Abstract
Background
Effective antimicrobial treatment is key for survival in bloodstream infection (BSI), but the impact of timing of treatment remains unclear. Our aim was to assess the association between time to appropriate antimicrobial treatment and 30-day mortality in BSI patients.
Methods
This was a retrospective cohort study using electronic health record data from a large academic center in Sweden. Adult patients admitted between the years 2012-2019, with onset of BSI at the emergency department or general wards, were included. Pathogen-antimicrobial drug combinations were classified as appropriate or inappropriate based on reported
in vitro susceptibilities. To avoid immortal time bias, the association between appropriate therapy and mortality was assessed with multivariable logistic regression analysis at pre-specified landmark times.
Results
We included 10628 BSI-episodes, occ urring in 9192 unique patients. The overall 30-day mortality was 11.8%. No association in favour of a protective effect between appropriate therapy and mortality was found at the 1, 3 and 6 hours landmark after blood culture collection. At 12 hours, the risk of death increased with inappropriate treatment (adjusted odds ratio 1.17 [95% confidence interval, 1.01-1.37]) and continued to increase gradually at 24, 48 and 72 hours. Stratifying by high or low SOFA-score generated similar odds ratios, with wider confidence intervals.
Conclusion
Delays in appropriate antimicrobial treatment were associated with increased 30-day mortality after 12 hours from blood culture collection, but not at 1, 3, and 6 hours, in BSI. These results indicate a benchmark for providing rapid microbiological diagnostics of blood cultures.
Δεν υπάρχουν σχόλια:
Δημοσίευση σχολίου