Mortality after Delay of Adequate Empiric Antimicrobial Treatment of Bloodstream Infection.

Merel M. C. Lambregts,Saskia le Cessie,Leo G. Visser,Roos Wijnakker,Alexandra T. Bernards,Mark G. J. de Boer

doi:10.3390/jcm9051378

Merel M. C. Lambregts, Saskia le Cessie + Show 4 more

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https://doi.org/10.3390/jcm9051378

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Abstract

Background: Timely empiric antimicrobial therapy is one of the cornerstones of the management of suspected bloodstream infection (BSI). However, studies about the effects of empiric therapy on mortality have reported inconsistent results. The objective of this study was to estimate the effect of delay of appropriate empiric therapy on early mortality in patients with BSI. Methods: Data for the propensity score matching (PSM) study were obtained from a cohort of patients with BSI. Inadequate empiric treatment was defined as in vitro resistance to the antimicrobial regimen administered <6 h after blood cultures were taken. The primary outcome measure was 14-day mortality. Thirty-day mortality and median length of stay (LOS) were secondary outcomes. PSM was applied to control for confounding. Results: Of a total of 893 included patients with BSI, 35.7% received inadequate initial empiric treatment. In the PSM cohort (n = 334), 14-day mortality was 9.6% for inadequate antibiotic treatment, compared to. 10.2% in adequate empiric treatment (p = 0.85). No prolonged median LOS was observed in patients who initially received inadequate therapy (10.5 vs. 10.7 days, p = 0.89). Conclusions: In this study, we found no clear effect of inadequate empirical treatment on mortality in a low-risk BSI population. The importance of early empiric therapy compared to other determinants, may be limited. This may not apply for specific subpopulations, e.g., patients with sepsis.

Highlights

Bacterial bloodstream infections (BSI) have an increasing incidence worldwide and are associated with considerable morbidity and high mortality rates [1,2]
A meta-analysis of prospective observational studies performed by Paul et al in 2010 concluded that all-cause mortality was lower in patients receiving adequate empiric antimicrobial treatment
The low average Pitt bacteremia score and quick sequential organ failure assessment score (qSOFA) (Table 1) in the current study shows that the majority of patients were only mild to moderately ill

Summary

Introduction

Bacterial bloodstream infections (BSI) have an increasing incidence worldwide and are associated with considerable morbidity and high mortality rates [1,2]. In previous studies inadequate empiric antimicrobial treatment was found to be associated with mortality. Empiric antimicrobial therapy is one of the cornerstones of the management of suspected bloodstream infection (BSI). The objective of this study was to estimate the effect of delay of appropriate empiric therapy on early mortality in patients with BSI. Results: Of a total of 893 included patients with BSI, 35.7% received inadequate initial empiric treatment. No prolonged median LOS was observed in patients who initially received inadequate therapy (10.5 vs 10.7 days, p = 0.89). Conclusions: In this study, we found no clear effect of inadequate empirical treatment on mortality in a low-risk BSI population. The importance of early empiric therapy compared to other determinants, may be limited This may not apply for specific subpopulations, e.g., patients with sepsis

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