Lam John C, Gregson Daniel B, Robinson Stephen, Somayaji Ranjani, Welikovitch Lisa, Conly John M, Parkins Michael D
Department of Medicine, University of Calgary, Calgary, Alberta, Canada.
Department of Pathology & Laboratory Medicine, University of Calgary, Calgary, Alberta, Canada.
J Assoc Med Microbiol Infect Dis Can. 2019 Mar 11;4(1):24-32. doi: 10.3138/jammi.2018-0036. eCollection 2019 Mar.
bacteremia (SAB) is associated with significant morbidity and mortality. We sought to identify factors associated with infectious diseases consultation (IDC) and understand how IDC associates with SAB patient management and outcomes.
A multicentre retrospective study was performed between 2012 and 2014 in a large Canadian Health Zone in order to determine factors associated with IDC and performance of key quality of care determinants in SAB management and clinical outcomes. Factors subject to quality of care determinants were established a priori and studied for associations with IDC and 30-day all-cause mortality using multivariable analysis.
Of 961 SAB episodes experienced by 892 adult patients, 605 episodes received an IDC. Patients receiving IDC were more likely to have prosthetic valves and joints and to have community-acquired and known sources of SAB, but increasing age decreased IDC occurrence. IDC was the strongest independent predictor for quality of care performance metrics, including repeat blood cultures and echocardiography. Mortality at 30 days was 20% in the cohort, and protective factors included IDC, achievement of source control, targeted therapy within 48 hours, and follow-up blood cultures but not the performance of echocardiography.
There were significant gaps between the treatments and investigations that patients actually received for SAB and what is considered the optimal management of their condition. IDC is associated with improved attainment of targeted SAB quality of care determinants and reduced mortality rates. Based on our findings, we propose a policy of mandatory IDC for all cases of SAB to improve patient management and outcomes.
血流感染（SAB）与显著的发病率和死亡率相关。我们试图确定与感染性疾病会诊（IDC）相关的因素，并了解IDC如何与SAB患者的管理及预后相关。
2012年至2014年期间，在加拿大一个大型健康区域进行了一项多中心回顾性研究，以确定与IDC相关的因素，以及SAB管理和临床结局中关键护理质量决定因素的执行情况。护理质量决定因素所涉及的因素是预先确定的，并使用多变量分析研究其与IDC及30天全因死亡率的关联。
892例成年患者经历了961次SAB发作，其中605次发作接受了IDC。接受IDC的患者更有可能有人工瓣膜和关节，以及社区获得性和已知的SAB来源，但年龄增加会降低IDC的发生率。IDC是护理质量绩效指标的最强独立预测因素，包括重复血培养和超声心动图。该队列30天死亡率为20%，保护因素包括IDC、实现源头控制、48小时内进行靶向治疗以及后续血培养，但不包括超声心动图检查。
患者实际接受的SAB治疗和检查与被认为对其病情的最佳管理之间存在显著差距。IDC与提高靶向SAB护理质量决定因素的达成率及降低死亡率相关。基于我们的研究结果，我们建议对所有SAB病例实行强制性IDC政策，以改善患者管理和预后。
