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Bloodstream Infection: The Influence of Risk Factors, Etiology and Antimicrobial Therapy on Mortality Rates

Abstract

Rosana de Oliveira Santos Guimarães, Thúlio Marquez Cunha, Ana Carolina Souza Oliveira, Lúcio Borges de Araújo, Reginaldo dos Santos Pedroso and Denise Von Dolinger de Brito Röder*

Introduction: Inappropriate initial antimicrobial therapy leads to higher mortality in patients with bloodstream infection. This study aimed to evaluate the relationship between risk factors, etiology and antimicrobial therapy on mortality rates of patients with bloodstream infection. Methods: Between January 2016 to December 2016, 167 patients with bloodstream infection were prospectively evaluated according to the presence or absence of inappropriate antimicrobial therapy of infection. Hospital mortality was the main outcome variable compared between the two study groups. Results: Infected patients who received inappropriate antimicrobial therapy had statistically more diabetes mellitus, chronic obstructive pulmonary disease, chronic renal disease and death than infected patients who initially received appropriate antimicrobial therapy. Loading dose error and error in starting antimicrobial administration were the most frequently detected error in our study and both were determinant factors related to increased mortality. Initial antimicrobial therapy was maintained, escalation and de-escalation 67.6%, 22.7% and 9.6% of cases, respectively. Coagulase negative staphylococci represented the majority reaching 40.7% and multi-drug resistant microorganisms were detected in 27.3% of infections. There was no observed difference in mortality rates among infections caused by resistant or susceptible microorganisms. Conclusion: Loading dose error and error in starting antimicrobial administration, were the most frequently detected error in our study and both were determinant factors related to increased mortality. Beside the multiple logistic regression analysis revealed that the delay in starting antimicrobial therapy was the only independent factor that increased mortality.