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Hospital mortality and length of stay associated with Enterobacterales positive blood cultures: a multicenter analysis.
- Source :
-
Microbiology spectrum [Microbiol Spectr] 2024 Aug 06; Vol. 12 (8), pp. e0040224. Date of Electronic Publication: 2024 Jul 02. - Publication Year :
- 2024
-
Abstract
- Delayed time to antimicrobial susceptibility results can impact patients' outcomes. Our study evaluated the impact of susceptibility turnaround time (TAT) and inadequate empiric antibacterial therapy (IET) in patients with bloodstream infections (BSI) caused by Enterobacterales (ENT) species on in-hospital mortality and length of stay (LOS). This retrospective, multicenter investigation which included 29,570 blood ENT-positive admissions across 161 US healthcare facilities evaluated the association between antimicrobial susceptibility testing (AST) TAT, carbapenem susceptibility, and empiric therapy on post-BSI in-hospital mortality and LOS following an ENT BSI event in adult patients. After adjusting for outcomes covariates, post-BSI in-hospital mortality was significantly higher for patients in the IET vs adequate empiric therapy (AET) group [odds ratio (OR): 1.61 (95% CI: 1.32, 1.98); P < 0.0001], and when AST TAT was >63 h [OR:1.48 (95% CI: 1.16, 1.90); P = 0.0017]. Patients with carbapenem non-susceptible (carb-NS) ENT BSI had significantly higher LOS (16.6 days, 95% CI: 15.6, 17.8) compared to carbapenem susceptible (carb-S, 12.2 days, 95% CI: 11.8, 12.6), ( P < 0.0001). Extended AST TAT was significantly associated with longer LOS for TAT of 57-65 h and >65 h ( P = 0.005 and P < 0.0001, respectively) compared to TAT ≤42 h (reference). Inadequate empiric therapy (IET), carb-NS, and delayed AST TAT are significantly associated with adverse hospital outcomes in ENT BSI. Workflows that accelerate AST TAT for ENT BSIs and facilitate timely and adequate therapy may reduce post-BSI in-hospital mortality rate and LOS.IMPORTANCEFor patients diagnosed with bloodstream infections (BSI) caused by Enterobacterales (ENT), delayed time to antimicrobial susceptibility (AST) results can significantly impact in-hospital mortality and hospital length of stay. However, this relationship between time elapsed from blood culture collection to AST results has only been assessed, to date, in a limited number of publications. Our study focuses on this important gap using retrospective data from 29,570 blood ENT-positive admissions across 161 healthcare facilities in the US as we believe that a thorough understanding of the dynamic between AST turnaround time, adequacy of empiric therapy, post-BSI event mortality, and hospital length of stay will help guide effective clinical management and optimize outcomes of patients with ENT infections.<br />Competing Interests: All authors are currently employed by Becton, Dickinson and Company with the exception of V.G. and G.Y who were employed by Becton, Dickinson and Company at the time of this study.
- Subjects :
- Humans
Retrospective Studies
Male
Female
Middle Aged
Aged
Microbial Sensitivity Tests
Carbapenems therapeutic use
Carbapenems pharmacology
Enterobacteriaceae drug effects
Adult
Aged, 80 and over
Length of Stay statistics & numerical data
Hospital Mortality
Enterobacteriaceae Infections mortality
Enterobacteriaceae Infections drug therapy
Enterobacteriaceae Infections microbiology
Anti-Bacterial Agents therapeutic use
Anti-Bacterial Agents pharmacology
Bacteremia mortality
Bacteremia drug therapy
Bacteremia microbiology
Blood Culture
Subjects
Details
- Language :
- English
- ISSN :
- 2165-0497
- Volume :
- 12
- Issue :
- 8
- Database :
- MEDLINE
- Journal :
- Microbiology spectrum
- Publication Type :
- Academic Journal
- Accession number :
- 38953323
- Full Text :
- https://doi.org/10.1128/spectrum.00402-24