Clinical impact of time to results from the microbiology laboratory in bloodstream infections caused by carbapenemase-producing Enterobacterales (TIME-CPE STUDY).
J Antimicrob Chemother
; 78(8): 1948-1954, 2023 08 02.
Article
em En
| MEDLINE
| ID: mdl-37325878
ABSTRACT
OBJECTIVES:
To evaluate the impact of time to results (TTR) on the outcome of patients with carbapenemase-producing Enterobacterales bloodstream infections (CPE-BSI).METHODS:
Times-series study conducted from January 2014 to December 2021, selecting patients with first CPE-BSI episodes. Periods of intervention were defined according to implementation of diagnostic bundle tests in the microbiology laboratory pre-intervention (January 2014-December 2017) and post-intervention (January 2018-December 2021). TTR was defined as time elapsed from positivity time of the blood culture bottles to physicians' notification of CPE-BSI episodes, and was evaluated in patients who received inappropriate empirical and switched to appropriate targeted treatment (switch group). Analysis of a composite unfavourable outcome (mortality at Day 30 and/or persistent and/or recurrent bacteraemia) was performed for the total episodes and in the switch group.RESULTS:
One hundred and nine episodes were analysed 66 pre-intervention and 43 post-intervention. Compared with pre-intervention, patients in the post-intervention period were younger (68 versus 63 years, P =â0.04), had INCREMENT scoreâ>â7 (31.8% versus 53.5%, Pâ=â0.02) and unfavourable outcome (37.9% versus 20.9%, Pâ=â0.04). Proportion of TTRâ>â30 h was more frequent pre-intervention than post-intervention (61.7% versus 35.5%, Pâ=â0.02). In multivariate analysis of the 109 episodes, source other than urinary or biliary (OR 2.76, 95% CI 1.11-6.86) was associated with unfavourable outcome, while targeted appropriate treatment trended to being protective (OR 0.17, 95% CI 0.03-1.00). Considering the switch group (nâ=â78), source other than urinary or biliary (OR 14.9, 95% CI 3.25-69.05) and TTRâ>â30 h (OR 4.72, 95% CI 1.29-17.22) were associated with unfavourable outcome.CONCLUSIONS:
Decreased TTR in the post-intervention period was associated with the outcome in patients with CPE-BSI episodes.
Texto completo:
1
Coleções:
01-internacional
Base de dados:
MEDLINE
Assunto principal:
Sepse
/
Gammaproteobacteria
/
Infecções por Enterobacteriaceae
Tipo de estudo:
Diagnostic_studies
/
Observational_studies
/
Risk_factors_studies
Limite:
Humans
Idioma:
En
Revista:
J Antimicrob Chemother
Ano de publicação:
2023
Tipo de documento:
Article
País de afiliação:
Espanha