Further considerations on the clinical applicability of time to positivity as a prognostic tool for catheter-related Pseudomonas aeruginosa bloodstream infections

IF 8.8 1区 医学 Q1 CRITICAL CARE MEDICINE
Daniel N. Marco, Àlex Soriano, Sabina Herrera
{"title":"Further considerations on the clinical applicability of time to positivity as a prognostic tool for catheter-related Pseudomonas aeruginosa bloodstream infections","authors":"Daniel N. Marco, Àlex Soriano, Sabina Herrera","doi":"10.1186/s13054-025-05370-2","DOIUrl":null,"url":null,"abstract":"<p>To the Editor,</p><p>We appreciate the thoughtful comments by Liao et al. [1] regarding our study [2] on “Time to positivity (TTP) as a predictor of catheter-related bacteremia and mortality in <i>Pseudomonas aeruginosa</i> bloodstream infections (PAE-BSI)”. Their insights highlight important aspects that warrant further discussion, particularly regarding additional variables that could influence the TTP, and about long-term outcome.</p><p>In response to the first point, we acknowledge the potential influence of resistance on TTP. We found that susceptible <i>P. aeruginosa</i> strains had a significantly shorter TTP (Table 1). Moreover, this property was consistent across all antibiotic families. Since no clinically relevant TTP cut-off for predicting resistance was identified, this data was not included in the main article due to length limitation. This finding supports that resistant strains may decelerate their replication rates because resistance mechanisms affect one or more metabolic pathways involved in bacterial replication. A previous study in <i>Staphylococcus aureus</i> bacteremia also demonstrated shorter TTP for methicillin-susceptible strains compared to methicillin-resistant ones [3]. However, we have to recognize that other studies focused in Enterobacterales and other non-fermenting gram-negative bacilli have shown contradictory results [4, 5].</p><figure><figcaption><b data-test=\"table-caption\">Table 1 Factors associated with shorter TTP. Univariate and multivariate analysis.</b></figcaption><span>Full size table</span><svg aria-hidden=\"true\" focusable=\"false\" height=\"16\" role=\"img\" width=\"16\"><use xlink:href=\"#icon-eds-i-chevron-right-small\" xmlns:xlink=\"http://www.w3.org/1999/xlink\"></use></svg></figure><p>The authors raise another point regarding immune suppression and comorbidities as potential modifiers of TTP. Although the role of host immunity seems reasonable, our data (Table 1) did not support this statement. In the univariable analysis, chronic kidney disease (CKD) in hemodialysis, neutropenia and corticosteroid therapy were significantly associated with shorter TTP. However, no one was finally included in the multivariable analysis. In the case of CKD in hemodialysis the reason to be excluded is that the majority of these cases were catheter-related bacteremia that is a significant determinant of shorter TTP. Neutropenia reduces the host capacity to clear bacteria from infected tissue resulting in higher bacterial loads in the bloodstream and corticosteroid therapy impair the reticuloendothelial system located at the liver and the spleen, both responsible of rapid bacterial clearance from the blood [6, 7]. Therefore, weak immune system increases the inoculum at the infectious foci and that is the variable superior in the multivariable analysis. According to our findings, we have summarized the main determinants of TTP in Fig. 1.