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Background <p>Time to positivity (TTP) and differential TTP (DTP) emerge as diagnostic and prognostic tools for bloodstream infections (BSI) though specific cut-off values need to be determined for each pathogen. <i>Pseudomonas aeruginosa</i> BSI (PAE-BSI) is of critical concern, particularly in immunocompromised patients, due to high mortality rates. Catheter-related infections are a common cause, necessitating rapid and accurate diagnostic tools for effective management (source-control).</p> Methods <p>Unicentric retrospective observational study analyzing the diagnostic utility and best cut-off values of time to positivity (TTP) and differential time to positivity (DTP) to identify catheter-related PAE-BSI and the association of TTP with 30-day mortality.</p> Results <p>1177 PAE-BSI cases TTP were included in the study. TTP was available in all episodes whereas DTP was available in 355 episodes. Breakthrough bacteremia disregarding the TTP, more than one positive blood culture or &gt; 7&#xa0;days with a catheter in place and both a TTP &lt; 13h and a DTP &gt; 2h were independently associated to catheter-related PAE-BSI. Secondly, lower TTP were significantly associated with higher 30-day mortality rates in both catheter-related and non-catheter-related PAE-BSI. For catheter-related infections, TTP &lt; 14h exacerbated mortality among patients among patients in whom the catheter was not removed within 48h (OR 2.9[1.04–8]); whereas for other sources TTP &lt; 16h increased mortality (OR 1.6[1.1–2.4]) particularly when the empiric antibiotic therapy was not active (OR 3.8[1.5–10]).</p> Conclusion <p>These findings advocate for the routine use of TTP over DTP as a diagnostic tool to guide timely interventions such as catheter removal, thereby potentially improving patient outcomes in PAE-BSI. Moreover, lower TTP have also prognostic implications in both catheter-related and non-catheter-related infections.</p>

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Time to positivity as a predictor of catheter-related bacteremia and mortality in adults with Pseudomonas aeruginosa bloodstream infection

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2025年2月6日

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  • Daniel N. Marco,
  • Maria Brey,
  • Sergi Anguera,
  • Cristina Pitart,
  • Ignacio Grafia,
  • Marta Bodro,
  • Jose Antonio Martínez,
  • Ana del Río,
  • Carolina Garcia-Vidal,
  • Abiu Sempere,
  • Celia Cardozo,
  • Pedro Puerta-Alcalde,
  • Mariana Chumbita,
  • Marta Hernández-Meneses,
  • Guillermo Cuervo,
  • Patricia Monzo-Gallo,
  • Miguel Ángel Verdejo,
  • Tommaso Francesco Aiello,
  • Mateu Espasa,
  • Climent Casals-Pascual,
  • Laura Morata,
  • Felipe García,
  • Josep Mensa,
  • Àlex Soriano,
  • Sabina Herrera

摘要

Background

Time to positivity (TTP) and differential TTP (DTP) emerge as diagnostic and prognostic tools for bloodstream infections (BSI) though specific cut-off values need to be determined for each pathogen. Pseudomonas aeruginosa BSI (PAE-BSI) is of critical concern, particularly in immunocompromised patients, due to high mortality rates. Catheter-related infections are a common cause, necessitating rapid and accurate diagnostic tools for effective management (source-control).

Methods

Unicentric retrospective observational study analyzing the diagnostic utility and best cut-off values of time to positivity (TTP) and differential time to positivity (DTP) to identify catheter-related PAE-BSI and the association of TTP with 30-day mortality.

Results

1177 PAE-BSI cases TTP were included in the study. TTP was available in all episodes whereas DTP was available in 355 episodes. Breakthrough bacteremia disregarding the TTP, more than one positive blood culture or > 7 days with a catheter in place and both a TTP < 13h and a DTP > 2h were independently associated to catheter-related PAE-BSI. Secondly, lower TTP were significantly associated with higher 30-day mortality rates in both catheter-related and non-catheter-related PAE-BSI. For catheter-related infections, TTP < 14h exacerbated mortality among patients among patients in whom the catheter was not removed within 48h (OR 2.9[1.04–8]); whereas for other sources TTP < 16h increased mortality (OR 1.6[1.1–2.4]) particularly when the empiric antibiotic therapy was not active (OR 3.8[1.5–10]).

Conclusion

These findings advocate for the routine use of TTP over DTP as a diagnostic tool to guide timely interventions such as catheter removal, thereby potentially improving patient outcomes in PAE-BSI. Moreover, lower TTP have also prognostic implications in both catheter-related and non-catheter-related infections.