Take Blood culture before initiating treatment in suspected sepsis: Annals of Internal Medicine

Take Blood culture before initiating treatment in suspected sepsis emphasizes a study appearing in journal Annals of Internal Medicine.Blood cultures drawn after the administration of antimicrobials resulted in a loss of about 50 per cent of the available clinical information in patients with sepsis, according to a recent study.

The results are in agreement with the current clinical guidelines that recommend that blood cultures should be drawn before the treatment begins. This could potentially decrease time to treatment and improve outcomes.

The authors point out that international guidelines call for early (before-therapy) testing with suspected sepsis. "Our study has, for the first time ever, produced clear evidence supporting current sepsis guidelines and underscores the urgent need for proper sepsis protocols," said David Sweet, MD, senior study author, in a University of British Columbia news release. "Emergency rooms must place more emphasis on sepsis guidelines and make sure they have the resources to implement them."

This study is significant as severe bacterial infections are a leading cause of deaths worldwide. And, any delay in the treatment can increase the risk of a patient's death but treating the patient before a blood culture is drawn aids in the identification of the bacteria causing the infection and make it challenging to identify the best treatment choice.

Matthew Cheng, a clinical instructor in the Brigham's Division of Infectious Diseases, and colleagues conducted this study to determine the sensitivity of blood cultures obtained shortly after initiation of antimicrobial therapy in patients with severe manifestations of sepsis.

The researchers conducted a study known as FABLED (eFfect of Antimicrobial administration on BLood culture positivity in patients with severe manifestations of sepsis in the Emergency Department), a patient-level, single-group, diagnostic study. Between November 2013 and September 2018, the team enrolled adult patients who presented to the emergency department with severe manifestations of sepsis. Each patient had two blood cultures drawn before treatment initiation and repeat blood cultures drawn within two hours after starting treatment.

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Key findings include:

• Pre-treatment blood cultures were positive for one or more microbial pathogens in 102-of-325 (31.4 per cent) patients.


• After-treatment blood cultures were positive for one or more microbial pathogens in 63-of-325 (19.4 per cent) patients.


• The sensitivity of post-treatment cultures, or the percentage of samples accurately identified as having the same pathogens pre-treatment, was 52.9 percent.

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"These findings provide a basis for clinical guidelines for the care of patients with sepsis," write the authors.

"These findings are important in considering the optimal balance between prompt antimicrobial administration and the need for accurate microbiological data in the care of patients with sepsis," said Dr. Cheng. "Given the global burden of sepsis, deepening our understanding of how best to treat this condition is critically important."

Patients with sepsis are generally treated initially with a broad-spectrum antibiotic, but Cheng and colleagues note the importance of identifying the right narrow-spectrum antibiotic based on a patient's blood culture. Without an accurate picture of the microbial landscape prior to initiating treatment, it may be extremely challenging for physicians to select the right antibiotic.

"When it comes to treating sepsis safely and effectively, microbiological diagnosis is key," said Cheng. "Despite the importance of starting treatment early for sepsis patients, our results support the Surviving Sepsis Campaign guidelines and suggest that blood cultures should not be routinely deferred."

"Among patients with severe manifestations of sepsis, initiation of empirical antimicrobial therapy significantly reduces the sensitivity of blood cultures drawn shortly after treatment initiation," concluded the authors.

To read the complete study log on to DOI: 10.7326/M19-1696