Impact on mortality of a bundle for the management of enterococcal bloodstream infection

BACKGROUND In this study we evaluated the effectiveness of a management bundle for Enterococcus spp BSI (E-BSI). METHODS This was a single-center quasi-experimental (pre/post) study. In the “pre” phase (January 2014 to December 2015) patients with monomicrobial E-BSI were retrospectively enrolled. During the “post” or “intervention” phase (January 2016 to December 2017), all patients with incident E-BSI were prospectively enrolled in a non-mandatory intervention arm consisting in infectious disease consultation, echocardiography, follow-up blood cultures and early targeted antibiotic treatment. Patients were followed-up to 1 year after E-BSI. The primary outcome was 30-day mortality. RESULTS Overall, 368 patients were enrolled, 173 in the “pre” phase and 195 in the “post” phase. The entire bundle was applied in 15% and 61% patients during the “pre” and “post” phase, respectively (P<0.001). Patients enrolled in the post-phase had a significant lower 30-day mortality rate (20% vs 32%, P=0.0042). At multivariate analysis, factors independently associated to mortality were age [HR 1.03 (95%CI 1.00-1.05)], ICU admission [HR 2.51 (95%CI 1.18-3.89)] healthcare associated [HR 2.32 (95%CI 1.05-5.16)] and hospital-acquired infection [HR 2.85 (95%CI 1.34-4.76)] whereas being enrolled in the “post” period [HR 0.49 (95%CI 0.32-0.75)] was associated with improved survival. Results were consistent also in the subgroups with severe sepsis [HR 0.37 (95%CI 0.16-0.90)] or healthcare-associated infections [HR 0.53 (95%CI 0.31-0.93)]. A significative lower 1-year mortality was observed in patients enrolled in the “post” period (50% vs 68%,p<0.001). CONCLUSION The introduction of a bundle for the management of E-BSI was associated with improved 30-day and 1-year survival.