Modifiable healthcare factors affecting 28-day survival in bloodstream infection: a prospective cohort study.
Aged
Aged, 80 and over
Anti-Bacterial Agents
/ therapeutic use
Antifungal Agents
/ therapeutic use
Bacteremia
/ drug therapy
Candidemia
/ drug therapy
Critical Care
/ methods
England
/ epidemiology
Female
Health Workforce
Humans
Male
Middle Aged
Prospective Studies
Risk Factors
State Medicine
Survival Rate
Treatment Outcome
Wales
/ epidemiology
Appropriate antimicrobial therapy
Bloodstream infection
Modifiable
Mortality
Observational cohort
Journal
BMC infectious diseases
ISSN: 1471-2334
Titre abrégé: BMC Infect Dis
Pays: England
ID NLM: 100968551
Informations de publication
Date de publication:
25 Jul 2020
25 Jul 2020
Historique:
received:
28
01
2020
accepted:
16
07
2020
entrez:
27
7
2020
pubmed:
28
7
2020
medline:
29
8
2020
Statut:
epublish
Résumé
Bloodstream infection is common in the UK and has significant mortality depending on the pathogen involved, site of infection and other patient factors. Healthcare staffing and ward activity may also impact on outcomes in a range of conditions, however there is little specific National Health Service (NHS) data on the impact for patients with bloodstream infection. Bloodstream Infections - Focus on Outcomes is a multicentre cohort study with the primary aim of identifying modifiable risk factors for 28-day mortality in patients with bloodstream infection due to one of six key pathogens. Adults under the care of five NHS Trusts in England and Wales between November 2010 and May 2012 were included. Multivariable Cox regression was used to quantify the association between modifiable risk factors, including staffing levels and timing of appropriate therapy, and 28-day mortality, after adjusting for non-modifiable risk factors such as patient demographics and long-term comorbidities. A total of 1676 patients were included in the analysis population. Overall, 348/1676 (20.8%) died within 28 days. Modifiable factors associated with 28-day mortality were ward speciality, ward activity (admissions and discharges), movement within ward speciality, movement from critical care, and time to receipt of appropriate antimicrobial therapy in the first 7 days. For each additional admission or discharge per 10 beds, the hazard increased by 4% (95% CI 1 to 6%) in medical wards and 11% (95% CI 4 to 19%) in critical care. Patients who had moved wards within speciality or who had moved out of a critical care ward had a reduction in hazard of mortality. In the first 7 days, hazard of death increased with increasing time to receipt of appropriate antimicrobial therapy. This study underlines the importance of appropriate antimicrobials within the first 7 days, and the potential for ward activity and ward movements to impact on survival in bloodstream infection.
Sections du résumé
BACKGROUND
BACKGROUND
Bloodstream infection is common in the UK and has significant mortality depending on the pathogen involved, site of infection and other patient factors. Healthcare staffing and ward activity may also impact on outcomes in a range of conditions, however there is little specific National Health Service (NHS) data on the impact for patients with bloodstream infection. Bloodstream Infections - Focus on Outcomes is a multicentre cohort study with the primary aim of identifying modifiable risk factors for 28-day mortality in patients with bloodstream infection due to one of six key pathogens.
METHODS
METHODS
Adults under the care of five NHS Trusts in England and Wales between November 2010 and May 2012 were included. Multivariable Cox regression was used to quantify the association between modifiable risk factors, including staffing levels and timing of appropriate therapy, and 28-day mortality, after adjusting for non-modifiable risk factors such as patient demographics and long-term comorbidities.
RESULTS
RESULTS
A total of 1676 patients were included in the analysis population. Overall, 348/1676 (20.8%) died within 28 days. Modifiable factors associated with 28-day mortality were ward speciality, ward activity (admissions and discharges), movement within ward speciality, movement from critical care, and time to receipt of appropriate antimicrobial therapy in the first 7 days. For each additional admission or discharge per 10 beds, the hazard increased by 4% (95% CI 1 to 6%) in medical wards and 11% (95% CI 4 to 19%) in critical care. Patients who had moved wards within speciality or who had moved out of a critical care ward had a reduction in hazard of mortality. In the first 7 days, hazard of death increased with increasing time to receipt of appropriate antimicrobial therapy.
CONCLUSION
CONCLUSIONS
This study underlines the importance of appropriate antimicrobials within the first 7 days, and the potential for ward activity and ward movements to impact on survival in bloodstream infection.
Identifiants
pubmed: 32711452
doi: 10.1186/s12879-020-05262-6
pii: 10.1186/s12879-020-05262-6
pmc: PMC7382856
doi:
Substances chimiques
Anti-Bacterial Agents
0
Antifungal Agents
0
Types de publication
Journal Article
Multicenter Study
Observational Study
Langues
eng
Sous-ensembles de citation
IM
Pagination
545Subventions
Organisme : Department of Health
ID : RP-PG-0707-10043
Pays : United Kingdom
Organisme : Programme Grants for Applied Research
ID : RP-PG-0707-10043
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