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Do death certificates accurately record deaths due to bloodstream infection?

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To the Editor: Sepsis and bloodstream infection (BSI) are associated with significant morbidity and mortality although they are amenable to targeted intervention in the hospital setting. The Australian Bureau of Statistics (ABS) reported 1463 deaths due to septicaemia in Australia in 20121 — a number that is likely an underestimate.2

These statistics are based on reporting of cause of death on death certificates by medical practitioners. However, previous studies in Australia have found inaccuracies in reporting, with major revision of cause of death required in half of cases referred for coronial review.3 The need for education of reporting doctors and supervision by senior clinicians has been highlighted.4

A review of BSI at our institution during 2012 identified 571 patient episodes of BSI. We were able to analyse death certificates for 65 of 73 patients who died within 30 days of a clinically significant blood culture. The mortality from BSI reported in the literature is high, with a 30-day mortality rate of up to 23% for BSI with any organism, and up to 43.9% for BSI involving methicillin-resistant Staphylococcus aureus.5,6We thus assumed that BSI was likely to…