• Matthew P Cheng, Robert Stenstrom, Katryn Paquette, Sarah N Stabler, Murtaza Akhter, Adam C Davidson, Marko Gavric, Alexander Lawandi, Rehman Jinah, Zahid Saeed, Koray Demir, Kelly Huang, Amirali Mahpour, Chris Shamatutu, Chelsea Caya, Jean-Marc Troquet, Greg Clark, Cedric P Yansouni, David Sweet, and FABLED Investigators.
• Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts (M.P.C.).
• Ann. Intern. Med. 2019 Oct 15; 171 (8): 547-554.

BackgroundAdministering antimicrobial agents before obtaining blood cultures could potentially decrease time to treatment and improve outcomes, but it is unclear how this strategy affects diagnostic sensitivity.ObjectiveTo determine the sensitivity of blood cultures obtained shortly after initiation of antimicrobial therapy in patients with severe manifestations of sepsis.DesignPatient-level, single-group, diagnostic study. (ClinicalTrials.gov: NCT01867905).Setting7 emergency departments in North America.ParticipantsAdults with severe manifestations of sepsis, including systolic blood pressure less than 90 mm Hg or a serum lactate level of 4 mmol/L or more.InterventionBlood cultures were obtained before and within 120 minutes after initiation of antimicrobial treatment.MeasurementsSensitivity of blood cultures obtained after initiation of antimicrobial therapy.ResultsOf 3164 participants screened, 325 were included in the study (mean age, 65.6 years; 62.8% men) and had repeated blood cultures drawn after initiation of antimicrobial therapy (median time, 70 minutes [interquartile range, 50 to 110 minutes]). Preantimicrobial blood cultures were positive for 1 or more microbial pathogens in 102 of 325 (31.4%) patients. Postantimicrobial blood cultures were positive for 1 or more microbial pathogens in 63 of 325 (19.4%) patients. The absolute difference in the proportion of positive blood cultures between pre- and postantimicrobial testing was 12.0% (95% CI, 5.4% to 18.6%; P < 0.001). Sensitivity of postantimicrobial culture was 52.9% (CI, 42.8% to 62.9%). When the results of other microbiological cultures were included, microbial pathogens were found in 69 of 102 (67.6% [CI, 57.7% to 76.6%]) patients.LimitationOnly a proportion of screened patients were recruited.ConclusionAmong patients with severe manifestations of sepsis, initiation of empirical antimicrobial therapy significantly reduces the sensitivity of blood cultures drawn shortly after treatment initiation.Primary Funding SourceVancouver Coastal Health, St. Paul's Hospital Foundation Emergency Department Support Fund, the Fonds de recherche Santé-Québec, and the Maricopa Medical Foundation.

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