Objectives 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.

中文翻译：

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革兰氏阴性血流感染住院患者传染病咨询与死亡率之间的关联：一项回顾性全人群队列研究


目的 支持革兰氏阴性血流感染 (GN-BSI) 常规传染病 (ID) 咨询的数据有限。我们利用关联的健康管理数据库，在安大略省进行的一项回顾性人群范围队列研究中，评估了 GN-BSI 患者的 ID 咨询与死亡率之间的关联。方法纳入2017年4月至2021年12月期间住院的GN-BSI成年患者。主要结局是 30 天时的全因死亡率时间，使用混合效应 Cox 比例风险模型进行分析，并以医院为随机效应。首次血培养呈阳性后 1-10 天的 ID 咨询被视为随时间变化的暴露。结果 53 家医院的 30,159 名 GN-BSI 患者中，11,013 名（36.5%）接受了 ID 咨询。各医院 GN-BSI 患者的 ID 咨询患病率中位数为 35.0%，差异较大（范围 2.7-76.1%，四分位数范围 19.6-41.1%）。接受身份咨询的患者有 1041 名（9.5%）在 30 天内死亡，而没有接受身份咨询的患者有 1797 名（9.4%）死亡。在完全调整的多变量模型中，ID会诊与死亡率获益相关（调整后HR 0.82，95% CI 0.77-0.88，p < 0.0001；转化为绝对风险降低-3.8%或NNT为27）。主要结局的探索性亚组分析表明，ID 咨询对于具有高危特征（医院感染、多种微生物或非肠杆菌感染、抗菌素耐药性或非尿路来源）的患者可能有更大的益处。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，应考虑对该患者群体进行常规 ID 咨询，以改善患者的治疗结果。