Single Daily versus Multiple-Daily Sputum Cultures for Guiding Antibiotic Therapy in ICU Patients with Pulmonary
Ji-Yun Wang1,2, Zhi Liu1, Qian-Cheng Xia1
1The First Department of Critical Care Medicine, The Second Affiliated Hospital of Anhui Medical University, Hefei, Anhui Province, People's Republic of China.
Background:
Effective antibiotic management is crucial for ICU patients with pulmonary infections. However, guidelines are unclear whether the optimal strategy is multiple cultures on the infection onset day or a single daily culture to guide antibiotic therapy.
Methods:
This study involved 362 ICU patients with confirmed pulmonary infections, categorized into a "multiple-daily" group (≥2 cultures within 24 hours) and a "once-daily" group (1 culture per 24 hours). Propensity score matching was used to balance baseline characteristics. Primary outcome was antibiotic adjustment rate. Secondary outcomes included mechanical ventilation duration, ICU and total hospital length of stay, hospitalization costs, and mortality.
Results:
The multiple-daily group had more frequent antibiotic adjustments both before and after matching (76.88% vs 67.33%, p = 0.048 pre-matching; p = 0.076 post-matching). The once-daily group experienced significantly shorter durations of mechanical ventilation (pre: 119.50 vs 159.50 hours; post: 116.00 vs 156.00 hours; both p < 0.001), ICU stay (pre: 10.00 vs 13.00 days; post: 9.00 vs 13.00 days; both p < 0.001), and lower hospitalization costs (pre: 138,150 vs 167,910 CNY, p = 0.011; post: 136,870 vs 167,780 CNY, p = 0.004). The hospital stay was also shorter in the once-daily group, with similar mortality rates between groups. Common multidrug-resistant pathogens included CRAB (32.52%), MRSA (24.39%), ESBL (18.70%), CRPA (15.45%), and CRE (12.00%). The multiple-daily group had higher detection rates of CRAB (38.46% vs 25.86%, p=0.050) and MRSA (30.77% vs 17.24%, p=0.048), with more frequent antibiotic adjustments, especially in multidrug-resistant cases (87.69% vs 70.69%, p=0.019).
Conclusion:
In ICU patients with pulmonary infections, multiple-daily sputum cultures lead to more frequent antibiotic adjustments and better detection of multidrug-resistant pathogens. However, a once-daily culture strategy is associated with reduced healthcare resource utilization and comparable mortality. Further randomized trials are needed to determine the optimal sputum culture frequency in the ICU setting.
Trial Registration:
This study was registered with the Chinese Clinical Trial Registry under the registration number ChiCTR2400091085.
Insights
For ICU patients with pulmonary infections, multiple daily sputum cultures increase antibiotic adjustments and pathogen detection. However, a once-daily strategy reduces healthcare costs and resource use with similar mortality outcomes.
Area of Science:
- Critical Care Medicine
- Infectious Diseases
- Clinical Microbiology
Background:
- Effective antibiotic management is vital for intensive care unit (ICU) patients with pulmonary infections.
- Current guidelines lack clarity on optimal sputum culture frequency for guiding antibiotic therapy.
Purpose of the Study:
- To compare the clinical outcomes and healthcare resource utilization between multiple-daily and once-daily sputum culture strategies in ICU patients with pulmonary infections.
- To evaluate the impact of different sputum culture frequencies on antibiotic adjustment rates and pathogen detection.
Main Methods:
- A study involving 362 ICU patients with confirmed pulmonary infections.
- Patients were divided into "multiple-daily" (≥2 cultures/24h) and "once-daily" (1 culture/24h) groups.
- Propensity score matching was employed to balance baseline characteristics and compare outcomes.
Main Results:
- The multiple-daily group showed more frequent antibiotic adjustments, particularly for multidrug-resistant pathogens (MDROs).
- The once-daily group had significantly shorter mechanical ventilation duration, ICU length of stay, and lower hospitalization costs.
- Mortality rates were comparable between the groups, despite higher detection rates of carbapenem-resistant *Acinetobacter baumannii* (CRAB) and methicillin-resistant *Staphylococcus aureus* (MRSA) in the multiple-daily group.
Conclusions:
- Multiple-daily sputum cultures in ICU patients with pulmonary infections enhance antibiotic adjustments and MDRO detection.
- A once-daily strategy is associated with reduced healthcare resource utilization and similar mortality.
- Further randomized trials are necessary to establish the optimal sputum culture frequency in the ICU setting.
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