Lorenzo-Hernández Elizabeth, Rivas-Ruiz Francisco, Fernández-Casañas Jorge, Puerto-Romero Vanesa, Martín-Escalante Maria Dolores, Del Arco-Jiménez Alfonso
Internal Medicine Department, Costa del Sol University Hospital, A-7, Km 187, 29603 Marbella, Malaga, Spain.
Research Unit, Costa del Sol University Hospital, A-7, Km 187, 29603 Marbella, Malaga, Spain.
Antibiotics (Basel). 2025 Jun 18;14(6):615. doi: 10.3390/antibiotics14060615.
This work aims to assess the evolution in the management of bacteremia (SAB) and the impact of the COVID-19 pandemic on it. SAB is associated with high morbidity and mortality, requiring structured management strategies. The COVID-19 pandemic led to major changes in hospital workflows, potentially affecting the quality of SAB care. We conducted a retrospective per-protocol analysis of SAB episodes at Costa del Sol University Hospital (Marbella, Spain) across three periods: pre-pandemic, pandemic, and post-pandemic. Patients with early mortality or early transfer were excluded. Clinical variables, adherence to recommended management bundles, and outcomes were compared. Demographic characteristics were similar across the analyzed periods. The incidence of SAB increased over time, with a notable rise post-pandemic. Key management indicators such as the identification of infection source and appropriate antibiotic therapy showed adherence rates of above 90%, while echocardiography exhibited an adherence rate of above 75% throughout the study. Adherence to the full management bundle was suboptimal, with no significant differences between periods. However, an appropriate treatment duration significantly improved in the post-pandemic group ( = 0.038). Mortality at 14 and 30 days was highest during the pandemic period (10.3% and 17.6%, respectively), although differences were not statistically significant. Complications and mortality were more frequent in patients with complete adherence to the bundle ( = 0.031). Despite stable or improved adherence to certain SAB management measures during the pandemic, mortality and complication rates did not significantly decrease, likely reflecting increased patient severity or healthcare system overload. These findings highlight the need for sustained, multidisciplinary, bedside-based approaches to SAB care, even during public health emergencies. Further research is needed to explore modifiable factors and enhance adherence to evidence-based recommendations.
这项工作旨在评估血流感染（SAB）管理的演变以及新冠疫情对其的影响。SAB与高发病率和死亡率相关，需要结构化的管理策略。新冠疫情导致医院工作流程发生重大变化，可能影响SAB的护理质量。我们对西班牙马贝拉太阳海岸大学医院三个时期（疫情前、疫情期间和疫情后）的SAB病例进行了回顾性按方案分析。排除早期死亡或早期转院的患者。比较了临床变量、对推荐管理方案的依从性和结果。各分析时期的人口统计学特征相似。SAB的发病率随时间增加，疫情后显著上升。关键管理指标如感染源识别和适当的抗生素治疗显示依从率高于90%，而超声心动图在整个研究中显示依从率高于75%。对整个管理方案的依从性不理想，各时期之间无显著差异。然而，疫情后组的适当治疗持续时间有显著改善（P = 0.038）。疫情期间14天和30天的死亡率最高（分别为10.3%和17.6%），尽管差异无统计学意义。完全依从方案的患者并发症和死亡率更高（P = 0.031）。尽管疫情期间对某些SAB管理措施的依从性稳定或有所改善，但死亡率和并发症发生率并未显著降低，这可能反映了患者病情加重或医疗系统负担过重。这些发现强调，即使在突发公共卫生事件期间，也需要持续的、多学科的、基于床边的SAB护理方法。需要进一步研究以探索可改变的因素并提高对循证建议的依从性。
