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. 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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}
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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.

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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

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  2. Àlex SorianoView author publications

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  3. Sabina HerreraView author publications

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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.

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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

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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.
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