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Microbiology test result reporting times and association with outcomes of adults hospitalised with unspecified pneumonia: a data linkage study.

Background: Pneumonia is one of the leading causes of mortality and
morbidity worldwide. Microbiology tests play a critical role in the
diagnosis of pneumonia. Our study aimed to determine microbiology result
reporting times and evaluate its association with outcomes of adult
patients (≥18 years) hospitalized with pneumonia. Methods: A 3-year
(2016-2018) retrospective cohort study in six hospitals in New South
Wales, Australia. Study data were obtained by linking hospital and
laboratory system databases. Result reporting times including time from
admission to the first and the last microbiology test results were
determined. The outcome measures were hospital length of stay (LOS) and
in-hospital mortality. We fit median and logistic regression to evaluate
the association of time-to-first microbiological result with hospital
LOS and in-hospital mortality respectively. Results: A total of 6,298
patients met the inclusion criteria. Of these, 85.3% (n=5,375) ordered
at least one microbiology test. The top 5 microbiology tests were blood
culture, urine culture, respiratory polymerase chain reaction (PCR),
urine antigen and sputum culture. The median time-to-first microbiology
result was 26 hrs while the median time-to last test result was 144 hrs.
The rate of in-hospital mortality was 5.9% (n=371). After adjusting for
confounders, every 5 hrs increase in the time to-first microbiology test
was associated with an increase of 3.9 hrs in the median hospital LOS
[95% Confidence Interval (CI), 3.5 to 4.3; P<0.001].
There was no association between time-to-first microbiology result and
in-hospital mortality (OR 1.01; 95% CI 1.00-1.02; P=0.122). Conclusion:
Time-to-first microbiology result reporting was significantly associated
with hospital LOS but not with in-hospital mortality. Further research
should be conducted to understand if improving result reporting times
can reduce the length of hospital stay of patients. Key words:
Microbiology diagnostics; Test result reporting; Pneumonia; Diagnostic
informatics