Evaluating the management of 493 patients presenting with bacteremia in 23 northern French hospitals

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• 作者：S. Alfandari^a ; ^{alfandari.s@gmail.com" class="auth_mail" title="E-mail the corresponding author} ; P. Cabaret^b ; S. Nguyen^c ; ¹ ; D. Descamps^d ; A. Vaché ; e^e ; C. Cattoen^f ; N. Van Grunderbeeck^g ; on behalf of the ARMEDA bacteremia groups
• 关键词：Antibiotics ; Bacteremia ; Antimicrobial stewardship
• 刊名：Médecine et Maladies Infectieuses
• 出版年：2016
• 出版时间：June 2016
• 年：2016
• 卷：46
• 期：4
• 页码：194-199
• 全文大小：323 K

文摘

We aimed to update the epidemiology of bacteremia and evaluate their management and short-term outcome.

Methods

We conducted a prospective multicenter survey from October to November 2011. Consecutive patients with at least one positive blood culture (BC) were included in the study. We evaluated the type and adequacy of empirical and documented antibiotic therapy, time to active antibiotic therapy, compliance with guidelines, and 10-day outcome.

Results

A total of 23 public and private hospitals and 633 patients (493 true pathogens and 140 contaminants) were included in the study. Patients’ wards were medicine (57%), surgery (19%), intensive care (14%), onco/hematology (3.7%), pediatrics (3.4%), infectious diseases (1.8%), and obstetrics (1.2%). Main pathogens were Escherichia coli (36%), Staphylococcus aureus (16%), coagulase-negative staphylococci, and Klebsiella sp. (8% each). A total of 43 (8.7%) multidrug-resistant strains were observed, including 26 extended-spectrum beta-lactamase strains and 15 methicillin-resistant S. aureus strains. An antibiotic active against the isolated pathogen was used in 74% of empirical and 96% of documented therapies. Median time between BC and administration of an active drug was 0.61 day. Empirical antibiotic therapies were protocol-compliant in 77% of cases. Few (4%) patients with contaminated BC received an antibiotic therapy (all inappropriate). Day-10 mortality was 12.1%, higher in patients presenting with severe sepsis or septic shock (22.5%) than in patients presenting with non-severe bacteremia (7.1%; P < 0.0001).

Conclusion

The management of bacteremia seems satisfactory in these volunteer hospitals but bacteremia remains a severe infection.