Blood culture reports by infectious disease physicians can improve prognosis of bacteremia, including weekend-onset cases. (November 2020)

• Record Type: Journal Article
• Authors: Yamada, Koichi; Kuwabara, Gaku; Imoto, Waki; Yamairi, Kazushi; Shibata, Wataru; Oshima, Kazuhiro; Yoshii, Naoko; Nakaie, Kiyotaka; Niki, Makoto; Okada, Yasuyo; Fujita, Akiko; Sakurai, Norihiro; Kaneko, Yukihiro; Kakeya, Hiroshi
• Is Part Of: International journal of infectious diseases. Volume 100(2020)
• Page Start: 174
• Page End: 179
• Publication Date: 2020-11
• Subjects: Antimicrobial stewardship -- Weekend -- Blood culture reports; Communicable diseases -- Periodicals; Communicable Diseases -- Periodicals; Communicable diseases; Periodicals; Electronic journals; 616.9
• DOI: 10.1016/j.ijid.2020.08.013
• Languages: English
• ISSNs: 1201-9712

Abstract

Highlights: The protocol for reporting cases of positive blood cultures was changed from by microbiological. technologists to by infectious disease physicians Infectious disease physicians proposed treatment to an attending physician and provided weekend support. The protocol change reduced 28-day and in-hospital mortality, including weekend-onset cases. Abstract: Objectives: Cases of positive blood cultures were previously reported by a microbiological technologist (MT) to an attending physician (AP), and the Antimicrobial Stewardship team provided medical assistance by grasping the situation at the morning meeting the next day. Since April 2018, MTs have reported positive blood cultures to an infectious disease physician (IDP), who proposes the management approach to the AP and provides weekend support. This study assessed the effectiveness of blood culture reports provided by IDPs to APs on outcomes of bacteremia, including weekend-onset cases. Methods: Patient characteristics and prognoses before (October 2017 to March 2018) and after intervention (April to September 2018) were compared. Results: The pre-intervention and post-intervention groups comprised 134 and 161 patients, respectively. Patients were more likely to be older (>65 years) in the post-intervention group ( p < 0.05). There were no significant between-group differences in infection severity. The rate of de-escalation significantly increased from 38.1%–57.8% ( p = 0.001). The rates of 28-day and in-hospital mortality reduced following the intervention (21.3% vs. 8.2% and 32.8% vs. 10.6%; p = 0.004 and p < 0.001, respectively). In-hospital mortality for weekend-onset cases also reduced following the intervention (33.3% vs. 12.9%, p = 0.01). Sepsis was a poor prognostic factor (OR 8.070, 95% CI 3.320–19.600, p < 0.001) and intervention was a good prognostic factor (OR 0.311, 95% CI 0.142–0.680, p = 0.003) affecting 28-day mortality in multivariate analysis. Conclusions: Changes to blood culture result reporting protocols can improve outcomes of bacteremia, including weekend-onset cases.