Time to blood culture positivity as a predictor of clinical outcome in patients with Candida albicans bloodstream infection

Authors

Cintia Zoya Nunes, Universidade Federal de São Paulo
Alexandre R. Marra, Universidade Federal de São Paulo
Michael B. Edmond, Virginia Commonwealth UniversityFollow
Elivane da Silva Victor, Hospital Israelita Albert Einstein
Carlos Alberto Pires Pereira, Universidade Federal de São Paulo

Document Type

Article

Original Publication Date

2013

Journal/Book/Conference Title

BMC Infectious Diseases

Volume

2013

DOI of Original Publication

10.1186/1471-2334-13-486

Comments

Originally published at http://dx.doi.org/10.1186/1471-2334-13-486

Date of Submission

September 2014

Abstract

Background Few studies have assessed the time to blood culture positivity as a predictor of clinical outcome in fungal bloodstream infections (BSIs). The purpose of this study was to evaluate the time to positivity (TTP) of blood cultures in patients with Candida albicans BSIs and to assess its impact on clinical outcome.

Methods A historical cohort study with 89 adults patients with C. albicans BSIs. TTP was defined as the time between the start of incubation and the time that the automated alert signal indicating growth in the culture bottle sounded.

Results Patients with BSIs and TTPs of culture of ≤36 h (n=39) and >36 h (n=50) were compared. Septic shock occurred in 46.2% of patients with TTPs of ≤36 h and in 40.0% of patients with TTP of >36 h (p=0.56). A central venous catheter source was more common with a BSI TTP of ≤36 h (p=0.04). Univariate analyis revealed that APACHE II score≥20 at BSI onset, the development of at least one organ system failure (respiratory, cardiovascular, renal, hematologic, or hepatic), SOFA at BSI onset, SAPS II at BSI onset, and time to positivity were associated with death. By using logistic regression analysis, the only independent predictor of death was time to positivity (1.04; 95% CI, 1.0-1.1, p=0.035), with the chance of the patient with C. albicans BSI dying increasing 4.0% every hour prior to culture positivity.

Conclusion A longer time to positivity was associated with a higher mortality for Candida albicans BSIs; therefore, initiating empiric treatment with antifungals may improve outcomes.

Rights

© 2013 Nunes et al.; licensee BioMed Central Ltd. This is an open access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Is Part Of

VCU Internal Medicine Publications