#VisualAbstract: Blood Culture Results Before and After Antimicrobial Administration in Patients With Severe Manifestations of Sepsis

1. In this prospective multicenter observational trial among adult patients with severe manifestations of sepsis, administration of antimicrobial treatment prior to collection of blood cultures resulted in significantly diminished sensitivity (52.9%).

2. Study findings demonstrated the importance of obtaining blood cultures prior to proceeding with antimicrobial therapy, strengthening the current recommendations of the Surviving Sepsis Campaign. 

Evidence level: 2 (Good)

Study Rundown: Sepsis is a life-threatening condition with short-term mortality rates approaching 20%. Prompt antimicrobial therapy is essential in combating severe symptoms, but accurate microbiological information is equally important in guiding subsequent treatment and deescalation. Current best-practice guidelines heavily emphasize the value of the latter, designating a therapy delay of 45 minutes to be acceptable in pursuit of accurate test results. However, at present, no studies have offered compelling evidence either in favor of or against this advice. In this single-group diagnostic trial of adult patients with severe manifestations of sepsis, sensitivity of blood cultures from all anatomical sites was found to significantly decrease following initiation of empirical antimicrobial therapy, offering strong evidence promoting adherence to existing guidelines propounded by the Surviving Sepsis Campaign. The main strength of the study lied in its repeated measure design which aided in minimizing the number of false-negative results, thereby bolstering the sample size and increasing power. Because of its broad inclusion criteria, these results can likely be generalized to larger, more diverse populations, but an important consideration is that ~20% of previously eligible patients were excluded from per protocol analysis due to delays in blood drawing and assessment, highlighting the difficulty of obtaining blood cultures in a timely manner.

Click to read the study in Annals of Internal Medicine

Click to read an accompanying editorial in Annals of Internal Medicine

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