Impact of a Multistep Bundles Intervention in the Management and Outcome of Gram-Negative Bloodstream Infections: A Single-Center "Proof-of-Concept" Study.
Open Forum Infect Dis
; 9(10): ofac488, 2022 Oct.
Article
em En
| MEDLINE
| ID: mdl-36267259
ABSTRACT
Background:
This is a "proof-of-concept" study aiming to evaluate the impact of a multistep bundles intervention in the management and outcomes of patients with gram-negative bloodstream infections (GN-BSIs).Methods:
This was a single-center, quasi-experimental design study. In the pre-phase (January 2019 to May 2020), patients were retrospectively enrolled. During the post-phase (June 2020 to September 2021), all patients were prospectively enrolled in a nonmandatory 3-step bundles intervention arm including (i) step 1 imaging to detect deep foci of infection, follow-up blood cultures and procalcitonin monitoring; (ii) step 2 early targeted antibiotic treatment and surgical source control; (iii) step 3 discontinuation of antibiotics within 7-10 days in case of uncomplicated BSI. Patients were followed up to 28 days from BSI onset. The primary outcome was 28-day mortality.Results:
A total of 271 patients were enrolled 127 and 144 in the pre- vs post-phase, respectively. Full application of step 1 (67% vs 42%; P < .001), step 2 (83% vs 72%; P = .031), and step 3 (54% vs 2%; P < .001) increased in the post-phase. Overall, the intervention reduced 28-day mortality (22% vs 35%, respectively; P = .016) and the median duration of total (11 vs 15 days; P < .001) and targeted (8 vs 12 days; P = .001) antibiotic therapy. Finally, the multivariate Cox regression confirmed the independent protective effect of adherence to step 1 (adjusted hazard ratio [aHR], 0.36; 95% CI, 0.20-0.63) and step 2 (aHR, 0.48; 95% CI, 0.29-0.81) on risk of 28-day mortality.Conclusions:
Clinical management and outcomes of patients with GN-BSIs may be improved by providing a pre-established multistep bundles intervention.
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MEDLINE
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En
Ano de publicação:
2022
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Article