</p><figure><figcaption><b data-test=\"figure-caption-text\">Fig. 1</b></figcaption><picture><img alt=\"figure 1\" aria-describedby=\"Fig1\" height=\"262\" loading=\"lazy\" src=\"//media.springernature.com/lw685/springer-static/image/art%3A10.1186%2Fs13054-025-05370-2/MediaObjects/13054_2025_5370_Fig1_HTML.png\" width=\"685\"/></picture><p>Diagram displaying the main determinants of time to positivity (TTP). The figure also represents the microbiological and clinical variables which in turn affect the two main determinants</p><span>Full size image</span><svg aria-hidden=\"true\" focusable=\"false\" height=\"16\" role=\"img\" width=\"16\"><use xlink:href=\"#icon-eds-i-chevron-right-small\" xmlns:xlink=\"http://www.w3.org/1999/xlink\"></use></svg></figure><p>While we agree that evaluating long-term mortality and post-infection complications would provide a more comprehensive perspective, this was not the primary scope of our study, and this information was not captured in our database.</p><p>No datasets were generated or analysed during the current study.</p><ol data-track-component=\"outbound reference\" data-track-context=\"references section\"><li data-counter=\"1.\"><p>Liao Y, Deng X, Xiao H. Further considerations on the clinical applicability of time to positivity as a prognostic tool for catheter-related pseudomonas aeruginosa bloodstream infections. Crit Care. 2025;29:94. https://doi.org/10.1186/s13054-025-05322-w.</p><p>Article PubMed PubMed Central Google Scholar </p></li><li data-counter=\"2.\"><p>Marco DN, Brey M, Anguera S, et al. Time to positivity as a predictor of catheter-related bacteremia and mortality in adults with <i>Pseudomonas aeruginosa</i> bloodstream infection. Crit Care. 2025;29:63. https://doi.org/10.1186/s13054-025-05292-z.</p><p>Article PubMed PubMed Central Google Scholar </p></li><li data-counter=\"3.\"><p>Kim J, Gregson DB, Ross T, Laupland KB. Time to blood culture positivity in Staphylococcus aureus bacteremia: association with 30-day mortality. J Infect. 2010;61(3):197–204. https://doi.org/10.1016/j.jinf.2010.06.001. (<b>Epub 2010 Jun 12</b>).</p><p>Article PubMed Google Scholar </p></li><li data-counter=\"4.\"><p>Pan F, Zhao W, Zhang H. Value of Time to Positivity of Blood Culture in Children with Bloodstream Infections. Can J Infect Dis Med Microbiol. 2019;10(2019):5975837. https://doi.org/10.1155/2019/5975837.</p><p>Article Google Scholar </p></li><li data-counter=\"5.\"><p>Lai CC, Wang CY, Liu WL, Cheng A, Lee YC, Huang YT, Hsueh PR. Time to blood culture positivity as a predictor of drug resistance in Acinetobacter baumannii complex bacteremia. J Infect. 2011;63(1):96–8. https://doi.org/10.1016/j.jinf.2011.05.009. (<b>Epub 2011 May 27</b>).</p><p>Article PubMed Google Scholar </p></li><li data-counter=\"6.\"><p>Weinstein RJ, Young LS. Neutrophil function in gram-negative rod bacteremia. The interaction between phagocytic cells, infecting organisms, and humoral factors. J Clin Invest. 1976;58(1):190–9. https://doi.org/10.1172/JCI108449.</p><p>Article CAS PubMed PubMed Central Google Scholar </p></li><li data-counter=\"7.\"><p>Derby BM, Rogers DE. Studies on bacteriemia. J Exp Med. 1961;113(6):1053–66. https://doi.org/10.1084/jem.113.6.1053.</p><p>Article CAS PubMed PubMed Central Google Scholar </p></li></ol><p>Download references<svg aria-hidden=\"true\" focusable=\"false\" height=\"16\" role=\"img\" width=\"16\"><use xlink:href=\"#icon-eds-i-download-medium\" xmlns:xlink=\"http://www.w3.org/1999/xlink\"></use></svg></p><p>None</p><p>None.