Prehospital delay is an important risk factor for mortality in community-acquired bloodstream infection (CA-BSI): a matched case–control study

Abstract

ObjectivesThe aim of this study was to identify prehospital and early hospital risk factors associated with 30-day mortality in patients with blood culture-confirmed community-acquired bloodstream infection (CA-BSI) in Sweden.MethodsA retrospective case–control study of 1624 patients with CA-BSI (2015–2016), 195 non-survivors satisfying the inclusion criteria were matched 1:1 with 195 survivors for age, gender and microorganism. All forms of contact with a healthcare provider for symptoms of infection within 7 days prior CA-BSI episode were registered. Logistic regression was used to analyse risk factors for 30-day all-cause mortality.ResultsOf the 390 patients, 61% (115 non-survivors and 121 survivors) sought prehospital contact. The median time from first prehospital contact till hospital admission was 13 hours (6–52) for non-survivors and 7 hours (3–24) for survivors (p<0.01). Several risk factors for 30-day all-cause mortality were identified: prehospital delay OR=1.26 (95% CI: 1.07 to 1.47), p<0.01; severity of illness (Sequential Organ Failure Assessment score) OR=1.60 (95% CI: 1.40 to 1.83), p<0.01; comorbidity score (updated Charlson Index) OR=1.13 (95% CI: 1.05 to 1.22), p<0.01 and inadequate empirical antimicrobial therapy OR=3.92 (95% CI: 1.64 to 9.33), p<0.01. In a multivariable model, prehospital delay >24 hours from first contact remained an important risk factor for 30-day all-cause mortality due to CA-BSI OR=6.17 (95% CI: 2.19 to 17.38), p<0.01.ConclusionPrehospital delay and inappropriate empirical antibiotic therapy were found to be important risk factors for 30-day all-cause mortality associated with CA-BSI. Increased awareness and earlier detection of BSI in prehospital and early hospital care is critical for rapid initiation of adequate management and antibiotic treatment.

Development and validation of an emergency bloodstream infection score for predicting in-hospital mortality in patients with community-acquired bloodstream infections

“…Onset time was defined as the duration between symptom onset and hospital visit. Holmbom et al [23] suggested that delayed admission was an independent risk factor for 30-day all-cause mortality in patients with CABSIs. We found that the risk of in-hospital mortality increased with the prolonged onset time for more than 1 d, and patients who did not visit the hospital for more than 10 d had a 3.9-fold higher risk of death than those who visited for less than 1 d. Those admitted within 5 to 10 d had a lower mortality rate than those admitted within 1 to 5 d, possibly due to prior treatment with empirical antibiotics in other hospitals for identified CABSIs.…”

Use of healthcare before and after sepsis in Sweden: a case–control study

“…In a Swedish study on patients with community-acquired bloodstream infection 61% of patients had sought prehospital contact. 8 Among these patients, a delay in time to hospitalisation was associated with an increased 30-day mortality. A recent systematic review found on average 33% of patients with sepsis had a healthcare encounter the week prior to sepsis, but the range between studies was big, and the definition of healthcare the week prior varied.…”

Risk Factors for 30-Day Mortality of Community-Acquired Bloodstream Infection Patients in Changsha City, Hunan Province, China

“… 8 Furthermore, geriatrics are more prone to BSI owing to compromised immune systems, where irrational use of empirical antibiotics and delayed treatment interventions deteriorate the poor prognosis of BSI. 9 In contrast, rational use of antibiotics can improve the prognosis and significantly reduce morbidity and mortality rates in BSI patients. 10–14 However, most of the published literature on BSI has been limited to the distribution of pathogenic bacteria in BSI, while studies focusing on the influencing factors on patient prognosis are rare.…”