Abstract：
OBJECTIVE: Data supporting routine infectious diseases (ID) consultation in Gram-negative bloodstream infection (GN-BSI) are limited. We evaluated the association between ID consultation and mortality in patients with GN-BSI in a retrospective population-wide cohort study in Ontario using linked health administrative databases.
METHODS: Hospitalized adult patients with GN-BSI between April 2017 and December 2021 were included. The primary outcome was time to all-cause mortality censored at 30 days, analyzed using a mixed effects Cox proportional hazards model with hospital as a random effect. ID consultation 1-10 days after the first positive blood culture was treated as a time-varying exposure.
RESULTS: Of 30,159 patients with GN-BSI across 53 hospitals, 11,013 (36.5%) received ID consultation. Median prevalence of ID consultation for patients with GN-BSI across hospitals was 35.0% with wide variability (range 2.7-76.1%, interquartile range 19.6-41.1%). 1041 (9.5%) patients who received ID consultation died within 30 days, compared to 1797 (9.4%) patients without ID consultation. In the fully-adjusted multivariable model, ID consultation was associated with mortality benefit (adjusted HR 0.82, 95% CI 0.77-0.88, p < 0.0001; translating to absolute risk reduction of -3.8% or NNT of 27). Exploratory subgroup analyses of the primary outcome showed that ID consultation could have greater benefit in patients with high-risk features (nosocomial infection, polymicrobial or non-Enterobacterales infection, antimicrobial resistance, or non-urinary tract source).
CONCLUSIONS: Early ID consultation was associated with reduced mortality in patients with GN-BSI. If resources permit, routine ID consultation for this patient population should be considered to improve patient outcomes.
METHODS: Hospitalized adult patients with GN-BSI between April 2017 and December 2021 were included. The primary outcome was time to all-cause mortality censored at 30 days, analyzed using a mixed effects Cox proportional hazards model with hospital as a random effect. ID consultation 1-10 days after the first positive blood culture was treated as a time-varying exposure.
RESULTS: Of 30,159 patients with GN-BSI across 53 hospitals, 11,013 (36.5%) received ID consultation. Median prevalence of ID consultation for patients with GN-BSI across hospitals was 35.0% with wide variability (range 2.7-76.1%, interquartile range 19.6-41.1%). 1041 (9.5%) patients who received ID consultation died within 30 days, compared to 1797 (9.4%) patients without ID consultation. In the fully-adjusted multivariable model, ID consultation was associated with mortality benefit (adjusted HR 0.82, 95% CI 0.77-0.88, p < 0.0001; translating to absolute risk reduction of -3.8% or NNT of 27). Exploratory subgroup analyses of the primary outcome showed that ID consultation could have greater benefit in patients with high-risk features (nosocomial infection, polymicrobial or non-Enterobacterales infection, antimicrobial resistance, or non-urinary tract source).
CONCLUSIONS: Early ID consultation was associated with reduced mortality in patients with GN-BSI. If resources permit, routine ID consultation for this patient population should be considered to improve patient outcomes.
摘要：
目的：支持革兰氏阴性血流感染（GN-BSI）常规感染性疾病（ID）咨询的数据有限。我们在安大略省的一项回顾性全人群队列研究中，使用链接的健康管理数据库，评估了ID咨询与GN-BSI患者死亡率之间的关联。
方法：纳入2017年4月至2021年12月期间GN-BSI住院的成年患者。主要结果是全因死亡率审查时间为30天，使用混合效应Cox比例风险模型分析，医院为随机效应。第一次阳性血培养后1-10天的ID咨询被视为随时间变化的暴露。
结果：在53家医院的30,159名GN-BSI患者中，11013（36.5%）接受了身份证咨询。各医院GN-BSI患者的ID咨询的中位数患病率为35.0％，差异很大（范围为2.7-76.1％，四分位数间距19.6-41.1%）。1041名（9.5%）接受ID咨询的患者在30天内死亡，与未进行ID咨询的1797例（9.4％）患者相比。在完全调整的多变量模型中，ID咨询与死亡率获益相关(调整后HR0.82,95%CI0.77-0.88,p<0.0001;转化为绝对风险降低-3.8%或NNT为27)。对主要结局的探索性亚组分析表明，ID咨询对具有高风险特征的患者（医院感染，多微生物或非肠杆菌感染，抗菌素耐药性，或非尿路源)。
结论：早期ID咨询与GN-BSI患者死亡率降低相关。如果资源允许,应考虑对该患者人群进行常规ID咨询,以改善患者预后.
方法：纳入2017年4月至2021年12月期间GN-BSI住院的成年患者。主要结果是全因死亡率审查时间为30天，使用混合效应Cox比例风险模型分析，医院为随机效应。第一次阳性血培养后1-10天的ID咨询被视为随时间变化的暴露。
结果：在53家医院的30,159名GN-BSI患者中，11013（36.5%）接受了身份证咨询。各医院GN-BSI患者的ID咨询的中位数患病率为35.0％，差异很大（范围为2.7-76.1％，四分位数间距19.6-41.1%）。1041名（9.5%）接受ID咨询的患者在30天内死亡，与未进行ID咨询的1797例（9.4％）患者相比。在完全调整的多变量模型中，ID咨询与死亡率获益相关(调整后HR0.82,95%CI0.77-0.88,p<0.0001;转化为绝对风险降低-3.8%或NNT为27)。对主要结局的探索性亚组分析表明，ID咨询对具有高风险特征的患者（医院感染，多微生物或非肠杆菌感染，抗菌素耐药性，或非尿路源)。
结论：早期ID咨询与GN-BSI患者死亡率降低相关。如果资源允许,应考虑对该患者人群进行常规ID咨询,以改善患者预后.
