Delayed Treatment of Bloodstream Infection at Admission is Associated With Initial Low Early Warning Score and Increased Mortality
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Delayed Treatment of Bloodstream Infection at Admission is Associated With Initial Low Early Warning Score and Increased Mortality. / Fischer, Christian P.; Kastoft, Emili; Olesen, Bente Ruth Scharvik; Myrup, Bjarne.
In: Critical Care Explorations, Vol. 5, No. 9, E0959, 2023.Research output: Contribution to journal › Journal article › Research › peer-review
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TY - JOUR
T1 - Delayed Treatment of Bloodstream Infection at Admission is Associated With Initial Low Early Warning Score and Increased Mortality
AU - Fischer, Christian P.
AU - Kastoft, Emili
AU - Olesen, Bente Ruth Scharvik
AU - Myrup, Bjarne
N1 - Publisher Copyright: © 2023 Wolters Kluwer Health. All rights reserved.
PY - 2023
Y1 - 2023
N2 - OBJECTIVES: To identify factors associated with antibiotic treatment delay in patients admitted with bloodstream infections (BSIs). DESIGN: Retrospective cohort study. SETTING: North Zealand Hospital, Denmark. PATIENTS: Adult patients with positive blood cultures obtained within the first 48 hours of admission between January 1, 2015, and December 31, 2015 (n = 926). MEASUREMENTS AND MAIN RESULTS: First recorded Early Warning Score (EWS), patient characteristics, time to antibiotic treatment, and survival at day 60 after admission were obtained from electronic health records and medicine module. Presence of contaminants and the match between the antibiotic treatment and susceptibility of the cultured microorganism were included in the analysis. Data were stratified according to EWS quartiles. Overall, time from admission to prescription of antibiotic treatment was 3.7 (3.4-4.0) hours, whereas time from admission to antibiotic treatment was 5.7 (5.4-6.1) hours. A gap between prescription and administration of antibiotic treatment was present across all EWS quartiles. Importantly, 23.4% of patients admitted with BSI presented with an initial EWS 0-1. Within this group of patients, time to antibiotic treatment was markedly higher among nonsurvivors at day 60 compared with survivors. Furthermore, time to antibiotic treatment later than 6 hours was associated with increased mortality at day 60. Among patients with an initial EWS of 0-1, 51.3% of survivors received antibiotic treatment within 6 hours, whereas only 19.0% of nonsurvivors received antibiotic treatment within 6 hours. CONCLUSIONS: Among patients with initial low EWS, delay in antibiotic treatment of BSIs was associated with increased mortality at day 60. Lag from prescription to administration may contribute to delayed antibiotic treatment. A more frequent reevaluation of patients with infections with a low initial EWS and reduction of time from prescription to administration may reduce the time to antibiotic treatment, thus potentially improving survival.
AB - OBJECTIVES: To identify factors associated with antibiotic treatment delay in patients admitted with bloodstream infections (BSIs). DESIGN: Retrospective cohort study. SETTING: North Zealand Hospital, Denmark. PATIENTS: Adult patients with positive blood cultures obtained within the first 48 hours of admission between January 1, 2015, and December 31, 2015 (n = 926). MEASUREMENTS AND MAIN RESULTS: First recorded Early Warning Score (EWS), patient characteristics, time to antibiotic treatment, and survival at day 60 after admission were obtained from electronic health records and medicine module. Presence of contaminants and the match between the antibiotic treatment and susceptibility of the cultured microorganism were included in the analysis. Data were stratified according to EWS quartiles. Overall, time from admission to prescription of antibiotic treatment was 3.7 (3.4-4.0) hours, whereas time from admission to antibiotic treatment was 5.7 (5.4-6.1) hours. A gap between prescription and administration of antibiotic treatment was present across all EWS quartiles. Importantly, 23.4% of patients admitted with BSI presented with an initial EWS 0-1. Within this group of patients, time to antibiotic treatment was markedly higher among nonsurvivors at day 60 compared with survivors. Furthermore, time to antibiotic treatment later than 6 hours was associated with increased mortality at day 60. Among patients with an initial EWS of 0-1, 51.3% of survivors received antibiotic treatment within 6 hours, whereas only 19.0% of nonsurvivors received antibiotic treatment within 6 hours. CONCLUSIONS: Among patients with initial low EWS, delay in antibiotic treatment of BSIs was associated with increased mortality at day 60. Lag from prescription to administration may contribute to delayed antibiotic treatment. A more frequent reevaluation of patients with infections with a low initial EWS and reduction of time from prescription to administration may reduce the time to antibiotic treatment, thus potentially improving survival.
KW - bacteremia
KW - blood culture
KW - organ dysfunction scores
KW - systemic inflammatory response syndrome
KW - triage
U2 - 10.1097/CCE.0000000000000959
DO - 10.1097/CCE.0000000000000959
M3 - Journal article
C2 - 37644974
AN - SCOPUS:85170664805
VL - 5
JO - Critical Care Explorations
JF - Critical Care Explorations
SN - 2639-8028
IS - 9
M1 - E0959
ER -
ID: 368247807