Delayed Reporting of Microbiological Information Negatively Affects BSI Prognosis

Reporting microbiologic information in real time may improve survival outcomes among patients with bloodstream infections (BSIs), according to results of a study published in Clinical Infectious Diseases.

This retrospective study was designed to compare BSI-related mortality outcomes between periods in which microbiological information was provided to infectious disease specialists in real time vs delayed for at least 8 hours. Researchers evaluated patients (N=6225) with BSIs who were admitted to a hospital in Spain between 2013 and 2019. The primary endpoint was 30-day mortality. Positive blood culture results obtained and reported during daytime working hours were considered real-time microbiological information. Positive blood culture results obtained during the night and reported the following morning were considered delayed microbiological information.

Among patients included in the analysis, microbiological information was sourced in real time for 2130 and delayed for 4095. Overall, the median patient age was 67 (IQR, 55-77) years, 39.00% were women, 64.88% had hospital-acquired bacteremia, 49.72% were catheterized, and 16.27% developed septic shock.

The majority of clinical characteristics were similar between patients in the real-time vs delayed information groups. However, rates of women (37.18% vs 39.95%; P =.03), catheter placement (47.9% vs 50.66%; P =.04), corticosteroid use (20.73% vs 23.36%; P =.02), and persistent bacteremia (7.75% vs 9.39%; P =.03) were significantly lower among patients in the real-time information group.

The most common sources of infection were urinary tract (23.87%), unknown (20.31%), abdominal (19.86%), and catheter (18.57%).

Overall, 30-day mortality occurred among 193 patients in the real-time information group and 432 in the delayed information group. In a univariate analysis, delayed reporting of microbiological information was associated with increased risk of mortality (odds ratio [OR], 1.18; 95% CI, 0.99-1.42; P =.06). Stratified by bacterial etiology, the risk of 30-mortality was significantly increased among patients with Enterobacterales BSI for whom microbiologic information was delayed vs sourced in real time (OR, 1.76; 95% CI, 1.30-2.38; P =.00).

Significant predictors of 30-day mortality due to Enterobacterales BSI were identified in a multivariate analysis. These included the occurrence of septic shock (OR, 5.20; P <.001) and disseminated intravascular coagulation (OR, 4.08; P <.001); delayed reporting of microbiological information (OR, 2.22; P <.001); and pulmonary (OR, 6.85; P <.001), abdominal (OR, 4.17; P <.001), and cutaneous (OR, 4.04; P =.008) vs urinary infection source.

The results of this study may not be generalizable to other hospitals, particularly those that do not have microbiologists and infectious disease specialists available at all times.

“The descriptive nature of the study cannot conclusively attribute mortality to the delay in communication of clinically relevant results,” the researchers noted. “However, we would cautiously speculate that lack of specialist coverage may affect the prognosis of BSI,” they added.