Impact of a multidisciplinary management team on clinical outcome in ICU patients affected by Gram-negative bloodstream infections: a pre-post quasi-experimental study

• Published in: Annals of intensive care Vol. 14; no. 1; p. 36
• Main Authors: Rinaldi, Matteo, Gatti, Milo, Tonetti, Tommaso, Nocera, Domenico, Ambretti, Simone, Berlingeri, Andrea, Nigrisoli, Giacomo, Pierucci, Elisabetta, Siniscalchi, Antonio, Pea, Federico, Viale, Pierluigi, Giannella, Maddalena
• Format: Journal Article
• Language: English
• Published: Cham Springer International Publishing 06.03.2024; Springer Nature B.V; SpringerOpen
• Subjects: Anesthesiology; Antibiotics; Critical Care Medicine; Critically ill patients; Emergency Medicine; Gram-negative bacteraemia; Infectious diseases; Intensive; Intensive care; Medicine; Medicine & Public Health; Multidisciplinary management team; Multidisciplinary teams; Multidrug resistant organisms; Pathogens; Multidisciplinary management team; Gram-negative bacteraemia; Critically ill patients
• ISSN: 2110-5820; 2110-5820
• DOI: 10.1186/s13613-024-01271-9

Background Bloodstream infections (BSIs) by Gram-negative pathogens play a major role in intensive care patients, both in terms of prevalence and severity, especially if multi-drug resistant pathogens are involved. Early appropriate antibiotic therapy is therefore a cornerstone in the management of these patients, and growing evidence shows that implementation of a multidisciplinary team may improve patients’ outcomes. Our aim was to evaluate the clinical and microbiological impact of the application of a multidisciplinary team on critically ill patients. Methods Pre-post study enrolling critically ill patients with Gram negative bloodstream infection in intensive care unit. In the pre-intervention phase (from January until December 2018) patients were managed with infectious disease consultation on demand, in the post-intervention phase (from January until December 2022) patients were managed with a daily evaluation by a multidisciplinary team composed of intensivist, infectious disease physician, clinical pharmacologist and microbiologist. Results Overall, 135 patients were enrolled during the study period, of them 67 (49.6%) in the pre-intervention phase and 68 (50.4%) in the post-intervention phase. Median age was 67 (58–75) years, sex male was 31.9%. Septic shock, the need for continuous renal replacement therapy and mechanical ventilation at BSI onset were similar in both groups, no difference of multidrug-resistant organisms (MDRO) prevalence was observed. In the post-phase, empirical administration of carbapenems decreased significantly (40.3% vs. 62.7%, p  = 0.02) with an increase of appropriate empirical therapy (86.9% vs. 55.2%, p  < 0.001) and a decrease of overall antibiotic treatment (12 vs. 16 days, p  < 0.001). Despite no differences in delta SOFA and all-cause 30-day mortality, a significant decrease in microbiological failure (10.3% vs. 29.9%, p  = 0.005) and a new-onset 30-day MDRO colonization (8.3% vs. 36.6%, p  < 0.001) in the post-phase was reported. At multivariable analysis adjusted for main covariates, the institution of a multidisciplinary management team (MMT) was found to be protective both for new MDRO colonization [OR 0.17, 95%CI(0.05–0.67)] and microbiological failure [OR 0.37, 95%CI (0.14–0.98)]. Conclusions The institution of a MMT allowed for an optimization of antimicrobial treatments, reflecting to a significant decrease in new MDRO colonization and microbiological failure among critically ill patients.