Management and outcome of bloodstream infections: a prospective survey in 121 French hospitals (SPA-BACT survey)

Abstract

BackgroundBloodstream infections (BSIs) are severe infections that can be community or hospital acquired. Effects of time to appropriate treatment and impact of antimicrobial management team are discussed in terms of outcome of BSI. We sought to evaluate the impact of initial BSI management on short-term mortality.Patients and methodsA prospective, multicenter survey was conducted in 121 French hospitals. Participants declaring BSI during a 1-month period were included consecutively. Data on patient comorbidities, illness severity, BSI management, and resistance profile of bacterial strains were collected. Predictors of 10-day mortality were identified by multivariate regression for overall BSI, health care-related and hospital-acquired BSI.ResultsWe included 1,952 BSIs. More than a third of them were hospital acquired (39%). Multidrug resistance was identified in 10% of cases, mainly in health care-related BSI. Empirical therapy and targeted therapy were appropriate for 61% and 94% of cases, respectively. Increased 10-day mortality was associated with severe sepsis, septic shock, increasing age, and any focus other than the urinary tract. Decreased mortality was associated with receiving at least one active antibiotic within the first 48 hours. Intervention of antimicrobial management team during the acute phase of BSI was associated with a decreased mortality at day 10 in the overall population and in health care-related BSI.ConclusionOptimizing BSI management by increasing rapidity of appropriate treatment initiation may decrease short-term mortality, even in countries with low rate of multidrug-resistant organisms. Early intervention of antimicrobial management team is crucial in terms of mortality.

Evaluation of Microbiological Performance and the Potential Clinical Impact of the ePlex® Blood Culture Identification Panels for the Rapid Diagnosis of Bacteremia and Fungemia

“…Over 1,700,000 episodes of bloodstream infections (BSI) are diagnosed each year in Europe and North America. They account for more than 230,000 deaths per year with mortality rates between 10 to 40%, largely impacted by the increased burden of bacterial resistance (Goto and Al-Hasan, 2013;Huang et al, 2013;Patel et al, 2017;Martin et al, 2018;Robineau et al, 2018). Early administration of an effective antimicrobial therapy is one of the main factors for survival in cases of sepsis and septic shock (Kumar et al, 2006;Seymour et al, 2017).…”

“…Early administration of an effective antimicrobial therapy is one of the main factors for survival in cases of sepsis and septic shock (Kumar et al, 2006;Seymour et al, 2017). However, empiric antibiotic therapy remains inappropriate in 20-40% of the patients mainly because there is wide diversity of pathogens and increased prevalence of resistance mechanisms while additionally only one quarter of patients with invasive fungal infections are receiving an adequate and early treatment (Eggimann et al, 2015;Robineau et al, 2018;Ioannidis et al, 2020;Seok et al, 2020).…”

Comparison of novel approaches for expedited pathogen identification and antimicrobial susceptibility testing against routine blood culture diagnostics

“…For instance, Robineau and colleagues demonstrated that in 1952, BSI episodes evaluated only 61% of the patients received an adequate antibiotic therapy (Robineau et al . 2018). Another study even reported that only 51·8% of the sepsis patients received an appropriate antibiotic when treated with an empirical antibiotic regime (Herzke et al .…”

“…Nonetheless, it has been demonstrated that empirical antibiotic therapy in BSI is occasionally inappropriate. For instance, Robineau and colleagues demonstrated that in 1,952 BSI episodes evaluated only 61% of the patients received an adequate antibiotic therapy (Robineau et al 2018).…”

Antimicrobial resistance profiles of bacterial pathogens isolated from the bloodstream in patients of a hospital institution in Montería — Córdoba

“…Various epidemiological studies of bloodstream infections (ITOS) have been carried out in Europe and the United States of America (USA), with patients registered in national databases; It is estimated that in Europe there are 1,213,460 to 1,381,590 episodes with 157,000 deaths per year and in the United States of America 575,462 and 677,389 with 79,000 to 94,000 deaths per year (7,8) . In the countries like South Africa and Ethiopia, the rate of Sepsis mortality is almost 53%, which is considered a major health problem in developing countries (9) .…”