Time to positivity in blood cultures of adults with Streptococcus pneumoniae bacteremia

Galo Peralta, María José Rodríguez-Lera, Jose Carlos Garrido, Luis Ansorena, María Pía Roiz, Galo Peralta, María José Rodríguez-Lera, Jose Carlos Garrido, Luis Ansorena, María Pía Roiz

Abstract

Background: previous studies have established that bacterial blood concentration is related with clinical outcome. Time to positivity of blood cultures (TTP) has relationship with bacterial blood concentration and could be related with prognosis. As there is scarce information about the usefulness of TTP, we study the relationship of TTP with clinical parameters in patients with Streptococcus pneumoniae bacteremia.

Methods: TTP of all cases of Streptococcus pneumoniae bacteremia, detected between January 1995 and December 2004 using the BacT/Alert automated blood culture system in a teaching community hospital was analyzed. When multiple cultures were positive only the shortest TTP was selected for the analysis.

Results: in the study period 105 patients with Streptococcus pneumoniae bacteremia were detected. Median TTP was 14.1 hours (range 1.2 h to 127 h). Immunosuppressed patients (n = 5), patients with confusion (n = 19), severe sepsis or shock at the time of blood culture extraction (n = 12), those with a diagnosis of meningitis (n = 7) and those admitted to the ICU (n = 14) had lower TTP. Patients with TTP in the first quartile were more frequently hospitalized, admitted to the ICU, had meningitis, a non-pneumonic origin of the bacteremia, and a higher number of positive blood cultures than patients with TTP in the fourth quartile. None of the patients with TTP in the 90th decile had any of these factors associated with shorter TTP, and eight out of ten patients with TTP in the 10th decile had at least one of these factors. The number of positive blood cultures had an inverse correlation with TTP, suggesting a relationship of TTP with bacterial blood concentration.

Conclusion: Our data support the relationship of TTP with several clinical parameters in patients with Streptococcus pneumoniae bacteremia, and its potential usefulness as a surrogate marker of outcome.

Figures

Figure 1
Figure 1
TTP in the 105 patients with Streptococcus pneumoniae bacteremia. Two patients with extreme values of TTP are excluded (120 h and 122 h respectively). One patient in the group of meningitis had also severe sepsis.
Figure 2
Figure 2
The minimal, maximal and mean TTP value of the blood cultures of each patient are represented. Two patients with extreme values of TTP are excluded (120 h and 122 h respectively, each only with one positive blood culture).
Figure 3
Figure 3
Comparative representation of TTP in patients with and without severe sepsis and meningitis.
Figure 4
Figure 4
Correlation of the TTP and the number of positive blood cultures of each episode of pneumococcal bacteremia. Two patients with extreme values with only positive one blood culture are excluded (120 h and 122 h respectively).

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