Blood culture time-to-positivity can identify S aureus, but not Enterococcal or Streptococcal endocarditis.

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Abstract

Background International guidelines for S aureus bacteraemia often recommend screening echocardiography irrespective clinical factors that influence the likelihood of endocarditis, but this is not the case for enterococci or streptoccoci that are also high risk organism. Time to blood culture positivity (TTP) reflects bacterial load and has the potential to identify patients at higher risk of endocarditis. Methods We performed a retrospective analysis of clinical data that have been performed in a tertiary hospital in England. We investigate time to positivity (TTP) as a predictor variable in our S. aureus , enterococci and streptococci in logistic regression models and assess non-linearity of this affect using generalised additive models. We calculate NPV for TTP beyond the median value. Results The odds ratio for endocarditis from S. aureus bacteria was 0.92 (95%CI 0.85-0.99, p = 0.02) for each hour increase in TTP, with a negative predictive value of TTP greater than the median being 90% (95% CI 85-95%). For streptococci the OR was 1.02 (95%CI 0.98-1.06, p:0.31) and enterococci 1.08 (95% CI 0.99-1.18, p = 0.1) for every increase in hour of TTP. Conclusion Longer TTP is associated with lower risk of endocarditis in S. aureus bacteraemia, at 8% reduction per hour, giving an NPV of 90% beyond 13 hours. There was no evidence of association with enterococci or streptococci.
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Keywords Bacteremia, Endocarditis, Diagnostic stewardship Alongside their report, reviewers assign a status to the article: Approved - the paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations - A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved - fundamental flaws in the paper seriously undermine the findings and conclusions Provide sufficient details of any financial or non-financial competing interests to enable users to assess whether your comments might lead a reasonable person to question your impartiality. Consider the following examples, but note that this is not an exhaustive list: Examples of 'Non-Financial Competing Interests' - Within the past 4 years, you have held joint grants, published or collaborated with any of the authors of the selected paper. - You have a close personal relationship (e.g. parent, spouse, sibling, or domestic partner) with any of the authors. - You are a close professional associate of any of the authors (e.g. scientific mentor, recent student). - You work at the same institute as any of the authors. - You hope/expect to benefit (e.g. favour or employment) as a result of your submission. - You are an Editor for the journal in which the article is published. Examples of 'Financial Competing Interests' - You expect to receive, or in the past 4 years have received, any of the following from any commercial organisation that may gain financially from your submission: a salary, fees, funding, reimbursements. - You expect to receive, or in the past 4 years have received, shared grant support or other funding with any of the authors. - You hold, or are currently applying for, any patents or significant stocks/shares relating to the subject matter of the paper you are commenting on. Sign up for content alerts and receive a weekly or monthly email with all newly published articles Register with NIHR Open Research Already registered? Sign in If you are a previous or current NIHR award holder, sign up for information about developments, publishing and publications from NIHR Open Research. We'll keep you updated on any major new updates to NIHR Open Research Sign In If you've forgotten your password, please enter your email address below and we'll send you instructions on how to reset your password. The email address should be the one you originally registered with F1000. Email address not valid, please try again You registered with F1000 via Google, so we cannot reset your password. To sign in, please click here. If you still need help with your Google account password, please click here. You registered with F1000 via Facebook, so we cannot reset your password. To sign in, please click here. If you still need help with your Facebook account password, please click here. Code not correct, please try again Email us for further assistance. Server error, please try again. If your email address is registered with us, we will email you instructions to reset your password. If you think you should have received this email but it has not arrived, please check your spam filters and/or contact for further assistance. Please wait...

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License: CC-BY-4.0