Impact of Incremental Delays in Appropriate Therapy on the Outcomes of Hospitalized Adult Patients with Gram‐negative Bloodstream Infections: “Every day matters”

Abstract

Background Serious bloodstream infections (BSIs) are often caused by Gram‐negative (GN) bacteria in hospitalized patients. Treatment of these infections has been further complicated by the continued rise and spread of drug‐resistant pathogens, including carbapenem resistant (CR) strains of Enterobacteriaceae, Acinetobacter baumannii, and Pseudomonas aeruginosa. Methods This retrospective cohort analysis used real‐world data from a large United States hospital‐based database to examine the association between key clinical outcomes and different lengths of time to appropriate treatment between October 2010 and September 2015. Results Of 40,549 patients with GN‐BSIs who were identified, 1117 (2.8%) had a CR GN‐BSI. Overall, outcomes of hospitalized adult patients with GN‐BSIs incrementally worsened the longer appropriate therapy was delayed. Patients with CR GN‐BSIs had a median infection‐associated length of stay (LOS) of 8, 9, 10, and 13 days, whereas patients with CS GN‐BSIs had a median infection‐associated LOS of 6, 7, 8, and 11 days for patients with days to appropriate therapy of 0, 1–2, 3–4, and ≥ 5 days, respectively. Among patients with CR GN‐BSIs, the percentage of patients discharged home was 38%, 33%, 35%, and 31%, whereas in patients with CS GN‐BSIs, the percentage of patients discharged home was 58%, 53%, 48%, and 43% for patients with days to appropriate therapy of 0, 1–2, 3–4, and ≥ 5 days, respectively. Conclusion The findings from this study highlight the clear need to deliver appropriate therapy more expeditiously in patients with CS and CR GN‐BSIs.

Epidemiology and Economic Outcomes Associated with Timely versus Delayed Receipt of Appropriate Antibiotic Therapy among US Patients Hospitalized for Native Septic Arthritis: A Retrospective Cohort Study

“…Our findings are consistent with prior research indicating that the receipt of delayed appropriate antibiotic therapy among patients hospitalized with serious bacterial infections is associated with worse outcomes (all relative to the receipt of timely appropriate therapy) [ 4 , 15 ]. A high proportion of patients in our study sample received timely appropriate therapy, while similar studies in other disease areas suggest that delays in appropriate therapy occur more frequently (10–25%) [ 8 , 9 , 10 , 11 , 12 , 13 , 18 ].…”

“…The proportion of patients with at least one ESKAPE organism (i.e., Enterococcus faecium , S. aureus , Klebsiella pneumoniae , Acinetobacter baumannii , Pseudomonas aeruginosa , Enterobacter spp.) was ascertained [ 15 ]. Antibiotic agents and treatment regimens received by patients during the index admission were also tabulated.…”

Clinical Characteristics and Prognosis Analysis of Acinetobacter baumannii Bloodstream Infection Based on Propensity Matching

“… 22 , 32 Even every day matters. 33 Of course, not only the empirical antibiotic therapy but also the definitive therapy was related to the prognosis of patients with Acinetobacter baumannii BSI. Some studies showed that colistin-containing therapies were associated with survival rates.…”

Activity of Omadacycline Alone and in Combination against Carbapenem-Nonsusceptible Acinetobacter baumannii with Varying Minocycline Susceptibility

“…The inability to achieve bactericidal activity in vitro , the obstinate link between resistance and delays in time to effective antimicrobial therapy, and the high mortality rates associated with monotherapy against CNSAb strongly support the use of combination therapy ( 8 , 15 ). Even when faced with favorable MICs, monotherapy is often inadequate as was demonstrated well in the recent cefiderocol CREDIBLE-CR study in which 85% of patients received cefiderocol monotherapy versus 72% combination therapy in the best available therapy (BAT) group ( 16 ).…”