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Pulmonary Physiology |

Yield of Blood Cultures (BC), Incidence of Systemic Inflammatory Response Syndrome (SIRS), and Acute Kidney Injury (AKI) in Patients Admitted With Acute Exacerbation of Cystic Fibrosis (AECF)

Sindhura Gogineni; Ghassan Kamel; Nirav Patel; Gwen Pendleton; Aditya Uppalapati
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Saint Louis University, Saint Louis, MO


Chest. 2014;146(4_MeetingAbstracts):720A. doi:10.1378/chest.1993811
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Abstract

SESSION TITLE: Cystic Fibrosis/Bronchiectasis Posters

SESSION TYPE: Original Investigation Poster

PRESENTED ON: Wednesday, October 29, 2014 at 01:30 PM - 02:30 PM

PURPOSE: Patients admitted with AECF have blood cultures drawn routinely at admission. In pediatric patients there has been a high incidence of AKI with AECF. Patients with cystic fibrosis(CF) suffer from severe and chronic pulmonary infections and inflammation. SIRS criteria can identify inflammatory response. To study the yield of blood cultures, incidence of SIRS and AKI in adult CF patients admitted with acute exacerbation.

METHODS: This is a retrospective observational descriptive study of all patients age >=16 years admitted with AECF to a university hospital. Patient’s data was obtained from medical record review, January 2010 to February 2013. Patients with the diagnosis of AECF as per the admitting physician were included. SIRS was defined as per ACCP/SCCM consensus conference, and AKI was defined based on the KDIGO guidelines for serum creatinine. BCs that yielded organisms considered likely to be contaminants were excluded, unless isolated from multiple sites. Descriptive statistics were used to analyze the data.

RESULTS: 44 patients, 25 (57%) male and 19 (43%) female with a total of 85 admissions were analyzed. 18 (41%) patients had CF-related diabetes. The mean age of patients included in the study was 28 years of age. Blood cultures were done in 68 admissions and the yield was 5 (7.35%). 2 Cultures were positive for Candida, 2 for Methicillin resistant Staphylococcus aureus and 1 for Methicillin sensitive Staphylococcus aureus. All 5 of the patients had a peripherally inserted central venous catheter (PICC) line or a port at admission. 41 (48%) of the total admissions had either a port or PICC line at admission. Among 72 sputum cultures, 67 (93%) were positive for bacterial organisms. Mean blood glucose at the time of admission was 141 gm/dl. Mean length of stay of an admission was 5.7 days. SIRS criteria were met in 27 (32%) of admissions. 16 (19%) admissions had AKI during the admission or hospital stay. AKI stage 1 was noted in10 admissions, Stage 2 found in 3 admissions, and Stage 3 found in 3 admissions.

CONCLUSIONS: The yield of blood cultures is low in patients with AECF. AKI occurs in patients with AECF. SIRS criteria were only met in a small proportion of AECF patients.

CLINICAL IMPLICATIONS: Routine blood cultures might not be helpful in patients with AECF. Patients need to be closely monitored to prevent AKI.SIRS criteria alone may not be sensitive to identify inflammation in patients with AECF at admission.

DISCLOSURE: The following authors have nothing to disclose: Sindhura Gogineni, Ghassan Kamel, Nirav Patel, Gwen Pendleton, Aditya Uppalapati

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