R.E.B.E.L.EM - March 2, 2020 - By Salim Rezaie
"Background: The cornerstones of sepsis management include early identification, early antimicrobial administration, and source control. The Surviving Sepsis Campaign guidelines recommend that blood cultures be drawn before starting antimicrobial therapy, however, obtaining cultures prior to antibiotics may be challenging due to shorter time windows (i.e. 1hr from identification) to initiate antibiotics. Some may prioritize administering antimicrobial agents before obtaining blood cultures to ensure they meet this core measure. This study (The FABLED Trial) tried to determine the sensitivity of blood cultures obtained both before and after initiation of antimicrobial therapy in patients with severe manifestations of sepsis.
Author Conclusion: “Among patients with severe manifestations of sepsis, initiation of empirical antimicrobial therapy significantly reduces the sensitivity of blood cultures drawn shortly after treatment initiation.”
Clinical Take Home Point: In a relatively sick septic patient population, drawing blood cultures after administration of antibiotic treatment reduces culture sensitivity which could affect downstream optimization of treatment as well as safe de-escalation of treatment."