Infection and Drug Resistance (Aug 2018)
Management and outcome of bloodstream infections: a prospective survey in 121 French hospitals (SPA-BACT survey)
Abstract
Oliver Robineau,1 Jérome Robert,2 Christian Rabaud,3 Jean-Pierre Bedos,4 Emmanuelle Varon,5 Yves Péan,6 Rémy Gauzit,7 Serge Alfandari8 On behalf of the Société de Pathologie Infectieuse de Langue Française (SPILF), the Observatoire National de l’Épidémiologie de la Résistance Bactérienne aux Antibiotiques (ONERBA), and the Surveillance de la Prescription des Antibiotiques (SPA) Group 1Infectious Disease Department, Dron Hospital, Univ Lille, Tourcoing, 2Sorbonne University, UPMC Univ Paris 06, CR7, CIMI, Team E13 (Bacteriology), Paris, 3Infectious Disease Department, Nancy University Hospital, Nancy, 4Intensive Care Unit, Henri Mignot Hospital, Le Chesnay, 5Bacteriology Laboratory, HEGP, 6Observatoire National de L’epidémiologie de la Résistance Bactérienne aux Antibiotiques (OneRBa), 7Intensive Care Unit, Cochin Hospital, APHP, Paris, 8Intensive Care Unit, Dron Hospital, Tourcoing, France Background: Bloodstream infections (BSIs) are severe infections that can be community or hospital acquired. Effects of time to appropriate treatment and impact of antimicrobial management team are discussed in terms of outcome of BSI. We sought to evaluate the impact of initial BSI management on short-term mortality. Patients and methods: A prospective, multicenter survey was conducted in 121 French hospitals. Participants declaring BSI during a 1-month period were included consecutively. Data on patient comorbidities, illness severity, BSI management, and resistance profile of bacterial strains were collected. Predictors of 10-day mortality were identified by multivariate regression for overall BSI, health care-related and hospital-acquired BSI. Results: We included 1,952 BSIs. More than a third of them were hospital acquired (39%). Multidrug resistance was identified in 10% of cases, mainly in health care-related BSI. Empirical therapy and targeted therapy were appropriate for 61% and 94% of cases, respectively. Increased 10-day mortality was associated with severe sepsis, septic shock, increasing age, and any focus other than the urinary tract. Decreased mortality was associated with receiving at least one active antibiotic within the first 48 hours. Intervention of antimicrobial management team during the acute phase of BSI was associated with a decreased mortality at day 10 in the overall population and in health care-related BSI. Conclusion: Optimizing BSI management by increasing rapidity of appropriate treatment initiation may decrease short-term mortality, even in countries with low rate of multidrug-resistant organisms. Early intervention of antimicrobial management team is crucial in terms of mortality. Keywords: mortality, bloodstream infections, antimicrobial management team, community-acquired infection, health care-related infection
