Sepsis & Septic Shock

https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2815769

Reliability of Admission Procalcitonin Testing for Capturing Bacteremia Across the Sepsis Spectrum: Real-World Utilization and Performance Characteristics, 65 U.S. Hospitals, 2008–2017

Procalcitonin-on-admission testing for patients with suspected bloodstream infections (BSIs) is often conducted, but its performance remains disputed. 📊 This research paper represents the largest study to date on the use of procalcitonin for identifying patients with bloodstream infections (BSI) in U.S. hospitals. Here are the key points:

• 🩺The study was a retrospective cohort study utilizing the Cerner HealthFacts Database from 2008 to 2017, and included all adult inpatients (≥ 18 years) who had blood cultures and procalcitonin tests within 24 hours of admission.

• ⚕️The study assessed the testing frequency of procalcitonin, sensitivity for detecting BSIs caused by different pathogens, and the discriminatory ability of procalcitonin-on-admission for BSI in patients with or without fever/hypothermia, ICU admission, and sepsis.

Contamination of Blood Cultures from Arterial Catheters and Peripheral Venipuncture in Critically Ill Patients

Blood cultures are crucial for detecting life-threatening bacteremia in critically ill patients. Contaminated blood cultures can lead to inappropriate antibiotic use, longer hospital stays, increased costs, and antimicrobial resistance risks. Strategies to reduce contamination include separate venipuncture sites or well-trained phlebotomy teams. In critically ill patients, using indwelling arterial catheters for blood culture collection is attractive due to reliable sampling and reduced invasiveness. Nakayama et al. conducted a multicenter trial comparing blood culture contamination rates between arterial catheters and peripheral venipuncture (0.3 vs 0.7%). The study found that obtaining cultures from arterial catheters is an acceptable alternative to venipuncture in critically ill adults with suspected bloodstream infections. More research is needed to consider other settings and patient groups.

Perspective:

The study by Nakayama et al. provides valuable insights into the use of arterial catheters as an…