RESUMO
We compared two periods, before and after systematic implementation of infectious diseases consultation for each Staphylococcus aureus bacteremia. Comparing these periods, we showed a significant increase in follow-up blood cultures (from 38% to 85%), transthoracic echocardiography (from 25% to 79%), and administration of appropriate antistaphylococcal agent (from 77% to 96%).
Assuntos
Bacteriemia/tratamento farmacológico , Gerenciamento Clínico , Implementação de Plano de Saúde , Hospitais Comunitários/estatística & dados numéricos , Encaminhamento e Consulta , Infecções Estafilocócicas/tratamento farmacológico , Idoso , Idoso de 80 Anos ou mais , Antibacterianos/uso terapêutico , Bacteriemia/mortalidade , Hemocultura/estatística & dados numéricos , Ecocardiografia/estatística & dados numéricos , Feminino , Fidelidade a Diretrizes , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Guias de Prática Clínica como Assunto , Estudos Retrospectivos , Infecções Estafilocócicas/mortalidade , Staphylococcus aureus/efeitos dos fármacos , Staphylococcus aureus/patogenicidade , SuíçaRESUMO
BACKGROUND: Influenza infections have been associated with high morbidity. The aims were to determine predictors of mortality among patients with influenza infections and to ascertain the role of quick Sequential Organ Failure Assessment (qSOFA) in predicting poor outcomes. METHODS: All adult patients with influenza infection at the Hospital of Jura, Switzerland during four influenza seasons (2014/15 to 2017/18) were included. Cepheid Xpert Xpress Flu/RSV was used during the first three influenza seasons and Cobas Influenza A/B and RSV during the 2017/18 season. RESULTS: Among 1684 influenza virus tests performed, 441 patients with influenza infections were included (238 for influenza A virus and 203 for B). The majority of infections were community onset (369; 83.7%). Thirty-day mortality was 6.0% (25 patients). Multivariate analysis revealed that infection due to A virus (P 0.035; OR 7.1; 95% CI 1.1-43.8), malnutrition (P < 0.001; OR 25.0; 95% CI 4.5-138.8), hospital-acquired infection (P 0.003; OR 12.2; 95% CI 2.3-65.1), respiratory insufficiency (PaO2/FiO2 < 300) (P < 0.001; OR 125.8; 95% CI 9.6-1648.7) and pulmonary infiltrate on X-ray (P 0.020; OR 6.0; 95% CI 1.3-27.0) were identified as predictors of mortality. qSOFA showed a very good accuracy (0.89) equivalent to other more specific and burdensome scores such as CURB-65 and Pneumonia Severity Index (PSI). CONCLUSION: qSOFA performed similarly to specific severity scores (PSI, CURB-65) in predicting mortality. Infection by influenza A virus, respiratory insufficiency and malnutrition were associated with worse prognosis.