Declining mortality but increasing impact of medical complexity among patients with healthcare-associated bloodstream infections
Nicole Claire Vissichelli, Stephen Biederman, Alexandra Bryson, Marie Kreck, Gonzalo Bearman, Leroy Thacker, Richard P. WenzelAbstract
Objective:
To determine how inpatient mortality associated with healthcare-associated bloodstream infections (HCA-BSI) in patients with high medical complexity and risk for frailty has changed since the implementation of sepsis-response interventions and the COVID-19 pandemic.
Design:
Retrospective cohort study.
Setting:
Tertiary care center.
Patients:
Patients with HCA-BSI in 2010 (preintervention), 2018 (postintervention) and 2023 (postCOVID).
Methods:
Using a modified Poisson regression, we estimated relative risk of inpatient mortality in 2010 (preintervention), 2018 (postintervention), and 2023 (postCOVID), associated with high Elixhauser comorbidity index (ECI), a validated score identifying increased risk of prolonged hospitalization and in-hospital mortality.
Results:
We included 931 patients. The rate of HCA-BSI (number per 10,000 patient-days) decreased from 4.2 in 2010 to 3.2 in 2018 but increased to 13.0 in 2023. Inpatient mortality was 21% in 2010, 26% in 2018, and 16% in 2023. While patients with both low and high ECI scores had a decrease in inpatient mortality in 2023, those with high ECI scores had an increase in mortality compared to 2010. ECI became a stronger predictor of mortality over time.
Conclusions:
The decline in mortality in patients with HCA-BSI with low ECI scores was likely due to successful infection prevention, sepsis-response interventions, and improved diagnostics. Despite this decline, increased comorbidities associated with higher risk for frailty had a larger role in mortality in 2023, suggesting a need for more targeted interventions in this population.