Quality of care indicators in the MAnageMent of BlOOdstream infections caused by Enterobacteriaceae (MAMBOO-E study): state of the art and research agenda.

Abstract Objective : The impact on outcome of five interventions was reviewed in order to investigate the state-of-art for management of Enterobacteriaceae bloodstream infection (E-BSI). Methods : We searched for randomized controlled trials (RCTs) and observational studies, published from January 2008 to March 2019 on PUBMED, EMBASE and COCHRANE library. Populations consisted of patients with E-BSI. Interventions: i. performance of imaging to assess BSI source and/or complications; ii. follow-up blood culture (FU-BC); iii. use of loading dose followed by extended/continuous infusion (E/CI) of beta-lactams; iv. duration of treatment (short vs. long-term); and v. infectious disease (ID) consultation. Patients without intervention were considered as controls. The main outcome was 30-day mortality. RoB 2.0 and ROBINS-I tools were used for bias assessment. Results : No study was eligible for intervention i, iii and v. For FU-BC, one observational study including 901 patients with E-BSI was considered. Intervention consisted of repeating BCs within 2-7 days after index BCs. All-cause 30-day mortality was observed in 35 out of 247 patients (14.2%) in the intervention group vs. 96 out of 654 patients (14.7%) in the control group. For short treatment duration, two RCTs and six observational studies were included comprising 4473 patients with E-BSI. All-cause mortality was similar in short and long treatment groups (OR 1.10, 95% CI 0.83-1.84). Conclusions : Out of the assessed interventions, only short treatment duration in non-immunocompromised patients with E-BSI is supported by current data. Studies investigating the use of systematic imaging, follow-up BCs, E/CI beta-lactams and ID consultation in patients with E-BSI are needed.