Clinical impact of time to results from the microbiology laboratory in bloodstream infections caused by carbapenemase-producing Enterobacterales (TIME-CPE STUDY)

• Published in: Journal of antimicrobial chemotherapy Vol. 78; no. 8; pp. 1948 - 1954
• Main Authors: De La Villa, Sofía, Sánchez-Carrillo, Carlos, Sánchez-Martínez, Celia, Cercenado, Emilia, Padilla, Belén, Álvarez-Uría, Ana, Aguilera-Alonso, David, Bermejo, Esther, Ramos, Rafael, Alcalá, Luis, Marín, Mercedes, Valerio, Maricela, Urbina, Luciana, Muñoz, Patricia
• Format: Journal Article
• Language: English
• Published: US Oxford University Press 02.08.2023
• ISSN: 0305-7453; 1460-2091
• DOI: 10.1093/jac/dkad188

Abstract Objectives To evaluate the impact of time to results (TTR) on the outcome of patients with carbapenemase-producing Enterobacterales bloodstream infections (CPE-BSI). Methods Times-series study conducted from January 2014 to December 2021, selecting patients with first CPE-BSI episodes. Periods of intervention were defined according to implementation of diagnostic bundle tests in the microbiology laboratory: pre-intervention (January 2014–December 2017) and post-intervention (January 2018–December 2021). TTR was defined as time elapsed from positivity time of the blood culture bottles to physicians’ notification of CPE-BSI episodes, and was evaluated in patients who received inappropriate empirical and switched to appropriate targeted treatment (switch group). Analysis of a composite unfavourable outcome (mortality at Day 30 and/or persistent and/or recurrent bacteraemia) was performed for the total episodes and in the switch group. Results One hundred and nine episodes were analysed: 66 pre-intervention and 43 post-intervention. Compared with pre-intervention, patients in the post-intervention period were younger (68 versus 63 years, P = 0.04), had INCREMENT score > 7 (31.8% versus 53.5%, P = 0.02) and unfavourable outcome (37.9% versus 20.9%, P = 0.04). Proportion of TTR > 30 h was more frequent pre-intervention than post-intervention (61.7% versus 35.5%, P = 0.02). In multivariate analysis of the 109 episodes, source other than urinary or biliary (OR 2.76, 95% CI 1.11–6.86) was associated with unfavourable outcome, while targeted appropriate treatment trended to being protective (OR 0.17, 95% CI 0.03–1.00). Considering the switch group (n = 78), source other than urinary or biliary (OR 14.9, 95% CI 3.25–69.05) and TTR > 30 h (OR 4.72, 95% CI 1.29–17.22) were associated with unfavourable outcome. Conclusions Decreased TTR in the post-intervention period was associated with the outcome in patients with CPE-BSI episodes.