Sepsis: Should Antimicrobials Come Before Blood Cultures?
The results of a recent study support the guideline-recommended practice of obtaining blood cultures before administering antibiotics in patients with sepsis.1
“The cornerstone of sepsis management is early administration of an antimicrobial, which kills or inhibits the growth of microorganisms such as bacteria or fungi. However, guidelines recommend two blood cultures be drawn before starting antimicrobial therapy, resulting in significant delays and decreasing the chance of survival,” according to an accompanying press release.2
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In order to determine whether initiation of antimicrobial therapy affects the sensitivity of blood cultures taken in patients with sepsis, the researchers conducted a patient-level, single-group, diagnostic study involving patients from 7 emergency departments in North America. The 325 included patients all had severe manifestations of sepsis, including systolic blood pressure less than 90 mm Hg or a serum lactate level of 4 mmol/L or more.
Blood cultures were obtained from the patients both before and within 120 minutes following the initiation of antimicrobial therapy. Overall, blood cultures taken before initiation of therapy were positive for one or more pathogens in 31.4% (n =102) patients, while blood cultures taken following antimicrobial therapy were positive for 1 or more pathogens in 19.4% (n = 63) of patients.
“The study revealed that initiating antibiotics immediately reduces the sensitivity of blood cultures drawn shortly after treatment. That, in turn, reduces the chances of treating and tailoring antibiotics to specific bacterial and fungal sepsis infections.”2
—Michael Potts
References:
Cheng MP, Stenstrom R, Paquette K, et al. Blood culture results before and after antimicrobial administration in patients with severe manifestations of sepsis: a diagnostic study [published online September 17, 2019]. Ann Intern Med. DOI: 10.7326/M19-1696.
Study changes guidelines for sepsis management [press release]. Phoenix, Arizona. September 17, 2019. https://uahs.arizona.edu/news/study-changes-guidelines-sepsis-management.