Impact on Mortality of a Bundle for the Management of Enterococcal Bloodstream Infection

Michele Bartoletti; Sara Tedeschi; Luigia Scudeller; Renato Pascale; Elena Rosselli Del Turco; Filippo Trapani; Fabio Tumietto; Giulio Virgili; Lorenzo Marconi; Stefano Ianniruberto; Matteo Rinaldi; Ilaria Contadini; Francesco Cristini; Linda Bussini; Caterina Campoli; Simone Ambretti; Andrea Berlingeri; Pierluigi Viale; Maddalena Giannella

doi:10.1093/ofid/ofz473

Impact on Mortality of a Bundle for the Management of Enterococcal Bloodstream Infection

Michele Bartoletti, Sara Tedeschi, Luigia Scudeller, Renato Pascale, Elena Rosselli Del Turco, Filippo Trapani, Fabio Tumietto, Giulio Virgili, Lorenzo Marconi, Stefano Ianniruberto, Matteo Rinaldi, Ilaria Contadini, Francesco Cristini, Linda Bussini, Caterina Campoli, Simone Ambretti, Andrea Berlingeri, Pierluigi Viale, Maddalena Giannella

Research output: Contribution to journal › Article › peer-review

Abstract

Objective: In this study, we evaluated the effectiveness of a management bundle for Enterococcus spp bloodstream infection (E-BSI).

Method: This was a single-center, quasi-experimental (pre/post) study. In the prephase (January 2014 to December 2015), patients with monomicrobial E-BSI were retrospectively enrolled. During the post- or intervention phase (January 2016 to December 2017), all patients with incident E-BSI were prospectively enrolled in a nonmandatory intervention arm comprising infectious disease consultation, echocardiography, follow-up blood cultures, and early targeted antibiotic treatment. Patients were followed up to 1 year after E-BSI. The primary outcome was 30-day mortality.

Results: Overall, 368 patients were enrolled, with 173 in the prephase and 195 in the postphase. The entire bundle was applied in 15% and 61% patients during the pre- and postphase, respectively (P < .001). Patients enrolled in the postphase had a significant lower 30-day mortality rate (20% vs 32%, P = .0042). At multivariate analysis, factors independently associated to mortality were age (hazard ratio [HR], 1.03; 95% confidence interval [CI], 1.00-1.05), intensive care unit admission (HR, 2.51; 95% CI, 1.18-3.89), and healthcare-associated (HR, 2.32; 95% CI, 1.05-5.16) and hospital-acquired infection (HR, 2.85; 95% CI, 1.34-4.76), whereas being enrolled in the postphase period (HR, 0.49; 95% CI, 0.32-0.75) was associated with improved survival. Results were consistent also in the subgroups with severe sepsis (HR, 0.37; 95% CI, 0.16-0.90) or healthcare-associated infections (HR, 0.53; 95% CI, 0.31-0.93). A significantly lower 1-year mortality was observed in patients enrolled in the postphase period (50% vs 68%, P < .001).

Conclusions: The introduction of a bundle for the management of E-BSI was associated with improved 30-day and 1-year survival.

Original language	English
Pages (from-to)	ofz473
Journal	Open Forum Infectious Diseases
Volume	6
Issue number	12
DOIs	https://doi.org/10.1093/ofid/ofz473
Publication status	Published - Dec 2019

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Impact on Mortality of a Bundle for the Management of Enterococcal Bloodstream Infection. / Bartoletti, Michele ; Tedeschi, Sara ; Scudeller, Luigia ; Pascale, Renato ; Rosselli Del Turco, Elena ; Trapani, Filippo ; Tumietto, Fabio ; Virgili, Giulio ; Marconi, Lorenzo ; Ianniruberto, Stefano ; Rinaldi, Matteo; Contadini, Ilaria; Cristini, Francesco; Bussini, Linda ; Campoli, Caterina ; Ambretti, Simone ; Berlingeri, Andrea ; Viale, Pierluigi ; Giannella, Maddalena.

In: Open Forum Infectious Diseases, Vol. 6, No. 12, 12.2019, p. ofz473.