</p><h3>Authors and Affiliations</h3><ol><li><p>Department of Infectious Diseases, Hospital Clínic, 170 Villarroel Street, 08036, Barcelona, Spain</p><p>Daniel N. Marco, Àlex Soriano &amp; Sabina Herrera</p></li><li><p>Faculty of Medicine, University of Barcelona, Barcelona, Spain</p><p>Daniel N. Marco, Àlex Soriano &amp; Sabina Herrera</p></li><li><p>Institut d’investigació Biomèdica August Pi i Sunyer (IDIBAPS), 08036, Barcelona, Spain</p><p>Àlex Soriano &amp; Sabina Herrera</p></li><li><p>Centro de Investigación Biomedical en Red en Enfermedades Infecciosas CIBERINFEC, 28029, Madrid, Spain</p><p>Àlex Soriano</p></li></ol><span>Authors</span><ol><li><span>Daniel N. Marco</span>View author publications<p><span>You can also search for this author in</span><span>PubMed<span> </span>Google Scholar</span></p></li><li><span>Àlex Soriano</span>View author publications<p><span>You can also search for this author in</span><span>PubMed<span> </span>Google Scholar</span></p></li><li><span>Sabina Herrera</span>View author publications<p><span>You can also search for this author in</span><span>PubMed<span> </span>Google Scholar</span></p></li></ol><h3>Contributions</h3><p>D.N.M., À.S., and S.H. contributed to the conception and design of the study. D.N.M. conducted the data collection and statistical analysis, with guidance from À.S. and S.H. The manuscript was drafted by D.N.M. and SH and critically revised by À.S. for important intellectual content. S.H. and A.S supervised the project and provided final approval of the version to be published. All authors have read and approved the final manuscript and agree to be accountable for all aspects of the work.</p><h3>Corresponding author</h3><p>Correspondence to Sabina Herrera.</p><h3>Competing interests</h3>\n<p>The authors declare no competing interests.</p><h3>Publisher's Note</h3><p>Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.</p><p><b>Open Access</b> This article is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License, which permits any non-commercial use, sharing, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if you modified the licensed material. You do not have permission under this licence to share adapted material derived from this article or parts of it. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by-nc-nd/4.0/.</p>\n<p>Reprints and permissions</p><img alt=\"Check for updates. Verify currency and authenticity via CrossMark\" height=\"81\" loading=\"lazy\" src=\"data:image/svg+xml;base64,<svg height="81" width="57" xmlns="http://www.w3.org/2000/svg"><g fill="none" fill-rule="evenodd"><path d="m17.35 35.45 21.3-14.2v-17.03h-21.3" fill="#989898"/><path d="m38.65 35.45-21.3-14.2v-17.03h21.3" fill="#747474"/><path d="m28 .5c-12.98 0-23.5 10.52-23.5 23.5s10.52 23.5 23.5 23.5 23.5-10.52 23.5-23.5c0-6.23-2.48-12.21-6.88-16.62-4.41-4.4-10.39-6.88-16.62-6.88zm0 41.25c-9.8 0-17.75-7.95-17.75-17.75s7.95-17.75 17.75-17.75 17.75 7.95 17.75 17.75c0 4.71-1.87 9.22-5.2 12.55s-7.84 5.2-12.55 5.2z" fill="#535353"/><path d="m41 36c-5.81 6.23-15.23 7.45-22.43 2.9-7.21-4.55-10.16-13.57-7.03-21.5l-4.92-3.11c-4.95 10.7-1.19 23.42 8.78 29.71 9.97 6.3 23.07 4.22 30.6-4.86z" fill="#9c9c9c"/><path d="m.2 58.45c0-.75.11-1.42.33-2.01s.52-1.09.91-1.5c.38-.41.83-.73 1.34-.94.51-.22 1.06-.32 1.65-.32.56 0 1.06.11 1.51.35.44.23.81.5 1.1.81l-.91 1.01c-.24-.24-.49-.42-.75-.56-.27-.13-.58-.2-.93-.2-.39 0-.73.08-1.05.23-.31.16-.58.37-.81.66-.23.28-.41.63-.53 1.04-.13.41-.19.88-.19 1.39 0 1.04.23 1.86.68 2.46.45.59 1.06.88 1.84.88.41 0 .77-.07 1.07-.23s.59-.39.85-.68l.91 1c-.38.43-.8.76-1.28.99-.47.22-1 .34-1.58.34-.59 0-1.13-.1-1.64-.31-.5-.2-.94-.51-1.31-.91-.38-.4-.67-.9-.88-1.48-.22-.59-.33-1.26-.33-2.02zm8.4-5.33h1.61v2.54l-.05 1.33c.29-.27.61-.51.96-.72s.76-.31 1.24-.31c.73 0 1.27.23 1.61.71.33.47.5 1.14.5 2.02v4.31h-1.61v-4.1c0-.57-.08-.97-.25-1.21-.17-.23-.45-.35-.83-.35-.3 