Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.
Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Victoria, Australia.
Clin Infect Dis. 2024 Oct 15;79(4):855-863. doi: 10.1093/cid/ciae282.
Data supporting routine infectious diseases (ID) consultation in gram-negative bloodstream infection (GN-BSI) are limited. We evaluated the association between ID consultation and mortality in patients with GN-BSI in a retrospective population-wide cohort study in Ontario using linked health administrative databases.
Hospitalized adult patients with GN-BSI between April 2017 and December 2021 were included. The primary outcome was time to all-cause mortality censored at 30 days, analyzed using a mixed effects Cox proportional hazards model with hospital as a random effect. ID consultation 1-10 days after the first positive blood culture was treated as a time-varying exposure.
Of 30 159 patients with GN-BSI across 53 hospitals, 11 013 (36.5%) received ID consultation. Median prevalence of ID consultation for patients with GN-BSI across hospitals was 35.0% with wide variability (range 2.7%-76.1%, interquartile range 19.6%-41.1%). In total, 1041 (9.5%) patients who received ID consultation died within 30 days, compared to 1797 (9.4%) patients without ID consultation. In the fully adjusted multivariable model, ID consultation was associated with mortality benefit (adjusted hazard ratio [HR] 0.82, 95% confidence interval [CI] .77-.88, P < .0001; translating to absolute risk reduction of -3.8% or number needed to treat [NNT] of 27). Exploratory subgroup analyses of the primary outcome showed that ID consultation could have greater benefit in patients with high-risk features (nosocomial infection, polymicrobial or non-Enterobacterales infection, antimicrobial resistance, or non-urinary tract source).
Early ID consultation was associated with reduced mortality in patients with GN-BSI. If resources permit, routine ID consultation for this patient population should be considered to improve patient outcomes.
有关革兰氏阴性菌血流感染（GN-BSI）常规感染病（ID）咨询的数据有限。我们使用安大略省的链接健康管理数据库，在一项回顾性全人群队列研究中评估了 ID 咨询与 GN-BSI 患者死亡率之间的关系。
纳入 2017 年 4 月至 2021 年 12 月住院的 GN-BSI 成年患者。主要结局是全因死亡率，以 30 天为截止点，使用混合效应 Cox 比例风险模型进行分析，以医院为随机效应。在首次阳性血培养后 1-10 天内的 ID 咨询被视为时间变化的暴露。
在 53 家医院的 30159 例 GN-BSI 患者中，有 11013 例（36.5%）接受了 ID 咨询。医院间 GN-BSI 患者 ID 咨询的中位流行率为 35.0%，差异很大（范围 2.7%-76.1%，四分位间距 19.6%-41.1%）。共有 1041 例（9.5%）接受 ID 咨询的患者在 30 天内死亡，而 1797 例（9.4%）未接受 ID 咨询的患者死亡。在完全调整的多变量模型中，ID 咨询与死亡率降低相关（调整后的危险比[HR]0.82，95%置信区间[CI]0.77-0.88，P<.0001；绝对风险降低-3.8%或需要治疗的人数[NNT]为 27）。主要结局的探索性亚组分析表明，ID 咨询在具有高危特征的患者（医院获得性感染、多种微生物或非肠杆菌科感染、抗生素耐药性或非尿路来源）中可能具有更大的益处。
早期 ID 咨询与 GN-BSI 患者的死亡率降低相关。如果资源允许，应考虑为该患者群体常规进行 ID 咨询，以改善患者结局。
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