Immediate initiation of proper antibiotics in patients with bacteremia is important. However, in various countries including Japan, it has not been a part of standard care to evaluate and intervene in the cases where blood culture results become positive over holidays, including weekends. Moreover, little is known about the epidemiology or clinical impact of positive blood culture results obtained over holidays.
To optimize the response to positive blood culture results over holidays, infectious diseases (ID) specialists began evaluating and intervening for such cases since June 2015. If ID specialists identified any cases of bacteremia on suboptimal antimicrobial coverage, they contacted the primary team for modification of antibiotic treatment. We retrospectively reviewed patients whose blood culture results became positive over holidays and compared the pre-intervention period (09/2014–05/2015) with the post-intervention period (06/2015–02/2016) to evaluate the impact of intervention.
A total of 886 bacteremia episodes were included in the current study (median age [IQR]; 73 [61.3–83], men; 511 [57.7%]). Post- and pre-intervention groups included 487 (55.0%) and 399 (45.0%) episodes, respectively. During the post-intervention period, 165 (33.9%) bacteremia episodes were detected over holidays. After the intervention, ID specialists evaluated the positive blood culture results 1-, 2-, and 3-days prior in 72 (14.8%), 73 (15.0%), and 20 (4.1%) cases, respectively. The 7-day mortality (post- vs. pre-intervention: 5.9% vs. 5%, p=0.82), 30-day mortality (20.8% vs. 21.6%, p=0.88), and the duration of hospitalization after bacteremia (median days [IQR]: 13 [5–23] vs. 14 [5–24], p=0.79) did not significantly improve after the intervention.
We found that blood cultures became positive during holidays in one third of bacteremia cases. Even though clinical outcome parameters such as mortality or duration of hospitalization did not change after the intervention in this study, further research is warranted on parameters associated with optimal use of antibiotics. Cases of positive blood culture results over holidays could be important targets for antimicrobial stewardship.
K. Mezaki, None
Y. Katanami, None
K. Yamamoto, None
S. Kutsuna, None
N. Takeshita, None
N. Ohmagari, None