0-.56.08-.79.22-.23.15-.49.36-.78.64v4.8h-1.61zm7.37 6.45c0-.56.09-1.06.26-1.51.18-.45.42-.83.71-1.14.29-.3.63-.54 1.01-.71.39-.17.78-.25 1.18-.25.47 0 .88.08 1.23.24.36.16.65.38.89.67s.42.63.54 1.03c.12.41.18.84.18 1.32 0 .32-.02.57-.07.76h-4.36c.07.62.29 1.1.65 1.44.36.33.82.5 1.38.5.29 0 .57-.04.83-.13s.51-.21.76-.37l.55 1.01c-.33.21-.69.39-1.09.53-.41.14-.83.21-1.26.21-.48 0-.92-.08-1.34-.25-.41-.16-.76-.4-1.07-.7-.31-.31-.55-.69-.72-1.13-.18-.44-.26-.95-.26-1.52zm4.6-.62c0-.55-.11-.98-.34-1.28-.23-.31-.58-.47-1.06-.47-.41 0-.77.15-1.07.45-.31.29-.5.73-.58 1.3zm2.5.62c0-.57.09-1.08.28-1.53.18-.44.43-.82.75-1.13s.69-.54 1.1-.71c.42-.16.85-.24 1.31-.24.45 0 .84.08 1.17.23s.61.34.85.57l-.77 1.02c-.19-.16-.38-.28-.56-.37-.19-.09-.39-.14-.61-.14-.56 0-1.01.21-1.35.63-.35.41-.52.97-.52 1.67 0 .69.17 1.24.51 1.66.34.41.78.62 1.32.62.28 0 .54-.06.78-.17.24-.12.45-.26.64-.42l.67 1.03c-.33.29-.69.51-1.08.65-.39.15-.78.23-1.18.23-.46 0-.9-.08-1.31-.24-.4-.16-.75-.39-1.05-.7s-.53-.69-.7-1.13c-.17-.45-.25-.96-.25-1.53zm6.91-6.45h1.58v6.17h.05l2.54-3.16h1.77l-2.35 2.8 2.59 4.07h-1.75l-1.77-2.98-1.08 1.23v1.75h-1.58zm13.69 1.27c-.25-.11-.5-.17-.75-.17-.58 0-.87.39-.87 1.16v.75h1.34v1.27h-1.34v5.6h-1.61v-5.6h-.92v-1.2l.92-.07v-.72c0-.35.04-.68.13-.98.08-.31.21-.57.4-.79s.42-.39.71-.51c.28-.12.63-.18 1.04-.18.24 0 .48.02.69.07.22.05.41.1.57.17zm.48 5.18c0-.57.09-1.08.27-1.53.17-.44.41-.82.72-1.13.3-.31.65-.54 1.04-.71.39-.16.8-.24 1.23-.24s.84.08 1.24.24c.4.17.74.4 1.04.71s.54.69.72 1.13c.19.45.28.96.28 1.53s-.09 1.08-.28 1.53c-.18.44-.42.82-.72 1.13s-.64.54-1.04.7-.81.24-1.24.24-.84-.08-1.23-.24-.74-.39-1.04-.7c-.31-.31-.55-.69-.72-1.13-.18-.45-.27-.96-.27-1.53zm1.65 0c0 .69.14 1.24.43 1.66.28.41.68.62 1.18.62.51 0 .9-.21 1.19-.62.29-.42.44-.97.44-1.66 0-.7-.15-1.26-.44-1.67-.29-.42-.68-.63-1.19-.63-.5 0-.9.21-1.18.63-.29.41-.43.97-.43 1.67zm6.48-3.44h1.33l.12 1.21h.05c.24-.44.54-.79.88-1.02.35-.24.7-.36 1.07-.36.32 0 .59.05.78.14l-.28 1.4-.33-.09c-.11-.01-.23-.02-.38-.02-.27 0-.56.1-.86.31s-.55.58-.77 1.1v4.2h-1.61zm-47.87 15h1.61v4.1c0 .57.08.97.25 1.2.17.24.44.35.81.35.3 0 .57-.07.8-.22.22-.15.47-.39.73-.73v-4.7h1.61v6.87h-1.32l-.12-1.01h-.04c-.3.36-.63.64-.98.86-.35.21-.76.32-1.24.32-.73 0-1.27-.24-1.61-.71-.33-.47-.5-1.14-.5-2.02zm9.46 7.43v2.16h-1.61v-9.59h1.33l.12.72h.05c.29-.24.61-.45.97-.63.35-.17.72-.26 1.1-.26.43 0 .81.08 1.15.24.33.17.61.4.84.71.24.31.41.68.53 1.11.13.42.19.91.19 1.44 0 .59-.09 1.11-.25 1.57-.16.47-.38.85-.65 1.16-.27.32-.58.56-.94.73-.35.16-.72.25-1.1.25-.3 0-.6-.07-.9-.2s-.59-.31-.87-.56zm0-2.3c.26.22.5.37.73.45.24.09.46.13.66.13.46 0 .84-.2 1.15-.6.31-.39.46-.98.46-1.77 0-.69-.12-1.22-.35-1.61-.23-.38-.61-.57-1.13-.57-.49 0-.99.26-1.52.77zm5.87-1.69c0-.56.08-1.06.25-1.51.16-.45.37-.83.65-1.14.27-.3.58-.54.93-.71s.71-.25 1.08-.25c.39 0 .73.07 1 .2.27.14.54.32.81.55l-.06-1.1v-2.49h1.61v9.88h-1.33l-.11-.74h-.06c-.25.25-.54.46-.88.64-.33.18-.69.27-1.06.27-.87 0-1.56-.32-2.07-.95s-.76-1.51-.76-2.65zm1.67-.01c0 .74.13 1.31.4 1.7.26.38.65.58 1.15.58.51 0 .99-.26 1.44-.77v-3.21c-.24-.21-.48-.36-.7-.45-.23-.08-.46-.12-.7-.12-.45 0-.82.19-1.13.59-.31.39-.46.95-.46 1.68zm6.35 1.59c0-.73.32-1.3.97-1.71.64-.4 1.67-.68 3.08-.84 0-.17-.02-.34-.07-.51-.05-.16-.12-.3-.22-.43s-.22-.22-.38-.3c-.15-.06-.34-.1-.58-.1-.34 0-.68.07-1 .2s-.63.29-.93.47l-.59-1.08c.39-.24.81-.45 1.28-.63.47-.17.99-.26 1.54-.26.86 0 1.51.25 1.93.76s.63 1.25.63 2.21v4.07h-1.32l-.12-.76h-.05c-.3.27-.63.48-.98.66s-.73.27-1.14.27c-.61 0-1.1-.19-1.48-.56-.38-.36-.57-.85-.57-1.46zm1.57-.12c0 .3.09.53.27.67.19.14.42.21.71.21.28 0 .54-.07.77-.2s.48-.31.73-.56v-1.54c-.47.06-.86.13-1.18.23-.31.09-.57.19-.76.31s-.33.25-.41.4c-.09.15-.13.31-.13.48zm6.29-3.63h-.98v-1.2l1.06-.07.2-1.88h1.34v1.88h1.75v1.27h-1.75v3.28c0 .8.32 1.2.97 1.2.12 0 .24-.01.37-.04.12-.03.24-.07.34-.11l.28 1.19c-.19.06-.4.12-.64.17-.23.05-.49.08-.76.08-.4 0-.74-.06-1.02-.18-.27-.13-.49-.3-.67-.52-.17-.21-.3-.48-.37-.78-.08-.3-.12-.64-.12-1.01zm4.36 2.17c0-.56.09-1.06.27-1.51s.41-.83.71-1.14c.29-.3.63-.54 1.01-.71.39-.17.78-.25 1.18-.25.47 0 .88.08 1.23.24.36.16.65.38.89.67s.42.63.54 1.03c.12.41.18.84.18 1.32 0 .32-.02.57-.07.76h-4.37c.08.62.29 1.1.65 1.44.36.33.82.5 1.38.5.3 0 .58-.04.84-.13.25-.09.51-.21.76-.37l.54 1.01c-.32.21-.69.39-1.09.53s-.82.21-1.26.21c-.47 0-.92-.08-1.33-.25-.41-.16-.77-.4-1.08-.7-.3-.31-.54-.69-.72-1.13-.17-.44-.26-.95-.26-1.52zm4.61-.62c0-.55-.11-.98-.34-1.28-.23-.31-.58-.47-1.06-.47-.41 0-.77.15-1.08.45-.31.29-.5.73-.57 1.3zm3.01 2.23c.31.24.61.43.92.57.3.13.63.2.98.2.38 0 .65-.08.83-.23s.27-.35.27-.6c0-.14-.05-.26-.13-.37-.08-.1-.2-.2-.34-.28-.14-.09-.29-.16-.47-.23l-.53-.22c-.23-.09-.46-.18-.69-.3-.23-.11-.44-.24-.62-.4s-.33-.35-.45-.55c-.12-.21-.18-.46-.18-.75 0-.61.23-1.1.68-1.49.44-.38 1.06-.57 1.83-.57.48 0 .91.08 1.29.25s.71.36.99.57l-.74.98c-.24-.17-.49-.32-.73-.42-.25-.11-.51-.16-.78-.16-.35 0-.6.07-.76.21-.17.15-.25.33-.25.54 0 .14.04.26.12.36s.18.18.31.26c.14.07.29.14.46.21l.54.19c.23.09.47.18.7.29s.44.24.64.4c.19.16.34.35.46.58.11.23.17.5.17.82 0 .3-.06.58-.17.83-.12.26-.29.48-.51.68-.23.19-.51.34-.84.45-.34.11-.72.17-1.15.17-.48 0-.95-.09-1.41-.27-.46-.19-.86-.41-1.2-.68z" fill="#535353"/></g></svg>\" width=\"57\"/><h3>Cite this article</h3><p>Marco, D.N., Soriano, À. &amp; Herrera, S. Further considerations on the clinical applicability of time to positivity as a prognostic tool for catheter-related <i>Pseudomonas aeruginosa</i> bloodstream infections. <i>Crit Care</i> <b>29</b>, 143 (2025). https://doi.org/10.1186/s13054-025-05370-2</p><p>Download citation<svg aria-hidden=\"true\" focusable=\"false\" height=\"16\" role=\"img\" width=\"16\"><use xlink:href=\"#icon-eds-i-download-medium\" xmlns:xlink=\"http://www.w3.org/1999/xlink\"></use></svg></p><ul data-test=\"publication-history\"><li><p>Received<span>: </span><span><time datetime=\"2025-03-07\">07 March 2025</time></span></p></li><li><p>Accepted<span>: </span><span><time datetime=\"2025-03-13\">13 March 2025</time></span></p></li><li><p>Published<span>: </span><span><time datetime=\"2025-04-01\">01 April 2025</time></span></p></li><li><p>DOI</abbr><span>: </span><span>https://doi.org/10.1186/s13054-025-05370-2</span></p></li></ul><h3>Share this article</h3><p>Anyone you share the following link with will be able to read this content:</p><button data-track=\"click\" data-track-action=\"get shareable link\" data-track-external=\"\" data-track-label=\"button\" type=\"button\">Get shareable link</button><p>Sorry, a shareable link is not currently available for this article.</p><p data-track=\"click\" data-track-action=\"select share url\" data-track-label=\"button\"></p><button data-track=\"click\" data-track-action=\"copy share url\" data-track-external=\"\" data-track-label=\"button\" type=\"button\">Copy to clipboard</button><p> Provided by the Springer Nature SharedIt content-sharing initiative </p>","PeriodicalId":10811,"journal":{"name":"Critical Care","volume":"39 1","pages":""},"PeriodicalIF":8.8000,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Critical Care","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1186/s13054-025-05370-2","RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"CRITICAL CARE MEDICINE","Score":null,"Total":0}
引用次数: 0

