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Follow-up blood cultures in Staphylococcus aureus bacteremia: a probability-based optimization

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Abstract

Staphylococcus aureus bacteremia (SAB) is a relevant finding which prompts a thorough diagnostic work-up. Follow-up blood cultures (BC) are essential in this work-up. We investigate the probability of detecting an ongoing bacteremia after initiation of active therapy according to the number of BC taken at key time points. A retrospective analysis of all patients with SAB in a 6-year period was performed. Total number of BCs taken and the positivity was registered for each day after start of therapy. A positivity-rate was corrected using a logistic mixed effects model. Observed detection frequencies were applied to calculate detection probabilities using binomial distributions. Three hundred and seventeen cases were withheld for analysis. A BC bottle positivity rate of 66.7% was found 1 day after initiation of active therapy, which decreased to 48.5% on day 4. When using 1 set of FU-BC, 73.4% of persisting SABs are detected. To maintain a probability of detection of ≥ 90%, 2 BC sets should be taken on day 2 and day 4 after start of therapy. In 10 of 109 patients with positive FU-BC, skip phenomena were registered, with a significant higher proportion in patients with < 4 BC bottles taken (14%) than when ≥ 4 BC bottles were taken (4.1%). We recommend taking 2 BC sets on days 2 and 4 after start of therapy in order to detect ≥ 90% of persisting SABs, limiting skip phenomena and blood volume required. We strongly advice against taking a single BC set as follow-up for SAB.

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Data availability

The dataset analyzed for the current study is not publicly available due to GDPR but are available from the corresponding author on reasonable request.

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Authors and Affiliations

  1. Laboratory of Medical Microbiology, Antwerp University Hospital, Drie Eikenstraat 655, 2650, Edegem, Belgium

    Sam Van Goethem, Hélène Boogaerts, Matthias Cuykx, Herman Goossens & Hilde Jansens

  2. University of Antwerp, Edegem, Belgium

    Pol van den Bremen

  3. Clinical Trial Center (CTC), CRC Antwerp, Antwerp University Hospital, University of Antwerp, Edegem, Belgium

    Kristien Wouters

  4. Department of General Internal Medicine, Infectious Diseases and Tropical Medicine, Antwerp University Hospital, Drie Eikenstraat 655, 2650, Edegem, Belgium

    Gerrit Luit ten Kate

Authors
  1. Sam Van Goethem
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  2. Hélène Boogaerts
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  3. Matthias Cuykx
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  4. Pol van den Bremen
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  5. Kristien Wouters
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  6. Herman Goossens
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  7. Hilde Jansens
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  8. Gerrit Luit ten Kate
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Contributions

All authors contributed significantly to the design of execution of this study.

Corresponding authors

Correspondence to Sam Van Goethem or Gerrit Luit ten Kate.

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Ethical approval

This study was performed in line with the principles of the Declaration of Helsinki. Approval was granted by the Ethics Committee of the University of Antwerp (Universiteit Antwerpen).

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No informed consents were requested, as it involves a retrospective study and it was not requested by the ethical committee.

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The authors declare no competing interests.

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Summary

Follow-up blood cultures are essential in the treatment of Staphylococcus aureus bacteremia. Using a retrospective analysis, we found that at least 4 blood culture bottles are needed at 2 and 4 days after start of therapy to obtain sufficient probability of detection.

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Van Goethem, S., Boogaerts, H., Cuykx, M. et al. Follow-up blood cultures in Staphylococcus aureus bacteremia: a probability-based optimization. Eur J Clin Microbiol Infect Dis 41, 1263–1268 (2022). https://doi.org/10.1007/s10096-022-04487-4

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  • DOI: https://doi.org/10.1007/s10096-022-04487-4

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