Single Daily versus Multiple-Daily Sputum Cultures for Guiding Antibiotic Therapy in ICU Patients with Pulmonary Infections: A Retrospective Cohort Study

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.

• Publication year

  2026

• Venue

  Infection and Drug Resistance

• Publication date

  2026-01-01

• Fields of study

  Not labeled

• Identifiers
  DOI 10.2147/idr.s567559
• External record

  Open on Semantic Scholar

• Source metadata

  Semantic Scholar

• No claims are published for this paper.

• No concepts are published for this paper.

• The agreement between bronchoalveolar lavage, bronchial wash and sputum culture: a retrospective study

  2024cited by this paper
• Metagenomics next-generation sequencing provides insights into the causative pathogens from critically ill patients with pneumonia and improves treatment strategies

  2023cited by this paper
• Evaluation of a novel ELISA test using synthetic mycolic acid antigens for serodiagnosis of non-tuberculous mycobacterial (NTM) infections

  2023cited by this paper
• Diagnostic Value of Metagenomic Next-Generation Sequencing for Pulmonary Infection in Intensive Care Unit and Non-Intensive Care Unit Patients

  2022cited by this paper
• Correlation between Sputum Bacterial Culture Positive Rate and Drug Sensitivity Test Results and Disease Severity inInpatients and Its Clinical Significance: A SystematicReview and Meta-Analysis

  2022cited by this paper
• Knowledge and Practice of Antibiotic Management and Prudent Prescribing among Polish Medical Doctors

  2022cited by this paper
• Combination of anti-glycopeptidolipid-core IgA antibody and clinical features for diagnosing potential nontuberculous mycobacterium pulmonary disease in routine practice

  2022cited by this paper
• Clinical value of metagenomic next-generation sequencing by Illumina and Nanopore for the detection of pathogens in bronchoalveolar lavage fluid in suspected community-acquired pneumonia patients

  2022cited by this paper
• Ventilator-associated pneumonia in the era of COVID-19 pandemic: How common and what is the impact?

  2021cited by this paper
• CombiANT: Antibiotic interaction testing made easy

  2020cited by this paper
• Clinical characteristics and day-90 outcomes of 4244 critically ill adults with COVID-19: a prospective cohort study

  2020cited by this paper
• Mechanistic Insight Into the Antifungal Effects of a Fatty Acid Derivative Against Drug-Resistant Fungal Infections

  2020cited by this paper
• Detection and identification of bacterial pathogens directly from sputum samples by pyrosequencing

  2019cited by this paper
• The potential economic value of sputum culture use in patients with community-acquired pneumonia and healthcare-associated pneumonia.

  2019cited by this paper
• Epidemiology of bronchiectasis in the UK: Findings from the British lung foundation's 'Respiratory health of the nation' project.

  2019cited by this paper
• The Epidemiology of Sepsis in Chinese ICUs: A National Cross-Sectional Survey

  2019cited by this paper
• Low incidence of multidrug-resistant bacteria and nosocomial infection due to a preventive multimodal nosocomial infection control: a 10-year single centre prospective cohort study in neurocritical care

  2018cited by this paper
• Influenza virus and factors that are associated with ICU admission, pulmonary co-infections and ICU mortality

  2018cited by this paper
• Healthcare-associated Pneumonia

  2018cited by this paper
• HIV-Associated Mycobacterium tuberculosis Bloodstream Infection Is Underdiagnosed by Single Blood Culture

  2018cited by this paper
• Interventions to improve antibiotic prescribing practices for hospital inpatients.

  2017cited by this paper
• Technical aspects of mediastinal ultrasound for pediatric pulmonary tuberculosis

  2017cited by this paper
• Management of Adults With Hospital-acquired and Ventilator-associated Pneumonia: 2016 Clinical Practice Guidelines by the Infectious Diseases Society of America and the American Thoracic Society.

  2016cited by this paper
• Prescription of antibiotics in community-acquired pneumonia in children: are we following the recommendations?

  2016cited by this paper
• Appropriateness of expectorated sputum cultures in the hospital setting.

  2015cited by this paper
• Rothia Bacteremia: a 10-Year Experience at Mayo Clinic, Rochester, Minnesota

  2014cited by this paper
• Universal glove and gown use and acquisition of antibiotic-resistant bacteria in the ICU: a randomized trial.

  2013cited by this paper
• Hospital costs of nosocomial multi-drug resistant Pseudomonas aeruginosa acquisition

  2012cited by this paper
• Extracorporeal membrane oxygenation in adult acute respiratory distress syndrome.

  2011cited by this paper
• Immunosuppression in patients who die of sepsis and multiple organ failure.

  2011cited by this paper
• Propensity score techniques and the assessment of measured covariate balance to test causal associations in psychological research.

  2010cited by this paper
• Ventilator-associated tracheobronchitis: the impact of targeted antibiotic therapy on patient outcomes.

  2009cited by this paper
• An official ATS/IDSA statement: diagnosis, treatment, and prevention of nontuberculous mycobacterial diseases.

  2007cited by this paper
• Infectious Diseases Society of America/American Thoracic Society Consensus Guidelines on the Management of Community-Acquired Pneumonia in Adults

  2007cited by this paper

• No citing papers are available for this paper.