Bacteraemia in emergency departments: effective antibiotic reassessment is associated with a better outcome

Aillet, C.; Jammes, Didier; Fribourg, A; Léotard, S.; Pellat, Olivier; Étienne, P.; Néri, Dominique; Lamèche, D.; Pantaloni, Olivier; Tournoud, Serge; Roger, Pierre‐Marie

doi:10.1007/s10096-017-3136-z

Cited by 18 publications

(6 citation statements)

References 29 publications

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“…In a study by Aillet et al, published in 2018, with an in-hospital mortality rate of 14% for bacteraemia, only the presence of an underlying cancer was associated with fatality. The presence of a cardiovascular, pulmonary, or neurological comorbidity, a diabetic or hepatic condition, or chronic kidney failure was not associated with mortality (Aillet et al, 2018). In the present study, the presence of major comorbidity was the sole parameter significantly associated with mortality in the multivariate analysis (OR 2.78, 95% CI 1.01-7.70; p = 0.04).…”

Section: Discussioncontrasting

confidence: 47%

Pasteurella bacteraemia: Impact of comorbidities on outcome, based on a case series and literature review

Chatelier

Mahieu

Hamel

et al. 2020

International Journal of Infectious Diseases

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Pasteurella bacteraemia is rare, but has been associated with a high mortality rate. The aim of this study was to estimate the impact of comorbidities on patients with Pasteurella bacteraemia. Methods: All cases of Pasteurella bacteraemia in adults treated in our centre between January 2008 and December 2017 were included retrospectively and compared with cases identified in a systematic review of the literature via MEDLINE covering the years 1951-2017. The epidemiological, bacteriological, and clinical data were collected, as well as the instances of death after 30 days. Results: Twenty cases of Pasteurella bacteraemia identified in our centre and 99 cases from the literature review were included. A major comorbidity was found in 80/119 (67.2%) patients. The death rate at 30 days was 31.1%. The most common comorbidities were cirrhosis, immunosuppressive therapy, and malignant diseases. Age was not associated with mortality. On multivariate analysis, the only factor associated with mortality was a major comorbidity (odds ratio 2.78, 95% confidence interval 1.01-7.70; p = 0.04). Conclusions: This study confirms the high mortality rate and highlights the importance of the host background, independent of age, in Pasteurella bacteraemia. Clinicians should be aware of the comorbidities in cases of Pasteurella infection, due to the poor prognosis of bacteraemia.

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Section: Discussioncontrasting

confidence: 47%

Pasteurella bacteraemia: Impact of comorbidities on outcome, based on a case series and literature review

Chatelier

Mahieu

Hamel

et al. 2020

International Journal of Infectious Diseases

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“…Empirical antibiotic regimens were usually modified during admission (61.5%) and oral antibiotics were prescribed for 84.5% of patients. Other studies looking at the process of antibiotic prescribing in hospitals have focused on review of empirical therapy in relation to patient outcome or effect of interventions on prescribing process measures [23][24][25]. Braykov et al found that by the 5th day of therapy, 21,5% of empirical antibiotics were narrowed or discontinued, while Aillet et al found that antibiotic review was performed in 69% of patients with bacteraemia [16,24].…”

Section: Discussionmentioning

confidence: 99%

“…Other studies looking at the process of antibiotic prescribing in hospitals have focused on review of empirical therapy in relation to patient outcome or effect of interventions on prescribing process measures [ 23 – 25 ]. Braykov et al found that by the 5th day of therapy, 21,5% of empirical antibiotics were narrowed or discontinued, while Aillet et al found that antibiotic review was performed in 69% of patients with bacteraemia [ 16 , 24 ]. In comparison, although we did not measure all patients at one specific day, 74,5% of empirical antibiotics were de-escalated (56,4%) and stopped (18,1%) as first modification of therapy in our study.…”

Section: Discussionmentioning

confidence: 99%

Identifying targets for antibiotic stewardship interventions through analysis of the antibiotic prescribing process in hospitals - a multicentre observational cohort study

