Prehospital delay is an important risk factor for mortality in community-acquired bloodstream infection (CA-BSI): a matched case-control study.
accident & emergency medicine
adult intensive & critical care
infectious diseases
primary care
public health
Journal
BMJ open
ISSN: 2044-6055
Titre abrégé: BMJ Open
Pays: England
ID NLM: 101552874
Informations de publication
Date de publication:
18 11 2021
18 11 2021
Historique:
entrez:
19
11
2021
pubmed:
20
11
2021
medline:
15
12
2021
Statut:
epublish
Résumé
The aim of this study was to identify prehospital and early hospital risk factors associated with 30-day mortality in patients with blood culture-confirmed community-acquired bloodstream infection (CA-BSI) in Sweden. A retrospective case-control study of 1624 patients with CA-BSI (2015-2016), 195 non-survivors satisfying the inclusion criteria were matched 1:1 with 195 survivors for age, gender and microorganism. All forms of contact with a healthcare provider for symptoms of infection within 7 days prior CA-BSI episode were registered. Logistic regression was used to analyse risk factors for 30-day all-cause mortality. Of the 390 patients, 61% (115 non-survivors and 121 survivors) sought prehospital contact. The median time from first prehospital contact till hospital admission was 13 hours (6-52) for non-survivors and 7 hours (3-24) for survivors (p<0.01). Several risk factors for 30-day all-cause mortality were identified: prehospital delay OR=1.26 (95% CI: 1.07 to 1.47), p<0.01; severity of illness (Sequential Organ Failure Assessment score) OR=1.60 (95% CI: 1.40 to 1.83), p<0.01; comorbidity score (updated Charlson Index) OR=1.13 (95% CI: 1.05 to 1.22), p<0.01 and inadequate empirical antimicrobial therapy OR=3.92 (95% CI: 1.64 to 9.33), p<0.01. In a multivariable model, prehospital delay >24 hours from first contact remained an important risk factor for 30-day all-cause mortality due to CA-BSI OR=6.17 (95% CI: 2.19 to 17.38), p<0.01. Prehospital delay and inappropriate empirical antibiotic therapy were found to be important risk factors for 30-day all-cause mortality associated with CA-BSI. Increased awareness and earlier detection of BSI in prehospital and early hospital care is critical for rapid initiation of adequate management and antibiotic treatment.
Identifiants
pubmed: 34794994
pii: bmjopen-2021-052582
doi: 10.1136/bmjopen-2021-052582
pmc: PMC8603295
doi:
Substances chimiques
Anti-Bacterial Agents
0
Types de publication
Journal Article
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
e052582Informations de copyright
© Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.
Déclaration de conflit d'intérêts
Competing interests: None declared.
Références
Clin Microbiol Infect. 2004 Jun;10(6):542-9
pubmed: 15191383
JAMA. 2016 Feb 23;315(8):801-10
pubmed: 26903338
Am J Epidemiol. 2011 Mar 15;173(6):676-82
pubmed: 21330339
Clin Microbiol Rev. 2014 Oct;27(4):647-64
pubmed: 25278570
CMAJ. 2020 Mar 9;192(10):E230-E239
pubmed: 32152051
PLoS One. 2019 Feb 7;14(2):e0212181
pubmed: 30730990
Clin Infect Dis. 2013 Mar;56(6):798-805
pubmed: 23223600
Clin Infect Dis. 2004 Aug 1;39(3):309-17
pubmed: 15306996
PLoS One. 2016 Nov 11;11(11):e0166527
pubmed: 27835663
Crit Care. 2015 Aug 28;19:286
pubmed: 26316210
BMJ. 2020 May 20;369:m1501
pubmed: 32434791
Eur J Clin Microbiol Infect Dis. 2019 Jul;38(7):1223-1234
pubmed: 30911928
N Engl J Med. 2001 Nov 8;345(19):1368-77
pubmed: 11794169
Clin Exp Emerg Med. 2017 Mar 30;4(1):48-55
pubmed: 28435902
Eur J Clin Microbiol Infect Dis. 2008 Sep;27(9):839-48
pubmed: 18449584
Crit Care Med. 2017 Apr;45(4):623-629
pubmed: 28169944
Lakartidningen. 2008 Jan 23-29;105(4):201-4
pubmed: 18306820
Am J Respir Crit Care Med. 2017 Oct 1;196(7):856-863
pubmed: 28345952
PLoS One. 2020 Mar 27;15(3):e0230501
pubmed: 32218575
J Emerg Med. 2011 Jun;40(6):623-8
pubmed: 18930373
J Hosp Infect. 2013 Jun;84(2):143-50
pubmed: 23602415
Clin Microbiol Infect. 2013 Jun;19(6):501-9
pubmed: 23473333
PLoS One. 2015 May 06;10(5):e0125827
pubmed: 25946168
Crit Care Med. 2020 Apr;48(4):484-490
pubmed: 32205594
Am J Respir Crit Care Med. 2017 Apr 1;195(7):906-911
pubmed: 27649072
Croat Med J. 2020 Oct 31;61(5):429-439
pubmed: 33150761
Crit Care Med. 2017 May;45(5):759-765
pubmed: 28234754
Crit Care Med. 2015 Jan;43(1):13-21
pubmed: 25251760
Australas Emerg Care. 2019 Sep;22(3):187-192
pubmed: 31042522
Crit Care Med. 2014 Aug;42(8):1749-55
pubmed: 24717459
BMJ Open. 2016 Aug 05;6(8):e011218
pubmed: 27496231
N Engl J Med. 2017 Jun 8;376(23):2235-2244
pubmed: 28528569
Crit Care Med. 2013 Feb;41(2):580-637
pubmed: 23353941
Med Care. 2005 Nov;43(11):1130-9
pubmed: 16224307
Emerg Med J. 2016 Jun;33(6):408-13
pubmed: 26864327
Clin Infect Dis. 2011 Jan 1;52(1):61-9
pubmed: 21148521
Clin Microbiol Infect. 2012 Jun;18(6):E170-6
pubmed: 22512663
Crit Care Med. 2006 Jun;34(6):1589-96
pubmed: 16625125
Intensive Care Med. 2017 Mar;43(3):304-377
pubmed: 28101605
BMC Infect Dis. 2017 Mar 11;17(1):205
pubmed: 28284196
Intensive Care Med. 1996 Jul;22(7):707-10
pubmed: 8844239
Emerg Med J. 2014 Jun;31(6):482-7
pubmed: 23475607
J Clin Epidemiol. 2004 Dec;57(12):1288-94
pubmed: 15617955
Chest. 2009 Nov;136(5):1237-1248
pubmed: 19696123