Research output: Contribution to journal › Article › peer-review

Bartoletti, Michele ; Tedeschi, Sara ; Scudeller, Luigia ; Pascale, Renato ; Rosselli Del Turco, Elena ; Trapani, Filippo ; Tumietto, Fabio ; Virgili, Giulio ; Marconi, Lorenzo ; Ianniruberto, Stefano ; Rinaldi, Matteo ; Contadini, Ilaria ; Cristini, Francesco ; Bussini, Linda ; Campoli, Caterina ; Ambretti, Simone ; Berlingeri, Andrea ; Viale, Pierluigi ; Giannella, Maddalena. / Impact on Mortality of a Bundle for the Management of Enterococcal Bloodstream Infection. In: Open Forum Infectious Diseases. 2019 ; Vol. 6, No. 12. pp. ofz473.

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title = "Impact on Mortality of a Bundle for the Management of Enterococcal Bloodstream Infection",

abstract = "Objective: In this study, we evaluated the effectiveness of a management bundle for Enterococcus spp bloodstream infection (E-BSI).Method: This was a single-center, quasi-experimental (pre/post) study. In the prephase (January 2014 to December 2015), patients with monomicrobial E-BSI were retrospectively enrolled. During the post- or intervention phase (January 2016 to December 2017), all patients with incident E-BSI were prospectively enrolled in a nonmandatory intervention arm comprising infectious disease consultation, echocardiography, follow-up blood cultures, and early targeted antibiotic treatment. Patients were followed up to 1 year after E-BSI. The primary outcome was 30-day mortality.Results: Overall, 368 patients were enrolled, with 173 in the prephase and 195 in the postphase. The entire bundle was applied in 15% and 61% patients during the pre- and postphase, respectively (P < .001). Patients enrolled in the postphase had a significant lower 30-day mortality rate (20% vs 32%, P = .0042). At multivariate analysis, factors independently associated to mortality were age (hazard ratio [HR], 1.03; 95% confidence interval [CI], 1.00-1.05), intensive care unit admission (HR, 2.51; 95% CI, 1.18-3.89), and healthcare-associated (HR, 2.32; 95% CI, 1.05-5.16) and hospital-acquired infection (HR, 2.85; 95% CI, 1.34-4.76), whereas being enrolled in the postphase period (HR, 0.49; 95% CI, 0.32-0.75) was associated with improved survival. Results were consistent also in the subgroups with severe sepsis (HR, 0.37; 95% CI, 0.16-0.90) or healthcare-associated infections (HR, 0.53; 95% CI, 0.31-0.93). A significantly lower 1-year mortality was observed in patients enrolled in the postphase period (50% vs 68%, P < .001).Conclusions: The introduction of a bundle for the management of E-BSI was associated with improved 30-day and 1-year survival.",

author = "Michele Bartoletti and Sara Tedeschi and Luigia Scudeller and Renato Pascale and {Rosselli Del Turco}, Elena and Filippo Trapani and Fabio Tumietto and Giulio Virgili and Lorenzo Marconi and Stefano Ianniruberto and Matteo Rinaldi and Ilaria Contadini and Francesco Cristini and Linda Bussini and Caterina Campoli and Simone Ambretti and Andrea Berlingeri and Pierluigi Viale and Maddalena Giannella",

note = "{\textcopyright} The Author(s) 2019. Published by Oxford University Press on behalf of Infectious Diseases Society of America.",

year = "2019",

month = dec,

doi = "10.1093/ofid/ofz473",

language = "English",

volume = "6",

pages = "ofz473",

journal = "Open Forum Infectious Diseases",

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TY - JOUR

T1 - Impact on Mortality of a Bundle for the Management of Enterococcal Bloodstream Infection