Wathne

Skodvin

Charani

et al. 2020

Antimicrob Resist Infect Control

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Background: In order to change antibiotic prescribing behaviour, we need to understand the prescribing process. The aim of this study was to identify targets for antibiotic stewardship interventions in hospitals through analysis of the antibiotic prescribing process from admission to discharge across five groups of infectious diseases. Methods: We conducted a multi-centre, observational cohort study, including patients with lower respiratory tract infections, exacerbation of chronic obstructive pulmonary disease, skin-and soft tissue infections, urinary tract infections or sepsis, admitted to wards of infectious diseases, pulmonary medicine and gastroenterology at three teaching hospitals in Western Norway. Data was collected over a 5-month period and included antibiotics prescribed and administered during admission, antibiotics prescribed at discharge, length of antibiotic therapy, indication for treatment and discharge diagnoses, estimated glomerular filtration rate (eGFR) on admission, antibiotic allergies, place of initiation of therapy, admittance from an institution, patient demographics and outcome data. Primary outcome measure was antibiotic use throughout the hospital stay, analysed by WHO AWaRe-categories and adherence to guideline. Secondary outcome measures were a) antibiotic prescribing patterns by groups of diagnoses, which were analysed using descriptive statistics and b) non-adherence to the national antibiotic guidelines, analysed using multivariate logistic regression.

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“…We observed a statistical trend toward shorter time to antibiotic de-escalation in the early ID group compared with standard care group and shorter duration of antibiotic therapy in patients with early ID consult compared to later ID consult in the subsample where an antibiotic duration recommendation was made, but neither reached statistical significance (possibly due to small sample size). Antibiotic reassessment, which is tailored to microbiological data, is protective against mortality in patients with bacteremia in the ED [37] and appropriate antibiotic de-escalation has been associated with improved mortality in SS/SS [38]. The mechanism by which de-escalation reduces mortality has not been proven, but reduction in toxicity and adverse drug events has been suggested [38].…”

Section: Discussionmentioning

confidence: 99%

Early Infectious Disease Consultation Is Associated With Lower Mortality in Patients With Severe Sepsis or Septic Shock Who Complete the 3-Hour Sepsis Treatment Bundle

Madaline

Montagne

Eisenberg

et al. 2019

Open Forum Infectious Diseases

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Objective Severe sepsis and septic shock (SS/SS) treatment bundles reduce mortality, and early infectious diseases (ID) consultation also improves patient outcomes. We retrospectively examined whether early ID consultation further improves outcomes in Emergency Department (ED) patients with SS/SS who complete the sepsis bundle. Method We included 248 adult ED patients with SS/SS who completed the 3-hour bundle. Patients with ID consultation within 12 hours of ED triage (n = 111; early ID) were compared with patients who received standard care (n = 137) for in-hospital mortality, 30-day readmission, length of hospital stay (LOS), and antibiotic management. A competing risk survival analysis model compared risks of in-hospital mortality and discharge alive between groups. Results In-hospital mortality was lower in the early ID group unadjusted (24.3% vs 38.0%, P = .02) and adjusted for covariates (odds ratio, 0.47; 95% confidence interval (CI), 0.25–0.89; P = .02). There was no significant difference in 30-day readmission (22.6% vs 23.5%, P = .89) or median LOS (10.2 vs 12.1 days, P = .15) among patients who survived. A trend toward shorter time to antibiotic de-escalation in the early ID group (log-rank test P = .07) was observed. Early ID consultation was protective of in-hospital mortality (adjusted subdistribution hazard ratio (asHR), 0.60; 95% CI 0.36–1.00, P = .0497) and predictive of discharge alive (asHR 1.58, 95% CI, 1.11–2.23; P-value .01) after adjustment. Conclusions Among patients receiving the SS/SS bundle, early ID consultation was associated with a 40% risk reduction for in-hospital mortality. The impact of team-based care and de-escalation on SS/SS outcomes warrants further study.

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Bacteraemia in emergency departments: effective antibiotic reassessment is associated with a better outcome

Cited by 18 publications

References 29 publications

Pasteurella bacteraemia: Impact of comorbidities on outcome, based on a case series and literature review

Pasteurella bacteraemia: Impact of comorbidities on outcome, based on a case series and literature review

Identifying targets for antibiotic stewardship interventions through analysis of the antibiotic prescribing process in hospitals - a multicentre observational cohort study

Early Infectious Disease Consultation Is Associated With Lower Mortality in Patients With Severe Sepsis or Septic Shock Who Complete the 3-Hour Sepsis Treatment Bundle

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