Effect of a rapid bacteraemia response programme on bacteraemia management and mortality.

BACKGROUND

bacteraemia confers significant morbidity and mortality. A multi-disciplinary team was created to optimize bacteraemia management.

METHODS

The intervention included integration of rapid diagnostic blood culture processing and a multi-disciplinary approach to real-time management of results. This was a retrospective, pre-post study to compare outcomes in the standard of care (SOC,  = 50) and intervention ( = 100) groups of patients with community-onset bacteraemia. Patients were excluded for death before Gram stain result, leaving against medical advice, polymicrobial bacteraemia or withdrawal of life sustaining treatments during hospitalization. The primary outcome was 30-day all-cause mortality. Secondary outcomes were in-hospital, 6 month and 1 year mortality as well as -related readmission and time to effective antibiotic therapy.

RESULTS

54% of the SOC group and 46% of the intervention group had methicillin-resistant infections. The primary outcome, 30-day mortality, was 3% in the intervention group compared to 20% in the SOC group ( = 0.004). There was no difference in in-hospital mortality ( = 0.08) but lower mortality in the intervention group at 30 days ( = 0.003), 6 months ( = 0.005) and 1 year ( < 0.001). -related readmission was significantly lower at 31 days-6 months after discharge in the intervention group. Median time to effective antibiotic therapy was 13 h versus 6.3 h in the SOC and intervention groups, respectively.

CONCLUSIONS

The integration of real-time rapid diagnostic blood culture technology tied to immediate clinical actions was associated with improved time to effective therapy and mortality in patients with community-onset bacteraemia.