Effect on 30-day mortality and duration of hospitalization of empirical antibiotic therapy in CRGNB-infected pneumonia

Rongrong Li,Shujin Li,Kunwei Cui,Huaming Xu,Hao Tang,Jilu Shen

doi:10.1186/s12941-021-00421-2

Abstract

BackgroundThe objective of this study was to investigate whether unreasonable empirical antibiotic treatment (UEAT) had an impact on 30-day mortality and duration of hospitalization in bacterial pneumonia caused by carbapenem-resistant gram-negative bacteria (CRGNB).MethodsThis was a retrospective cohort study involving CRGNB-infected pneumonia. All CRGNB-infected pneumonia patients received empirical and targeted antibiotic treatment (TAT), and they were divided into reasonable empirical antibiotic treatment (REAT) and UEAT according to whether the empirical antibiotic treatment (EAT) was reasonable. The data of the two groups were compared to analyze their influence on the 30-day mortality and hospitalization time in CRGNB-infected pneumonia patients. Moreover, we also considered other variables that might be relevant and conducted multivariable regression analysis of 30-day mortality and duration of hospitalization in CRGNB-infected pneumonia patients.ResultsThe study collected 310 CRGNB-infected pneumonia patients, the most common bacterium is Acinetobacter baumannii (211/310 [68%]), the rest were Klebsiella pneumoniae (46/310 [15%]), Pseudomonas aeruginosa and others (53/310 [17%]). Among them, 76/310 (24.5%) patients received REAT. In the analysis of risk factors, dementia, consciousness were risk factors of 30-day mortality, pulmonary disease, hemodynamic support at culture taken day and recent surgery were risk factors for longer hospital stay. The analysis of 30-day mortality showed that UEAT was not associated with 30-day mortality for the 30-day mortality of REAT and UEAT were 9 of 76 (11.84%) and 36 of 234 (15.38%) (P = 0.447), respectively. Meanwhile, there was difference between REAT and UEAT (P = 0.023) in the analysis of EAT on hospitalization time in CRGNB-infected pneumonia patients.ConclusionsUEAT was not associated with 30-day mortality while was related to duration of hospitalization in CRGNB-infected pneumonia patients, in which Acinetobacter baumanniii accouned for the majority.

Highlights

empirical antibiotic treatment (EAT) was carried out before the identification of bacteria and the determination of drug susceptibility
In the analysis of risk factors, dementia, unconsciousness were risk factors of 30-day mortality and pulmonary disease, hemodynamic support at culture taken day and recent surgery were risk factors for longer hospital stay. 30-day mortality was 9 of 76(11.84%) with reasonable empirical antibiotic treatment (REAT) vs 36 of 234 (15.38%) with unreasonable empirical antibiotic treatment (UEAT) (P =0.447), UEAT was not associated with 30-day mortality
UEAT was not associated with 30-day mortality while was related to duration of hospitalization in carbapenem-resistant gram-negative bacteria (CRGNB)-infected pneumonia, in which Acinetobacter baumanniii accouned for the majority

Summary

Introduction

EAT was carried out before the identification of bacteria and the determination of drug susceptibility. The excessive or unreasonable use of antibiotics were related to the increase of bacterial resistance, side effects and treatment costs. These problem were related to the treatment of infected patients by clinicians [10]. For some patients who needed catheter insertion, such as nasal catheter, mask, tracheal intubation and so on, bacteria entered the body through the catheter cavity and lead to catheter-related infection . The untime treatment of such infection often resulted in death[12]. Based on this background, we studied the effects of EAT on 30day mortality and hospital length of stay

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