Rx Delay Increases Deaths In Bloodstream Infections

SAN FRANCISCO — A delay in administering adequate antimicrobial therapy is strongly associated with elevated mortality in patients with bloodstream infections, according to a prospective study involving 381 patients.

The association between therapeutic delay and mortality was seen not only in patients with severe sepsis or septic shock, but also in patients with less-severe sepsis or with bloodstream infections not involving systemic inflammatory response syndrome, according to a poster presentation by Dr. Ana Fernández-Cruz at the Interscience Conference on Antimicrobial Agents and Chemotherapy, sponsored by the American Society for Microbiology.

Each hour of delay in administering adequate antimicrobial therapy increased the risk of death by an average of 1.4%, wrote Dr. Fernández-Cruz and her colleagues from the Hospital General Universitario Gregorio Marañón, Madrid. The mean time from blood culture to adequate antimicrobial therapy was 12.9 hours, and the median time was 4.5 hours.

Overall, the initial antibiotic treatment was adequate in 74% of the patients and inadequate in the remaining 26%. The investigators defined adequate antimicrobial therapy as the administration of an antimicrobial to which the microorganism isolated in the blood culture was susceptible in vitro according to the antibiogram.

The study included all patients with a microbiologically significant bloodstream infection at a 1,450-bed tertiary care hospital during a 3-month period. Of the 381 patients, 61% were male; their median age was 64 years, and 72% of their infections were hospital acquired or health care associated.

According to the Bone sepsis score when the blood culture was taken, 68% of the patients had sepsis, 15% had severe sepsis, 7% had septic shock, and 6% had a bloodstream infection without systemic anti-inflammatory response syndrome.

Mortality increased with delay in adequate antimicrobial therapy, irrespective of the severity of sepsis. For example, among patients with severe sepsis, a 20-hour delay corresponded to about 25% mortality, and a 100-hour delay corresponded to about 90% mortality. Among patients with a bloodstream infection without systemic anti-inflammatory response syndrome, mortality was about 10% with a 20-hour delay, and about 40% with a 100-hour delay.

At discharge, 16.5% of the patients had died. In a multivariate analysis, three variables emerged as independent predictors of mortality. For each hour of delay from blood culture to adequate antimicrobial therapy, the risk of death increased by an average of 1.4%. For each one-point increase in the patient's Charlson score, the risk of death increased by a mean of 24%. And for each year of age, the risk of death increased by a mean of 1.9%. The multivariate analysis was adjusted for place of acquisition, McCabe and Jackson classification, Charlson Index, underlying disease, sepsis score, bloodstream infection source, hospital ward, previous length of stay, and previous antimicrobial therapy.

The investigators reported no relevant conflicts of interest.

SAN FRANCISCO — A delay in administering adequate antimicrobial therapy is strongly associated with elevated mortality in patients with bloodstream infections, according to a prospective study involving 381 patients.

The association between therapeutic delay and mortality was seen not only in patients with severe sepsis or septic shock, but also in patients with less-severe sepsis or with bloodstream infections not involving systemic inflammatory response syndrome, according to a poster presentation by Dr. Ana Fernández-Cruz at the Interscience Conference on Antimicrobial Agents and Chemotherapy, sponsored by the American Society for Microbiology.

Each hour of delay in administering adequate antimicrobial therapy increased the risk of death by an average of 1.4%, wrote Dr. Fernández-Cruz and her colleagues from the Hospital General Universitario Gregorio Marañón, Madrid. The mean time from blood culture to adequate antimicrobial therapy was 12.9 hours, and the median time was 4.5 hours.

Overall, the initial antibiotic treatment was adequate in 74% of the patients and inadequate in the remaining 26%. The investigators defined adequate antimicrobial therapy as the administration of an antimicrobial to which the microorganism isolated in the blood culture was susceptible in vitro according to the antibiogram.

The study included all patients with a microbiologically significant bloodstream infection at a 1,450-bed tertiary care hospital during a 3-month period. Of the 381 patients, 61% were male; their median age was 64 years, and 72% of their infections were hospital acquired or health care associated.

