Int J Infect Dis. 2020 Aug 7:S1201-9712(20)30639-1. doi: 10.1016/j.ijid.2020.08.013. Online ahead of print.
ABSTRACT
OBJECTIVES: Previously, cases of positive blood cultures were reported by a microbiological technologist (MT) to an attending physician (AP), and the AS team provided medical assistance by grasping the situation at the morning meeting the next day. Since April 2018, MTs have reported positive blood cultures to an infectious disease physician (IDP) who proposed management approach to the AP and provided weekend support. This study assessed the effectiveness of blood culture reports provided by IDPs to APs on outcomes of bacteremia, including cases of weekend onset.
METHODS: Patient characteristics and prognoses before (October 2017 to March 2018) and after intervention (April to September 2018) were compared.
RESULTS: The pre- and post-intervention groups were comprised of 134 and 161 patients, respectively. Patients were more likely to be older (over 65 years old) in the post-intervention group (P < 0.05).There were no significant differences in infection severity between two groups. The rate of de-escalation increased significantly from 38.1% to 57.8% (p = 0.001). The rates of 28-day and in-hospital mortality reduced following the intervention (21.3% vs. 8.2%, 32.8% vs. 10.6%: P = 0.004 and P < 0.001, respectively). In-hospital mortality for cases with weekend onset also reduced following the intervention (33.3% vs. 12.9%, P = 0.01). Sepsis was a poor prognostic factor (OR: 8.070, 95%CI: 3.320-19.600, P < 0.001) and intervention was a good prognostic factor (OR: 0.311, 95%CI: 0.142-0.680, P = 0.003) affecting 28-day mortality in multivariate analysis.
CONCLUSIONS: Changes to blood culture results reporting protocol can improve outcomes of bacteremia, including cases of weekend onset.
PMID:32777587 | DOI:10.1016/j.ijid.2020.08.013