1
|
Morquin D, Lejeune J, Agostini C, Godreuil S, Reynes J, Le Moing V, Lamy B. Time Is of the Essence: Achieving Prompt and Effective Antimicrobial Therapy of Bloodstream Infection With Advanced Hospital Information Systems. Clin Infect Dis 2024; 78:1434-1442. [PMID: 38059510 DOI: 10.1093/cid/ciad744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Revised: 11/28/2023] [Accepted: 12/01/2023] [Indexed: 12/08/2023] Open
Abstract
The early administration of appropriate antibiotic therapy is crucial for the survival of patients with bacteremia. Current research focuses on improving analytical times through technology, whereas there have been very few efforts to improve postanalytical times even though they represent 40% of the time between blood taking and appropriate treatment administration. One of the clues is the efficiency and appropriateness of the result communication system. Here, we review all delays in the entire process with the aim of improving time to appropriate treatment administration. We discuss causes for long times to adjust treatment once microbiological results are released. We argue that the pervasive health information system in this organization serves as both a bottleneck and a rigid framework. Finally, we explore how next-generation hospital information systems should be designed to effectively assist the doctors in treating patients with bacteremia.
Collapse
Affiliation(s)
- David Morquin
- Département des Maladies Infectieuses et Tropicales, CHU Montpellier, Montpellier, France
- Espace de Recherche et d'Intégration des Outils numériques en Santé (ERIOS), CHU Montpellier, Montpellier, France
| | - Jordan Lejeune
- Département des Maladies Infectieuses et Tropicales, CHU Montpellier, Montpellier, France
| | - Céline Agostini
- Département des Maladies Infectieuses et Tropicales, CHU Montpellier, Montpellier, France
| | - Sylvain Godreuil
- Laboratoire de bactériologie, CHU Montpellier, Université Montpellier, Montpellier, France
| | - Jacques Reynes
- Département des Maladies Infectieuses et Tropicales CHU, CHU Montpellier, Université Montpellier, Montpellier, France
| | - Vincent Le Moing
- Département des Maladies Infectieuses et Tropicales CHU, CHU Montpellier, Université Montpellier, Montpellier, France
| | - Brigitte Lamy
- UFR Médecine, Université Côte d'Azur, CHU de Nice, INSERM, C3M, Nice, France
- UFR SMBH, Université Sorbonne Paris Nord, Bobigny, France
- Service de Microbiologie, Assistance publique - Hopitaux de Paris (APHP), Hôpitaux Universitaires Paris Seine Saint-Denis (HUPSSD), Bobigny, France
| |
Collapse
|
2
|
Müller MM, Baldauf C, Hornischer S, Klassert TE, Schneegans A, Behnert A, Pletz MW, Hagel S, Slevogt H. Staphylococcus aureus induces tolerance in human monocytes accompanied with expression changes of cell surface markers. Front Immunol 2023; 14:1046374. [PMID: 37063823 PMCID: PMC10104166 DOI: 10.3389/fimmu.2023.1046374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Accepted: 03/16/2023] [Indexed: 04/03/2023] Open
Abstract
Exposure of human monocytes to lipopolysaccharide (LPS) or other pathogen-associated molecular pattern (PAMPs) induces a temporary insensitivity to subsequent LPS challenges, a cellular state called endotoxin tolerance (ET), associated with the pathogenesis of sepsis. In this study, we aimed to characterize the cellular state of human monocytes from healthy donors stimulated with Staphylococcus aureus in comparison to TLR2-specific ligands. We analyzed S. aureus induced gene expression changes after 2 and 24 hours by amplicon sequencing (RNA-AmpliSeq) and compared the pro-inflammatory response after 2 hours with the response in re-stimulation experiments. In parallel, glycoprotein expression changes in human monocytes after 24 hours of S. aureus stimulation were analyzed by proteomics and compared to stimulation experiments with TLR2 ligands Malp-2 and Pam3Cys and TLR4 ligand LPS. Finally, we analyzed peripheral blood monocytes of patients with S. aureus bloodstream infection for their ex vivo inflammatory responses towards S. aureus stimulation and their glycoprotein expression profiles. Our results demonstrate that monocytes from healthy donors stimulated with S. aureus and TLR ligands of Gram-positive bacteria entered the tolerant cell state after activation similar to LPS treatment. In particular reduced gene expression of pro-inflammatory cytokines (TNF, IL1β) and chemokines (CCL20, CCL3, CCL4, CXCL2, CXCL3 and CXCL8) could be demonstrated. Glycoprotein expression changes in monocytes tolerized by the different TLR agonists were highly similar while S. aureus-stimulated monocytes shared some of the PAMP-induced changes but also exhibited a distinct expression profile. 11 glycoproteins (CD44, CD274, DSC2, ICAM1, LAMP3, LILRB1, PTGS2, SLC1A3, CR1, FGL2, and HP) were similarly up- or downregulated in all four comparisons in the tolerant cell state. Monocytes from patients with S. aureus bacteremia revealed preserved pro-inflammatory responsiveness to S. aureus stimulation ex vivo, expressed increased CD44 mRNA but no other glycoprotein of the tolerance signature was differentially expressed.
