Division of Hospital Medicine, Department of Medicine, Washington University School of Medicine, St. Louis, MO.
Department of Pharmacy, Barnes-Jewish Hospital, St. Louis, MO.
Chest. 2020 Oct;158(4):1385-1396. doi: 10.1016/j.chest.2020.06.011. Epub 2020 Jun 17.
Bloodstream infections (BSIs) are common after hematopoietic stem cell transplantation (HSCT) and are associated with increased long-term morbidity and mortality. However, short-term outcomes related to BSI in this population remain unknown. More specifically, it is unclear whether choices related to empiric antimicrobials for potentially infected patients are associated with patient outcomes.
Are potential delays in appropriate antibiotics associated with hospital outcomes among HSCT recipients with BSI?
We conducted a retrospective cohort study at a large comprehensive inpatient academic cancer center between January 2014 and June 2017. We identified all admissions for HSCT and prior recipients of HSCT. We defined potential delay in appropriate antibiotics as > 24 h between positive blood culture results and the initial dose of an antimicrobial with activity against the pathogen.
We evaluated 2,751 hospital admissions from 1,086 patients. Of these admissions, 395 (14.4%) involved one or more BSIs. Of these 395 hospitalizations, 44 (11.1%) involved potential delays in appropriate antibiotics. The incidence of mortality was higher in BSI hospitalizations than in those without BSI (23% vs 4.5%; P < .001). In multivariable analysis, BSI was an independent predictor of mortality (OR, 8.14; 95% CI, 5.06-13.1; P < .001). Mortality was higher for admissions with potentially delayed appropriate antibiotics than for those with appropriate antibiotics (48% vs 20%; P < .001). Potential delay in antibiotics was also an independent predictor of mortality in multivariable analysis (OR, 13.8; 95% CI, 5.27-35.9; P < .001).
BSIs were common and independently associated with increased morbidity and mortality. Delays in administration of appropriate antimicrobials were identified as an important factor in hospital morbidity and mortality. These findings may have important implications for our current practice of empiric antibiotic treatment in HSCT patients.
造血干细胞移植（HSCT）后常发生血流感染（BSI），并与长期发病率和死亡率增加相关。然而，该人群中与 BSI 相关的短期结局尚不清楚。更具体地说，尚不清楚针对疑似感染患者的经验性抗菌药物的选择是否与患者结局相关。
BSI 接受 HSCT 治疗的患者中，抗生素应用延迟是否与住院结局相关？
我们在一家大型综合住院学术癌症中心进行了一项回顾性队列研究，研究时间为 2014 年 1 月至 2017 年 6 月。我们纳入了所有 HSCT 入院和之前接受过 HSCT 的患者。我们将抗生素应用的潜在延迟定义为阳性血培养结果与针对病原体具有活性的初始抗生素剂量之间的时间间隔＞24 小时。
我们评估了 1086 名患者的 2751 次住院治疗。这些住院治疗中，395 次（14.4%）涉及一次或多次 BSI。在这 395 次住院治疗中，44 次（11.1%）存在抗生素应用的潜在延迟。BSI 住院患者的死亡率高于无 BSI 住院患者（23%比 4.5%；P＜0.001）。多变量分析显示，BSI 是死亡的独立预测因素（OR，8.14；95%CI，5.06-13.1；P＜0.001）。与及时应用抗生素相比，潜在延迟应用抗生素的患者死亡率更高（48%比 20%；P＜0.001）。在多变量分析中，抗生素应用的潜在延迟也是死亡的独立预测因素（OR，13.8；95%CI，5.27-35.9；P＜0.001）。
BSI 很常见，且与发病率和死亡率增加独立相关。抗菌药物应用的延迟被确定为住院发病率和死亡率的重要因素。这些发现可能对我们目前 HSCT 患者经验性抗生素治疗的实践具有重要意义。
