Early ID involvement improves mortality in bloodstream infections
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Key takeaways:
- Delaying information, particularly with Enterobacteriaceae in bloodstream infections, is associated with increased mortality.
- Results were similar for 14-, 30- and 70-day mortality rates.
Delivering blood culture results to an infectious diseases specialist in real time improved mortality among patients with bloodstream infections compared with delivering the information the following morning, a study found.
“The study is the result of what we call a clinical audit, ie, an assessment of routine activities that we want to improve, but before we make changes, we want to document the evidence that the modification in clinical practice is worth pursuing as these changes usually involve additional costs,” Climent Casals-Pascual, MD, PhD, microbiologist at the University of Barcelona, told Healio.
“The need of a clinical microbiologist or an infectious diseases specialist 24/7 is highly debated in hospitals but not anymore in light of the findings we have published,” Casals-Pascual said.
To evaluate the clinical and prognostic impact of communicating patient microbiological information in real time, Casals-Pascual and colleagues retrospectively reviewed 6,225 cases of bacteremia between January 2013 and December 2019.
According to the study, bacteremia-associated mortality was compared when blood culture results were relayed to the infectious diseases specialist (IDS) in real time and periods when results were relayed the following morning. The researchers assessed the impact of information availability and used 30-day mortality as the main outcome and measure.
Overall, the study did not show an association between mortality and information delay to the IDS in initial analysis (OR = 1.18; 95% CI, 0.99-1.42). However, information delay of bloodstream infections caused by fast-growing microorganisms such as Enterobacterales was associated with a significant increase in 30-day mortality in univariate (OR = 1.76; 95% CI, 1.3-2.38) and multivariate analyses (OR = 2.22; 95% CI, 1.5-3.3).
Additionally, the study demonstrated similar results for mortality at 14 days (OR = 1.54; 95% CI, 1.08-2.2) and 7 days (OR = 1.56; 95% CI, 1.03-2.37) in the univariate analysis and 14 days (OR = 2.05; 95% CI, 1.27-3.32) and 7 days (OR = 1.92; 95% CI, 1.09-3.4) in the multivariate analysis.
Casals-Pascual said the results from the study are “important and far reaching.”
“On the one hand, we report mortalities in a hospital with a high IDS/microbiologist coverage, which begs the following question: What is the preventable mortality in all those hospitals where no microbiologist or IDS [is] available for an entire weekend,” Casals-Pascual said. “On the other hand, European hospitals have been lobbying for some time to get personnel 24/7 — either IDSs, clinical microbiologists, or both. In our view, this is a strong piece of actionable evidence that may support these claims.”
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