgment: The authors thank the FABLED Investigators (members are listed in the Appendix).Disclosures: Disclosures can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M19-1696. 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 Blood Culture Results Before and After Antimicrobial Administration Larry M. Bush and Donald Kaye Blood Culture Results Before and After Antimicrobial Administration Shinya Yamamoto and Koh Okamoto Blood Culture Results Before and After Antimicrobial Administration Michiel Schinkel , Rishi Nannan Panday , and Prabath Nanayakkara Metrics Cited byEvaluation of hospital blood culture utilization rates to identify opportunities for diagnostic stewardshipEarly Care of Adults With Suspected Sepsis in the Emergency Department and Out-of-Hospital Environment: A Consensus-Based Task Force Report 17 March 2020Volume 172, Issue 6Page: 440-441KeywordsAntimicrobial resistanceAntimicrobialsBloodBlood volumeChild healthDisclosureHospital medicinePathogensSepsisSevere sepsis ePublished: 17 March 2020 Issue Published: 17 March 2020 Copyright & PermissionsCopyright © 2020 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...