Abstract

To the Editor,

We appreciate the thoughtful comments by Liao et al. [1] regarding our study [2] on “Time to positivity (TTP) as a predictor of catheter-related bacteremia and mortality in Pseudomonas aeruginosa bloodstream infections (PAE-BSI)”. Their insights highlight important aspects that warrant further discussion, particularly regarding additional variables that could influence the TTP, and about long-term outcome.

In response to the first point, we acknowledge the potential influence of resistance on TTP. We found that susceptible P. aeruginosa strains had a significantly shorter TTP (Table 1). Moreover, this property was consistent across all antibiotic families. Since no clinically relevant TTP cut-off for predicting resistance was identified, this data was not included in the main article due to length limitation. This finding supports that resistant strains may decelerate their replication rates because resistance mechanisms affect one or more metabolic pathways involved in bacterial replication. A previous study in Staphylococcus aureus bacteremia also demonstrated shorter TTP for methicillin-susceptible strains compared to methicillin-resistant ones [3]. However, we have to recognize that other studies focused in Enterobacterales and other non-fermenting gram-negative bacilli have shown contradictory results [4, 5].

Table 1 Factors associated with shorter TTP. Univariate and multivariate analysis.
Full size table

The authors raise another point regarding immune suppression and comorbidities as potential modifiers of TTP. Although the role of host immunity seems reasonable, our data (Table 1) did not support this statement. In the univariable analysis, chronic kidney disease (CKD) in hemodialysis, neutropenia and corticosteroid therapy were significantly associated with shorter TTP. However, no one was finally included in the multivariable analysis. In the case of CKD in hemodialysis the reason to be excluded is that the majority of these cases were catheter-related bacteremia that is a significant determinant of shorter TTP. Neutropenia reduces the host capacity to clear bacteria from infected tissue resulting in higher bacterial loads in the bloodstream and corticosteroid therapy impair the reticuloendothelial system located at the liver and the spleen, both responsible of rapid bacterial clearance from the blood [6, 7]. Therefore, weak immune system increases the inoculum at the infectious foci and that is the variable superior in the multivariable analysis. According to our findings, we have summarized the main determinants of TTP in Fig. 1.

Fig. 1
Abstract Image

Diagram displaying the main determinants of time to positivity (TTP). The figure also represents the microbiological and clinical variables which in turn affect the two main determinants

Full size image

While we agree that evaluating long-term mortality and post-infection complications would provide a more comprehensive perspective, this was not the primary scope of our study, and this information was not captured in our database.

No datasets were generated or analysed during the current study.

  1. Liao Y, Deng X, Xiao H. Further considerations on the clinical applicability of time to positivity as a prognostic tool for catheter-related pseudomonas aeruginosa bloodstream infections. Crit Care. 2025;29:94. https://doi.org/10.1186/s13054-025-05322-w.

    Article PubMed PubMed Central Google Scholar

  2. Marco DN, Brey M, Anguera S, et al. Time to positivity as a predictor of catheter-related bacteremia and mortality in adults with Pseudomonas aeruginosa bloodstream infection. Crit Care. 2025;29:63. https://doi.org/10.1186/s13054-025-05292-z.

    Article PubMed PubMed Central Google Scholar

  3. Kim J, Gregson DB, Ross T, Laupland KB. Time to blood culture positivity in Staphylococcus aureus bacteremia: association with 30-day mortality. J Infect. 2010;61(3):197–204. https://doi.org/10.1016/j.jinf.2010.06.001. (Epub 2010 Jun 12).

    Article PubMed Google Scholar

  4. Pan F, Zhao W, Zhang H. Value of Time to Positivity of Blood Culture in Children with Bloodstream Infections. Can J Infect Dis Med Microbiol. 2019;10(2019):5975837. https://doi.org/10.1155/2019/5975837.

    Article Google Scholar

  5. Lai CC, Wang CY, Liu WL, Cheng A, Lee YC, Huang YT, Hsueh PR. Time to blood culture positivity as a predictor of drug resistance in Acinetobacter baumannii complex bacteremia. J Infect. 2011;63(1):96–8. https://doi.org/10.1016/j.jinf.2011.05.009. (Epub 2011 May 27).

    Article PubMed Google Scholar

  6. Weinstein RJ, Young LS. Neutrophil function in gram-negative rod bacteremia. The interaction between phagocytic cells, infecting organisms, and humoral factors. J Clin Invest. 1976;58(1):190–9. https://doi.org/10.1172/JCI108449.

    Article CAS PubMed PubMed Central Google Scholar

  7. Derby BM, Rogers DE. Studies on bacteriemia. J Exp Med. 1961;113(6):1053–66. https://doi.org/10.1084/jem.113.6.1053.

    Article CAS PubMed PubMed Central Google Scholar

Download references

None

None.

Authors and Affiliations

  1. Department of Infectious Diseases, Hospital Clínic, 170 Villarroel Street, 08036, Barcelona, Spain

    Daniel N. Marco, Àlex Soriano & Sabina Herrera

  2. Faculty of Medicine, University of Barcelona, Barcelona, Spain

    Daniel N. Marco, Àlex Soriano & Sabina Herrera

  3. Institut d’investigació Biomèdica August Pi i Sunyer (IDIBAPS), 08036, Barcelona, Spain

    Àlex Soriano & Sabina Herrera

  4. Centro de Investigación Biomedical en Red en Enfermedades Infecciosas CIBERINFEC, 28029, Madrid, Spain

    Àlex Soriano

Authors
  1. Daniel N. MarcoView author publications

    You can also search for this author inPubMed Google Scholar

  2. Àlex SorianoView author publications

    You can also search for this author inPubMed Google Scholar

  3. Sabina HerreraView author publications

    You can also search for this author inPubMed Google Scholar

Contributions

D.N.M., À.S., and S.H. contributed to the conception and design of the study. D.N.M. conducted the data collection and statistical analysis, with guidance from À.S. and S.H. The manuscript was drafted by D.N.M. and SH and critically revised by À.S. for important intellectual content. S.H. and A.S supervised the project and provided final approval of the version to be published. All authors have read and approved the final manuscript and agree to be accountable for all aspects of the work.

