Abstract
IntroductionThe aims of this study were to explore the incidence of in-hospital inappropriate empiric antibiotic use in patients with severe infection and to identify its relationship with patient outcomes.MethodsMedline (from 2004 to 2014) was systematically searched by using predefined inclusion criteria. Reference lists of retrieved articles were screened for additional relevant studies. The systematic review included original articles reporting a quantitative measure of the association between the use of (in)appropriate empiric antibiotics in patients with severe in-hospital infections and their outcomes. A meta-analysis, using a random-effects model, was conducted to quantify the effect on mortality by using risk ratios.ResultsIn total, 27 individual articles fulfilled the inclusion criteria. The percentage of inappropriate empiric antibiotic use ranged from 14.1% to 78.9% (Q1-Q3: 28.1% to 57.8%); 13 of 27 studies (48.1%) described an incidence of 50% or more. A meta-analysis for 30-day mortality and in-hospital mortality showed risk ratios of 0.71 (95% confidence interval 0.62 to 0.82) and 0.67 (95% confidence interval 0.56 to 0.80), respectively. Studies with outcome parameter 28-day and 60-day mortality reported significantly (P ≤0.02) higher mortality rates in patients receiving inappropriate antibiotics. Two studies assessed the total costs, which were significantly higher in both studies (P ≤0.01).ConclusionsThis systematic review with meta-analysis provides evidence that inappropriate use of empiric antibiotics increases 30-day and in-hospital mortality in patients with a severe infection.Electronic supplementary materialThe online version of this article (doi:10.1186/s13054-015-0795-y) contains supplementary material, which is available to authorized users.
Highlights
The aims of this study were to explore the incidence of in-hospital inappropriate empiric antibiotic use in patients with severe infection and to identify its relationship with patient outcomes
Definition and measuring incidence of (I)antibiotic treatment (AAT) We reviewed how empiric (I)AAT was defined and measured
Previous studies confirmed—as proven by the low number needed to treat—that correct antibiotic treatment is a crucial determinant of therapeutic success [66]
Summary
The aims of this study were to explore the incidence of in-hospital inappropriate empiric antibiotic use in patients with severe infection and to identify its relationship with patient outcomes. Infections are among the top three leading causes of death worldwide [1]. Bloodstream infections (BSIs) are associated with substantial morbidity, mortality, and health-care costs [3]. Sepsis is one of the leading causes of death in the critically ill, with a mortality rate of 28% to 55% [4]. Antibiotics are the mainstay of treatment for these serious infections [5]. Antibiotic treatment for moderate to severe infections has to start early and, in the absence of evidence on the causative pathogen or its sensitivity to antibiotics, is often guided by empirical evidence [6]
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