The relationship between blood culture time-to-positivity and Enterococcus faecalis infective endocarditis.

IF 3.6 3区 医学 Q1 PATHOLOGY
Christopher Robson, Hakim Khan, Ralph K Junckerstorff, Maryza Graham, Rhonda L Stuart, Stephen J Nicholls, Benjamin A Rogers
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Abstract

Infective endocarditis (IE) can be difficult to diagnose due to non-specific symptoms and the imperfect sensitivity of blood cultures and echocardiography. The interval between blood culture collection and the first detection of bacterial growth is known as time-to-positivity (TTP) and is considered a proxy for bacterial load. Several studies have demonstrated a shorter TTP in staphylococcal IE compared to staphylococcal bacteraemia of other sources; however, evidence in enterococcal IE is limited. We characterise the relationship between blood culture TTP and a diagnosis of Enterococcus faecalis IE, along with the impact of demographic and patient-specific factors. Retrospective analysis was performed for patients with blood cultures growing E. faecalis at a single centre from 2017 to 2021. Exclusion criteria included polymicrobial growth, repeat/relapsed episodes of enterococcal bacteraemia and receipt of pre-blood culture antibiotics. TTP was compared between participants with and without a definite diagnosis of IE per the 2023 Duke-International Society for Cardiovascular Infectious Diseases criteria. Comparison was also made between participants with and without a clinical diagnosis of IE. After exclusions, 114 episodes of E. faecalis bacteraemia were identified. Twenty-seven (24%) had a definite diagnosis of IE. Nineteen of the 27 (70%) IE cases were left-sided, and three (11%) were device-related. One case of prosthetic valve endocarditis was included. Other infective sources included the urinary tract ​(37/114, 32%) or an unidentified source (34/114, 30%). Median TTP was shorter in bacteraemia of other sources than in Duke definite IE (10.6 vs 11.3 h), but was not statistically significant (p=0.07). The area under the receiver-operator characteristic curve for the ability of TTP to diagnose IE was 0.62. Median TTP was shorter in the clinical IE group than bacteraemia of other sources (10.0 vs 11.4 h); however, this difference was not significant (p=0.34). E. faecalis IE was not associated with a shorter TTP than bacteraemia of other sources in this study. Higher-quality evidence is required to inform the utility of TTP in this condition.

血培养时间与粪肠球菌感染性心内膜炎的关系。
感染性心内膜炎(IE)可能难以诊断,由于非特异性症状和不完善的敏感性血培养和超声心动图。血培养收集和首次检测细菌生长之间的时间间隔称为阳性时间(TTP),被认为是细菌负荷的代表。一些研究表明,与其他来源的葡萄球菌性菌血症相比,葡萄球菌性IE的TTP较短;然而,肠球菌性IE的证据有限。我们描述了血培养TTP与粪肠球菌IE诊断之间的关系,以及人口统计学和患者特异性因素的影响。回顾性分析了2017年至2021年在单一中心进行血培养的粪肠球菌患者。排除标准包括多微生物生长、肠球菌菌血症重复/复发发作和接受血前培养抗生素。根据2023年杜克-国际心血管传染病学会的标准,比较有和没有明确诊断为IE的参与者之间的TTP。还对有和没有临床诊断为IE的参与者进行了比较。排除后,确定了114例粪肠杆菌菌血症。27例(24%)确诊为IE。27例IE中有19例(70%)为左侧,3例(11%)与设备相关。报告人工瓣膜心内膜炎1例。其他感染源包括尿路(37/ 114,32%)或不明来源(34/ 114,30%)。其他来源菌血症的中位TTP短于Duke明确IE (10.6 h vs 11.3 h),但无统计学意义(p=0.07)。TTP诊断IE的能力的受-操作者特征曲线下面积为0.62。临床IE组的中位TTP短于其他来源的菌血症(10.0 h vs 11.4 h);然而,这种差异不显著(p=0.34)。在本研究中,粪肠杆菌IE与其他来源的菌血症相比,与较短的TTP无关。在这种情况下,需要更高质量的证据来说明TTP的效用。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
Pathology
Pathology 医学-病理学
CiteScore
6.50
自引率
2.20%
发文量
459
审稿时长
54 days
期刊介绍: Published by Elsevier from 2016 Pathology is the official journal of the Royal College of Pathologists of Australasia (RCPA). It is committed to publishing peer-reviewed, original articles related to the science of pathology in its broadest sense, including anatomical pathology, chemical pathology and biochemistry, cytopathology, experimental pathology, forensic pathology and morbid anatomy, genetics, haematology, immunology and immunopathology, microbiology and molecular pathology.
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