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Infectio

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Abstract

CONTRERAS, María Encarnación Hernández et al. Influencia en la evolución de los pacientes con bacteriemia/candidemia de la participación activa del especialista clínico en Patología Infecciosa. Estudio de una cohorte prospectiva. Infect. [online]. 2017, vol.21, n.1, pp.32-38. ISSN 0123-9392.  http://dx.doi.org/10.22354/in.v21i1.639.

Introduction:

Our objective is to evaluate the impact of active care by an Infectious Diseases specialist (IDS) on the outcome of patients with bacteraemia/candidemia.

Patients and methods:

Observational, longitudinal and prospective study of a cohort of patients with bacteraemia/candidemia in a tertiary level hospital (2010-2011). Factors associated with treatment failure (persistent bacteraemia or related death) were analysed (bivariate and multivariate analysis).

Results:

A total of 324 episodes of bacteraemia were included, of which surveillance by IDS was implemented in 252 cases (78%). Acquisition was considered nosocomial or healthcare-related in 154 patients (47.5%) and community acquired in 170 (52.5%). More frequent sources of bacteraemia were urinary tract (31%), vascular catheter (14%), intra-abdominal (12%); and unknown (15%); 31.6% had a urinary catheter and 35.4% had a central venous catheter. When blood cultures were processed, 24% of patients had no fever (> 38 °C). Bacteraemia was persistent in 35 patients (11%). Overall mortality was 17.4% and 15% related (therapeutic "failure", 20%). Failure was associated with Pitt ≥ 3 (OR 7.94), McCabe III (OR 3.11), previous use of antibiotics (OR 2.93) and no active care by IDS (OR 2.44).

Conclusions:

In our study cohort, severity at presentation, underlying medical conditions, previous antibiotic use and no active Infectious Diseases specialist care

were statistically associated with mortality or microbiological failure.

Keywords : Outcome; Bacteraemia; Infectious disease consultant.

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