The Role of Routine Surveillance Cultures in Optimising Sepsis Management in High-Risk Patient Groups

Area of Science:

• Clinical Microbiology
• Infectious Diseases
• Antimicrobial Stewardship

Background:

• Sepsis, especially from multidrug-resistant organisms (MDROs), is a major cause of illness and death.
• Early pathogen identification via surveillance cultures can guide antimicrobial therapy.
• This study evaluated surveillance cultures in haemato-oncology (HO) and acute care (AC) settings.

Purpose of the Study:

• To assess the prevalence of MDROs and resistance phenotypes in surveillance cultures.
• To determine the concordance between surveillance cultures and subsequent bloodstream infection (BSI) episodes.
• To compare the utility of surveillance cultures across different clinical settings (HO vs. AC) and specimen types.

Main Methods:

• Retrospective analysis of surveillance and blood culture data from January 1 to December 31, 2024.
• Inclusion of ESCAPE pathogens (excluding Clostridioides difficile) from positive blood cultures.
• Evaluation of pathogen prevalence, resistance, and specimen type concordance.

Main Results:

• MDRO prevalence was 5% in AC and 6.56% in HO settings.
• ESBL-producing Enterobacterales were the predominant MDROs in both settings.
• Rectal swabs showed high concordance (100%) for E. coli and K. pneumoniae BSIs in HO, while respiratory samples were more concordant in AC.

Conclusions:

• The effectiveness of surveillance cultures depends on the specimen type and clinical setting.
• Surveillance cultures offer valuable data on colonization and resistance, aiding early risk assessment.
• These cultures support timely and targeted antimicrobial therapy for high-risk patients.