AU - Bartoletti, Michele

AU - Tedeschi, Sara

AU - Scudeller, Luigia

AU - Pascale, Renato

AU - Rosselli Del Turco, Elena

AU - Trapani, Filippo

AU - Tumietto, Fabio

AU - Virgili, Giulio

AU - Marconi, Lorenzo

AU - Ianniruberto, Stefano

AU - Rinaldi, Matteo

AU - Contadini, Ilaria

AU - Cristini, Francesco

AU - Bussini, Linda

AU - Campoli, Caterina

AU - Ambretti, Simone

AU - Berlingeri, Andrea

AU - Viale, Pierluigi

AU - Giannella, Maddalena

PY - 2019/12

Y1 - 2019/12

N2 - Objective: In this study, we evaluated the effectiveness of a management bundle for Enterococcus spp bloodstream infection (E-BSI).Method: This was a single-center, quasi-experimental (pre/post) study. In the prephase (January 2014 to December 2015), patients with monomicrobial E-BSI were retrospectively enrolled. During the post- or intervention phase (January 2016 to December 2017), all patients with incident E-BSI were prospectively enrolled in a nonmandatory intervention arm comprising infectious disease consultation, echocardiography, follow-up blood cultures, and early targeted antibiotic treatment. Patients were followed up to 1 year after E-BSI. The primary outcome was 30-day mortality.Results: Overall, 368 patients were enrolled, with 173 in the prephase and 195 in the postphase. The entire bundle was applied in 15% and 61% patients during the pre- and postphase, respectively (P < .001). Patients enrolled in the postphase had a significant lower 30-day mortality rate (20% vs 32%, P = .0042). At multivariate analysis, factors independently associated to mortality were age (hazard ratio [HR], 1.03; 95% confidence interval [CI], 1.00-1.05), intensive care unit admission (HR, 2.51; 95% CI, 1.18-3.89), and healthcare-associated (HR, 2.32; 95% CI, 1.05-5.16) and hospital-acquired infection (HR, 2.85; 95% CI, 1.34-4.76), whereas being enrolled in the postphase period (HR, 0.49; 95% CI, 0.32-0.75) was associated with improved survival. Results were consistent also in the subgroups with severe sepsis (HR, 0.37; 95% CI, 0.16-0.90) or healthcare-associated infections (HR, 0.53; 95% CI, 0.31-0.93). A significantly lower 1-year mortality was observed in patients enrolled in the postphase period (50% vs 68%, P < .001).Conclusions: The introduction of a bundle for the management of E-BSI was associated with improved 30-day and 1-year survival.

AB - Objective: In this study, we evaluated the effectiveness of a management bundle for Enterococcus spp bloodstream infection (E-BSI).Method: This was a single-center, quasi-experimental (pre/post) study. In the prephase (January 2014 to December 2015), patients with monomicrobial E-BSI were retrospectively enrolled. During the post- or intervention phase (January 2016 to December 2017), all patients with incident E-BSI were prospectively enrolled in a nonmandatory intervention arm comprising infectious disease consultation, echocardiography, follow-up blood cultures, and early targeted antibiotic treatment. Patients were followed up to 1 year after E-BSI. The primary outcome was 30-day mortality.Results: Overall, 368 patients were enrolled, with 173 in the prephase and 195 in the postphase. The entire bundle was applied in 15% and 61% patients during the pre- and postphase, respectively (P < .001). Patients enrolled in the postphase had a significant lower 30-day mortality rate (20% vs 32%, P = .0042). At multivariate analysis, factors independently associated to mortality were age (hazard ratio [HR], 1.03; 95% confidence interval [CI], 1.00-1.05), intensive care unit admission (HR, 2.51; 95% CI, 1.18-3.89), and healthcare-associated (HR, 2.32; 95% CI, 1.05-5.16) and hospital-acquired infection (HR, 2.85; 95% CI, 1.34-4.76), whereas being enrolled in the postphase period (HR, 0.49; 95% CI, 0.32-0.75) was associated with improved survival. Results were consistent also in the subgroups with severe sepsis (HR, 0.37; 95% CI, 0.16-0.90) or healthcare-associated infections (HR, 0.53; 95% CI, 0.31-0.93). A significantly lower 1-year mortality was observed in patients enrolled in the postphase period (50% vs 68%, P < .001).Conclusions: The introduction of a bundle for the management of E-BSI was associated with improved 30-day and 1-year survival.

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DO - 10.1093/ofid/ofz473

M3 - Article

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JO - Open Forum Infectious Diseases

JF - Open Forum Infectious Diseases

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