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

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Abstract

In this study, we evaluated the effectiveness of a management bundle for Enterococcus spp bloodstream infection (E-BSI).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.Overall, 368 patients were enrolled, with 173 in the prephase and 195 in the postphase. The entire bundle was applied in 15\1\ and postphase, respectively (P \lt; .001). Patients enrolled in the postphase had a significant lower 30-day mortality rate (20\2\ P = .0042). At multivariate analysis, factors independently associated to mortality were age (hazard ratio [HR], 1.03; 95\CI], 1.00–1.05), intensive care unit admission (HR, 2.51; 95\ 1.18–3.89), and healthcare-associated (HR, 2.32; 95\ 1.05–5.16) and hospital-acquired infection (HR, 2.85; 95\ 1.34–4.76), whereas being enrolled in the postphase period (HR, 0.49; 95\ 0.32–0.75) was associated with improved survival. Results were consistent also in the subgroups with severe sepsis (HR, 0.37; 95\ 0.16–0.90) or healthcare-associated infections (HR, 0.53; 95\ 0.31–0.93). A significantly lower 1-year mortality was observed in patients enrolled in the postphase period (50\8\ P \lt; .001).The introduction of a bundle for the management of E-BSI was associated with improved 30-day and 1-year survival.
Original languageUndefined/Unknown
JournalOpen Forum Infect. Dis.
Volume6
Issue number12
DOIs
Publication statusPublished - Nov 1 2019

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