Corresponding author

Correspondence to Sabina Herrera.

Competing interests

The authors declare no competing interests.

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Open Access This article is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License, which permits any non-commercial use, sharing, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if you modified the licensed material. You do not have permission under this licence to share adapted material derived from this article or parts of it. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by-nc-nd/4.0/.

Reprints and permissions

Abstract Image

Cite this article

Marco, D.N., Soriano, À. & Herrera, S. Further considerations on the clinical applicability of time to positivity as a prognostic tool for catheter-related Pseudomonas aeruginosa bloodstream infections. Crit Care 29, 143 (2025). https://doi.org/10.1186/s13054-025-05370-2

Download citation

  • Received:

  • Accepted:

  • Published:

  • DOI: https://doi.org/10.1186/s13054-025-05370-2

Share this article

Anyone you share the following link with will be able to read this content:

Sorry, a shareable link is not currently available for this article.

Provided by the Springer Nature SharedIt content-sharing initiative

进一步考虑将阳性时间作为导管相关铜绿假单胞菌血流感染的预后工具的临床适用性
致编辑:我们感谢Liao等人对我们的研究b[1]的周到评论,该研究的题目是“到达阳性时间(TTP)作为铜绿假单胞菌血流感染(PAE-BSI)导管相关菌血症和死亡率的预测指标”。他们的见解突出了值得进一步讨论的重要方面,特别是关于可能影响tpp的其他变量以及长期结果。针对第一点,我们承认耐药性对TTP的潜在影响。我们发现,敏感的铜绿假单胞菌菌株的TTP明显较短(表1)。此外,这一特性在所有抗生素家族中都是一致的。由于没有发现预测耐药的临床相关TTP截止值,由于篇幅限制,该数据未包括在主要文章中。这一发现支持耐药菌株可能会减慢其复制速率,因为耐药机制影响细菌复制中涉及的一个或多个代谢途径。先前一项关于金黄色葡萄球菌菌血症的研究也表明,与耐甲氧西林菌株相比,甲氧西林敏感菌株的TTP更短。然而,我们必须认识到,其他针对肠杆菌和其他非发酵革兰氏阴性杆菌的研究得出了相互矛盾的结果[4,5]。表1与TTP缩短相关的因素。单变量和多变量分析。作者提出了另一个观点,即免疫抑制和合并症是TTP的潜在修饰因素。虽然宿主免疫的作用似乎是合理的,但我们的数据(表1)并不支持这一说法。在单变量分析中,血液透析、中性粒细胞减少和皮质类固醇治疗中的慢性肾脏疾病(CKD)与较短的TTP显著相关。然而,最终没有人被纳入多变量分析。在血液透析的CKD病例中,被排除的原因是大多数病例是导管相关性菌血症,这是TTP较短的重要决定因素。中性粒细胞减少降低了宿主清除受感染组织中细菌的能力,导致血液中细菌负荷增加,皮质类固醇治疗损害了位于肝脏和脾脏的网状内皮系统,这两个系统都负责快速清除血液中的细菌[6,7]。因此,弱免疫系统增加了感染灶的接种量,这是多变量分析中的优势变量。根据我们的发现,我们在图1中总结了TTP的主要决定因素。显示积极时间(TTP)的主要决定因素的图表。虽然我们同意评估长期死亡率和感染后并发症将提供一个更全面的视角,但这不是我们研究的主要范围,而且我们的数据库中没有捕获这些信息。在本研究中没有生成或分析数据集。廖莹,邓鑫,肖华。导管相关铜绿假单胞菌血流感染的预后判断时间对临床适用性的进一步探讨。危重护理。2025;29:94。https://doi.org/10.1186/s13054-025-05322-w.Article PubMed PubMed Central谷歌学者Marco DN, Brey M, Anguera S,等。铜绿假单胞菌血流感染成人导管相关菌血症和死亡率的预测指标。危重护理。2025;29:63。https://doi.org/10.1186/s13054-025-05292-z.Article PubMed PubMed Central谷歌学者Kim J, Gregson DB, Ross T, Laupland KB。金黄色葡萄球菌菌血症的血培养阳性时间:与30天死亡率的关系中华传染病杂志,2010;61(3):197-204。https://doi.org/10.1016/j.jinf.2010.06.001。(Epub 2010年6月12日)。学者潘峰,赵伟,张华。时间对血流感染患儿血培养阳性的价值。中华感染与微生物杂志,2019;10(2019):5975837。https://doi.org/10.1155/2019/5975837.Article谷歌学者赖春春,王云云,刘文伟,程安,李玉春,黄玉涛,薛永荣。血培养时间对鲍曼不动杆菌复合菌血症耐药的预测作用。中华传染病杂志,2011;63(1):96-8。https://doi.org/10.1016/j.jinf.2011.05.009。