Task of diagnostic stewardship: Mortality–predicting risk factors in patients positive for blood culture

• Published in: Journal of Japan Society for Surgical Infection Vol. 17; no. 6; pp. 514 - 519
• Main Authors: Tamura, Tetsuro, Ueno, Takako, Kikuchi, Tetsuya, Yoshida, Junichi, Mataga, Akiko, Tanaka, Masao
• Format: Journal Article
• Language: Japanese
• Published: Japan Society for Surgical Infection 31.12.2020; 一般社団法人 日本外科感染症学会
• Subjects: Diagnostic stewardship; Sepsis–3; SOFA score
• ISSN: 1349-5755; 2434-0103
• DOI: 10.24679/gekakansen.17.6_514

Background: Diagnostic stewardship (DS) constitutes a triad of strategy in combination with antimicrobial stewardship (AS) and infection control. Of note, blood culture (BC) plays a pivotal role for resistant microbe. Herein, we analyzed risk factors such as age, gender, resistant microbes in BC, and difference in Sepsis Organ Failure Assessment (SOFA) score (Δ) for the primary endpoint of in–hospital death. Patients and methods: Subjects were in–patients during 2011–18 aged 15 years old or older, whose BC showed microbes excluding coagulase negative Staphylococci. Methods were logistic regression analyses to see risk factors for in–hospital deaths. Results: A total of 868 patients showed a total of 926 microbes at BC. They were aged 80 by median and included 474 men and 394 women. Their disease organs included the central nervous system (n=3), the respiratory system (n=188), the bloodstream (n=66), the urinary tract (n=270), the hepatobiliary pancreatic system (n=125), the peritoneal and alimentary tract (n=100), and the bone and soft tissue (n=116). For the primary endpoint of in–hospital death, significant factors were Δ≧2 (Odds Ratio 2.786, 95％ Confidence Interval 1.856–4.181; P＜0.001), methicillin–resistant S. aureus (MRSA) at BC (3.405, 1.646–7.046; P=0.001), and respiratory disease (2.850, 1.915–4.242; P＜0.001, respectively). Conclusion: For DS strategy, BC submitted before antimicrobial administration is the foremost. Targeting MRSA, its rapid diagnosis and specific treatment along with infection control are strongly indicated to prevent another drug–resistant infection.