Collapse
Affiliation(s)
- Mario M. Müller
- Septomics Research Center, Jena University Hospital, Jena, Germany
- Integrated Research and Treatment Center - Center for Sepsis Control and Care (CSCC), Jena University Hospital, Jena, Germany
| | | | | | - Tilman E. Klassert
- Septomics Research Center, Jena University Hospital, Jena, Germany
- Department of Respiratory Medicine, Hannover Medical School, Hannover, Germany
| | | | - Andrea Behnert
- Septomics Research Center, Jena University Hospital, Jena, Germany
- Integrated Research and Treatment Center - Center for Sepsis Control and Care (CSCC), Jena University Hospital, Jena, Germany
| | - Mathias W. Pletz
- Institute for Infectious Diseases and Infection Control, Jena University Hospital – Friedrich Schiller University Jena, Jena, Germany
| | - Stefan Hagel
- Institute for Infectious Diseases and Infection Control, Jena University Hospital – Friedrich Schiller University Jena, Jena, Germany
| | - Hortense Slevogt
- Septomics Research Center, Jena University Hospital, Jena, Germany
- Department of Respiratory Medicine, Hannover Medical School, Hannover, Germany
- *Correspondence: Hortense Slevogt,
| |
Collapse
|
3
|
Veillette JJ, May SS, Gabrellas AD, Gelman SS, Albritton J, Lyons MD, Stenehjem EA, Webb BJ, Dalto JD, Throneberry SK, Stanfield V, Grisel NA, Vento TJ. A Fully Integrated Infectious Diseases and Antimicrobial Stewardship Telehealth Service Improves Staphylococcus aureus Bacteremia Bundle Adherence and Outcomes in 16 Small Community Hospitals. Open Forum Infect Dis 2022; 9:ofac549. [PMID: 36381624 PMCID: PMC9645643 DOI: 10.1093/ofid/ofac549] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Accepted: 10/12/2022] [Indexed: 02/03/2024] Open
Abstract
Background Infectious diseases (ID) and antimicrobial stewardship (AS) improve Staphylococcus aureus bacteremia (SAB) outcomes. However, many small community hospitals (SCHs) lack on-site access to these services, and it is not known if ID telehealth (IDt) offers the same benefit for SAB. We evaluated the impact of an integrated IDt service on SAB outcomes in 16 SCHs. Methods An IDt service offering IDt physician consultation plus IDt pharmacist surveillance was implemented in October 2016. Patients treated for SAB in 16 SCHs between January 2009 and August 2019 were identified for review. We compared SAB bundle adherence and outcomes between patients with and without an IDt consult (IDt group and control group, respectively). Results A total of 423 patients met inclusion criteria: 157 in the IDt group and 266 in the control group. Baseline characteristics were similar between groups. Among patients completing their admission at an SCH, IDt consultation increased SAB bundle adherence (79% vs 23%; odds ratio [OR], 16.9; 95% CI, 9.2-31.0). Thirty-day mortality and 90-day SAB recurrence favored the IDt group, but the differences were not statistically significant (5% vs 9%; P = .2; and 2% vs 6%; P = .09; respectively). IDt consultation significantly decreased 30-day SAB-related readmissions (9% vs 17%; P = .045) and increased length of stay (median [IQR], 5 [5-8] days vs 5 [3-7] days; P = .04). In a subgroup of SAB patients with a controllable source, IDt appeared to have a mortality benefit (2% vs 9%; OR, 0.12; 95% CI, 0.01-0.98). Conclusions An integrated ID/AS telehealth service improved SAB management and outcomes at 16 SCHs. These findings provide important insights for other IDt programs.
Collapse
Affiliation(s)
- John J Veillette
- Infectious Diseases TeleHealth Service, Intermountain Medical Center, Murray, Utah, USA
- Department of Pharmacy, Intermountain Medical Center, Murray, Utah, USA
| | - Stephanie S May
- Infectious Diseases TeleHealth Service, Intermountain Medical Center, Murray, Utah, USA
- Department of Pharmacy, Intermountain Medical Center, Murray, Utah, USA
| | - Alithea D Gabrellas
- Division of Infectious Diseases, University of Utah, Salt Lake City, Utah, USA
| | - Stephanie S Gelman
- Infectious Diseases TeleHealth Service, Intermountain Medical Center, Murray, Utah, USA
- Division of Clinical Epidemiology and Infectious Diseases, Intermountain Medical Center, Murray, Utah, USA
| | - Jordan Albritton
- TeleHealth Services, Intermountain Healthcare, Midvale, Utah, USA
- RTI International, Durham, North Carolina, USA
| | - Michael D Lyons
- TeleHealth Services, Intermountain Healthcare, Midvale, Utah, USA
| | - Edward A Stenehjem
- Division of Clinical Epidemiology and Infectious Diseases, Intermountain Medical Center, Murray, Utah, USA
- Division of Infectious Diseases and Geographic Medicine, Stanford University School of Medicine, Stanford, California, USA
| | - Brandon J Webb
- Division of Clinical Epidemiology and Infectious Diseases, Intermountain Medical Center, Murray, Utah, USA
- Division of Infectious Diseases and Geographic Medicine, Stanford University School of Medicine, Stanford, California, USA
| | - Joseph D Dalto
- TeleHealth Services, Intermountain Healthcare, Midvale, Utah, USA
| | - S Kyle Throneberry
- Infectious Diseases TeleHealth Service, Intermountain Medical Center, Murray, Utah, USA
- Division of Clinical Epidemiology and Infectious Diseases, Intermountain Medical Center, Murray, Utah, USA
| | - Valoree Stanfield
- Division of Clinical Epidemiology and Infectious Diseases, Intermountain Medical Center, Murray, Utah, USA
| | - Nancy A Grisel
- Division of Clinical Epidemiology and Infectious Diseases, Intermountain Medical Center, Murray, Utah, USA
| | - Todd J Vento
- Infectious Diseases TeleHealth Service, Intermountain Medical Center, Murray, Utah, USA
- Division of Clinical Epidemiology and Infectious Diseases, Intermountain Medical Center, Murray, Utah, USA
| |
Collapse
|