Persistence of positive Brucella Melitensis blood cultures is not associated with focal infection
Objectives: Brucellosis is a global zoonotic disease complicated by focal infections requiring treatment modifications. In other bacterial infections, persistent positive blood cultures prompt evaluation for metastatic foci. We aimed to assess whether persistent bacteremia predicts focal infections...
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| Language: | English |
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Elsevier
2025-09-01
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| Series: | International Journal of Infectious Diseases |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S1201971225001651 |
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| author | Meir Cherniak Matan J Cohen Yonatan Oster Daniel Grupel |
| author_facet | Meir Cherniak Matan J Cohen Yonatan Oster Daniel Grupel |
| author_sort | Meir Cherniak |
| collection | DOAJ |
| description | Objectives: Brucellosis is a global zoonotic disease complicated by focal infections requiring treatment modifications. In other bacterial infections, persistent positive blood cultures prompt evaluation for metastatic foci. We aimed to assess whether persistent bacteremia predicts focal infections in patients with Brucella melitensis infection. Methods: We conducted a retrospective cohort study from 2010 to 2022. We included adults hospitalized due to Brucella melitensis bacteremia. Patients were categorized into persistently positive (PFUBC), negative (NFUBC), or no follow-up cultures. The primary outcome was focal infection (FI). Results: Of 108 patients included, 74.8% exhibited persistent bacteremia (PFUBC). FI occurred in 27.8% of cases. Persistent bacteremia was not associated with FI occurrence. Localizing symptoms at presentation strongly predicted FI (OR: 9.4; 95% CI, 3.24-27.4). Among FI-negative patients, PFUBC status was associated with a significant increase in imaging studies (mean 1.8 vs 0.9; P = 0.003) and physician encounters (17.4 vs 11.9; P = 0.012), but did not improve clinical outcomes. Conclusion: Persistently positive blood cultures in B. melitensis bacteremia do not predict focal infections or adverse clinical outcomes but significantly increase healthcare resource utilization without clinical benefit. Clinical symptoms should guide diagnostic evaluations rather than repeated blood cultures. |
| format | Article |
| id | doaj-art-5c1aa838fee548bea6b0c1ecdfbff7fa |
| institution | Kabale University |
| issn | 1201-9712 |
| language | English |
| publishDate | 2025-09-01 |
| publisher | Elsevier |
| record_format | Article |
| series | International Journal of Infectious Diseases |
| spelling | doaj-art-5c1aa838fee548bea6b0c1ecdfbff7fa2025-08-20T03:42:52ZengElsevierInternational Journal of Infectious Diseases1201-97122025-09-0115810794110.1016/j.ijid.2025.107941Persistence of positive Brucella Melitensis blood cultures is not associated with focal infectionMeir Cherniak0Matan J Cohen1Yonatan Oster2Daniel Grupel3Clinical Microbiology and Infectious Diseases Department, Hadassah Medical Center, Faculty of Medicine, Hebrew University of JerusalemClalit Health Services Jerusalem district, Faculty of Medicine, Hebrew University of JerusalemClinical Microbiology and Infectious Diseases Department, Hadassah Medical Center, Faculty of Medicine, Hebrew University of JerusalemClinical Microbiology and Infectious Diseases Department, Hadassah Medical Center, Faculty of Medicine, Hebrew University of Jerusalem; Corresponding author: Daniel Grupel, Department of Clinical Microbiology and Infectious Diseases, Hadassah-Hebrew University Medical Center, Kalman Mann St, Jerusalem, Israel.Objectives: Brucellosis is a global zoonotic disease complicated by focal infections requiring treatment modifications. In other bacterial infections, persistent positive blood cultures prompt evaluation for metastatic foci. We aimed to assess whether persistent bacteremia predicts focal infections in patients with Brucella melitensis infection. Methods: We conducted a retrospective cohort study from 2010 to 2022. We included adults hospitalized due to Brucella melitensis bacteremia. Patients were categorized into persistently positive (PFUBC), negative (NFUBC), or no follow-up cultures. The primary outcome was focal infection (FI). Results: Of 108 patients included, 74.8% exhibited persistent bacteremia (PFUBC). FI occurred in 27.8% of cases. Persistent bacteremia was not associated with FI occurrence. Localizing symptoms at presentation strongly predicted FI (OR: 9.4; 95% CI, 3.24-27.4). Among FI-negative patients, PFUBC status was associated with a significant increase in imaging studies (mean 1.8 vs 0.9; P = 0.003) and physician encounters (17.4 vs 11.9; P = 0.012), but did not improve clinical outcomes. Conclusion: Persistently positive blood cultures in B. melitensis bacteremia do not predict focal infections or adverse clinical outcomes but significantly increase healthcare resource utilization without clinical benefit. Clinical symptoms should guide diagnostic evaluations rather than repeated blood cultures.http://www.sciencedirect.com/science/article/pii/S1201971225001651Brucellosispersistenceblood culturesfocal infectionsresource utilization |
| spellingShingle | Meir Cherniak Matan J Cohen Yonatan Oster Daniel Grupel Persistence of positive Brucella Melitensis blood cultures is not associated with focal infection International Journal of Infectious Diseases Brucellosis persistence blood cultures focal infections resource utilization |
| title | Persistence of positive Brucella Melitensis blood cultures is not associated with focal infection |
| title_full | Persistence of positive Brucella Melitensis blood cultures is not associated with focal infection |
| title_fullStr | Persistence of positive Brucella Melitensis blood cultures is not associated with focal infection |
| title_full_unstemmed | Persistence of positive Brucella Melitensis blood cultures is not associated with focal infection |
| title_short | Persistence of positive Brucella Melitensis blood cultures is not associated with focal infection |
| title_sort | persistence of positive brucella melitensis blood cultures is not associated with focal infection |
| topic | Brucellosis persistence blood cultures focal infections resource utilization |
| url | http://www.sciencedirect.com/science/article/pii/S1201971225001651 |
| work_keys_str_mv | AT meircherniak persistenceofpositivebrucellamelitensisbloodculturesisnotassociatedwithfocalinfection AT matanjcohen persistenceofpositivebrucellamelitensisbloodculturesisnotassociatedwithfocalinfection AT yonatanoster persistenceofpositivebrucellamelitensisbloodculturesisnotassociatedwithfocalinfection AT danielgrupel persistenceofpositivebrucellamelitensisbloodculturesisnotassociatedwithfocalinfection |