(Epub 2011年5月27日)。学者Weinstein RJ, Young LS。中性粒细胞在革兰氏阴性杆状菌血症中的功能。吞噬细胞、感染生物体和体液因子之间的相互作用。中华临床医学杂志,2002;16(1):1 - 4。https://doi.org/10.1172/JCI108449.Article CAS PubMed PubMed Central谷歌学者Derby BM, Rogers DE.菌血症的研究。中华检验医学杂志,2011;32(6):563 - 568。https://doi.org/10.1084/jem.113.6.1053.Article CAS PubMed PubMed Central谷歌Scholar下载参考文献。 作者和单位:西班牙巴塞罗那Villarroel街170号,08036,医院传染病科Clínic daniel N. Marco, Àlex Soriano &;Sabina herre西班牙巴塞罗那大学医学院daniel N. Marco, Àlex Soriano &amp;Sabina HerreraInstitut 'investigació biom<s:1> dica August Pi i Sunyer (IDIBAPS), 08036, Barcelona, SpainÀlex Soriano &amp;Sabina HerreraCentro de Investigación Biomedical en Red en Enfermedades infecias CIBERINFEC, 28029,马德里,SpainÀlex SorianoAuthorsDaniel N. MarcoView作者出版物您也可以在pubmed谷歌ScholarÀlex SorianoView作者出版物您也可以在pubmed谷歌ScholarSabina HerreraView作者出版物您也可以在pubmed谷歌ScholarContributionsD.N.M中搜索该作者。、可靠,和S.H.对这项研究的构思和设计做出了贡献。D.N.M.在À.S的指导下进行了数据收集和统计分析。手稿由D.N.M.和SH起草,并由À.S进行了严格的修改。重要的知识内容。S.H.和a.s.监督了这个项目,并最终批准了将要出版的版本。所有作者都已阅读并批准了最终稿件,并同意对工作的各个方面负责。通讯作者:Sabina Herrera利益竞争作者声明没有利益竞争。出版商声明:对于已出版的地图和机构关系中的管辖权要求,普林格·自然保持中立。开放获取本文遵循知识共享署名-非商业-非衍生品4.0国际许可协议,该协议允许以任何媒介或格式进行非商业用途、共享、分发和复制,只要您适当注明原作者和来源,提供知识共享许可协议的链接,并注明您是否修改了许可材料。根据本许可协议,您无权分享源自本文或其部分内容的改编材料。本文中的图像或其他第三方材料包含在文章的知识共享许可协议中,除非在材料的署名中另有说明。如果材料未包含在文章的知识共享许可中,并且您的预期用途不被法律法规允许或超过允许的用途,您将需要直接获得版权所有者的许可。要查看本许可的副本,请访问http://creativecommons.org/licenses/by-nc-nd/4.0/.Reprints和permissionsCite这篇文章marco, d.n., Soriano, À。,进一步考虑将阳性时间作为导管相关铜绿假单胞菌血流感染的预后工具的临床适用性。危重护理29,143(2025)。https://doi.org/10.1186/s13054-025-05370-2Download citation:收稿日期:2025年3月7日接受日期:2025年3月13日发布日期:2025年4月1日doi: https://doi.org/10.1186/s13054-025-05370-2Share本文任何与您共享以下链接的人都可以阅读此内容:获取可共享链接对不起,本文目前没有可共享链接。复制到剪贴板由施普林格自然共享内容倡议提供
本文章由计算机程序翻译,如有差异,请以英文原文为准。
求助全文
约1分钟内获得全文 求助全文
来源期刊
Critical Care
Critical Care 医学-危重病医学
CiteScore
20.60
自引率
3.30%
发文量
348
审稿时长
1.5 months
期刊介绍: Critical Care is an esteemed international medical journal that undergoes a rigorous peer-review process to maintain its high quality standards. Its primary objective is to enhance the healthcare services offered to critically ill patients. To achieve this, the journal focuses on gathering, exchanging, disseminating, and endorsing evidence-based information that is highly relevant to intensivists. By doing so, Critical Care seeks to provide a thorough and inclusive examination of the intensive care field.
×
引用
GB/T 7714-2015
复制
MLA
复制
APA
复制
导出至
BibTeX EndNote RefMan NoteFirst NoteExpress
×
提示
您的信息不完整,为了账户安全,请先补充。
现在去补充
×
提示
您因"违规操作"
具体请查看互助需知
我知道了
×
提示
确定
请完成安全验证×
copy
已复制链接
快去分享给好友吧!
我知道了
右上角分享
点击右上角分享
0
联系我们:info@booksci.cn Book学术提供免费学术资源搜索服务,方便国内外学者检索中英文文献。致力于提供最便捷和优质的服务体验。 Copyright © 2023 布克学术 All rights reserved.
京ICP备2023020795号-1
ghs 京公网安备 11010802042870号
Book学术文献互助
Book学术文献互助群
群 号:481959085
Book学术官方微信