According to the Bone sepsis score when the blood culture was taken, 68% of the patients had sepsis, 15% had severe sepsis, 7% had septic shock, and 6% had a bloodstream infection without systemic anti-inflammatory response syndrome.

Mortality increased with delay in adequate antimicrobial therapy, irrespective of the severity of sepsis. For example, among patients with severe sepsis, a 20-hour delay corresponded to about 25% mortality, and a 100-hour delay corresponded to about 90% mortality. Among patients with a bloodstream infection without systemic anti-inflammatory response syndrome, mortality was about 10% with a 20-hour delay, and about 40% with a 100-hour delay.

At discharge, 16.5% of the patients had died. In a multivariate analysis, three variables emerged as independent predictors of mortality. For each hour of delay from blood culture to adequate antimicrobial therapy, the risk of death increased by an average of 1.4%. For each one-point increase in the patient's Charlson score, the risk of death increased by a mean of 24%. And for each year of age, the risk of death increased by a mean of 1.9%. The multivariate analysis was adjusted for place of acquisition, McCabe and Jackson classification, Charlson Index, underlying disease, sepsis score, bloodstream infection source, hospital ward, previous length of stay, and previous antimicrobial therapy.

The investigators reported no relevant conflicts of interest.

SAN FRANCISCO — A delay in administering adequate antimicrobial therapy is strongly associated with elevated mortality in patients with bloodstream infections, according to a prospective study involving 381 patients.

The association between therapeutic delay and mortality was seen not only in patients with severe sepsis or septic shock, but also in patients with less-severe sepsis or with bloodstream infections not involving systemic inflammatory response syndrome, according to a poster presentation by Dr. Ana Fernández-Cruz at the Interscience Conference on Antimicrobial Agents and Chemotherapy, sponsored by the American Society for Microbiology.

Each hour of delay in administering adequate antimicrobial therapy increased the risk of death by an average of 1.4%, wrote Dr. Fernández-Cruz and her colleagues from the Hospital General Universitario Gregorio Marañón, Madrid. The mean time from blood culture to adequate antimicrobial therapy was 12.9 hours, and the median time was 4.5 hours.

Overall, the initial antibiotic treatment was adequate in 74% of the patients and inadequate in the remaining 26%. The investigators defined adequate antimicrobial therapy as the administration of an antimicrobial to which the microorganism isolated in the blood culture was susceptible in vitro according to the antibiogram.

The study included all patients with a microbiologically significant bloodstream infection at a 1,450-bed tertiary care hospital during a 3-month period. Of the 381 patients, 61% were male; their median age was 64 years, and 72% of their infections were hospital acquired or health care associated.

According to the Bone sepsis score when the blood culture was taken, 68% of the patients had sepsis, 15% had severe sepsis, 7% had septic shock, and 6% had a bloodstream infection without systemic anti-inflammatory response syndrome.

Mortality increased with delay in adequate antimicrobial therapy, irrespective of the severity of sepsis. For example, among patients with severe sepsis, a 20-hour delay corresponded to about 25% mortality, and a 100-hour delay corresponded to about 90% mortality. Among patients with a bloodstream infection without systemic anti-inflammatory response syndrome, mortality was about 10% with a 20-hour delay, and about 40% with a 100-hour delay.

At discharge, 16.5% of the patients had died. In a multivariate analysis, three variables emerged as independent predictors of mortality. For each hour of delay from blood culture to adequate antimicrobial therapy, the risk of death increased by an average of 1.4%. For each one-point increase in the patient's Charlson score, the risk of death increased by a mean of 24%. And for each year of age, the risk of death increased by a mean of 1.9%. The multivariate analysis was adjusted for place of acquisition, McCabe and Jackson classification, Charlson Index, underlying disease, sepsis score, bloodstream infection source, hospital ward, previous length of stay, and previous antimicrobial therapy.

The investigators reported no relevant conflicts of interest.