Inappropriate empirical antibiotic therapy for bloodstream infections based on discordant in-vitro susceptibilities: a retrospective cohort analysis of prevalence, predictors, and mortality risk in US hospitals

Kadri, Sameer S; Lai, Yanhao; Warner, Sarah; Strich, Jeffrey R; Babiker, Ahmed; Ricotta, Emily; Demirkale, Cumhur Y; Dekker, John P.; Palmore, Tara N.; Rhee, Chanu; Klompas, Michael; Hooper, David C.; Powers, John H.; Srinivasan, Arjun; Danner, Robert L.; Adjemian, Jennifer

doi:10.1016/s1473-3099(20)30477-1

Cited by 180 publications

(141 citation statements)

References 31 publications

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“…Second, the study sample was relatively small compared to other multicenter studies on empiric antibiotic therapy [ 7 , 27 ]. Local hospitals cannot undertake such a large study for quality improvement projects.…”

Section: Discussionmentioning

confidence: 99%

Local audit of empiric antibiotic therapy in bacteremia: A retrospective cohort study

et al. 2021

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Background It is unclear if a local audit would be useful in providing guidance on how to improve local practice of empiric antibiotic therapy. We performed an audit of antibiotic therapy in bacteremia to evaluate the proportion and risk factors for inadequate empiric antibiotic coverage. Methods This retrospective cohort study included patients with positive blood cultures across 3 hospitals in Hamilton, Ontario, Canada during October of 2019. Antibiotic therapy was considered empiric if it was administered within 24 hours after blood culture collection. Adequate coverage was defined as when the isolate from blood culture was tested to be susceptible to the empiric antibiotic. A multivariable logistic regression model was used to predict inadequate empiric coverage. Diagnostic accuracy of a clinical pathway based on patient risk factors was compared to clinician’s decision in predicting which bacteria to empirically cover. Results Of 201 bacteremia cases, empiric coverage was inadequate in 56 (27.9%) cases. Risk factors for inadequate empiric coverage included unknown source at initiation of antibiotic therapy (adjusted odds ratio (aOR) of 2.76 95% CI 1.27–6.01, P = 0.010) and prior antibiotic therapy within 90 days (aOR of 2.46 95% CI 1.30–4.74, P = 0.006). A clinical pathway that considered community-associated infection as low risk for Pseudomonas was better at ruling out Pseudomonas bacteremia with a negative likelihood ratio of 0.17 (95% CI 0.03–1.10) compared to clinician’s decision with negative likelihood ratio of 0.34 (95% CI 0.10–1.22). Conclusions An audit of antibiotic therapy in bacteremia is feasible and may provide useful feedback on how to locally improve empiric antibiotic therapy.

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Section: Discussionmentioning

confidence: 99%

Local audit of empiric antibiotic therapy in bacteremia: A retrospective cohort study

et al. 2021

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“…Bloodstream infection (BSI) is the seventh leading cause of death in the United States [1] . Appropriate clinical and antimicrobial management of BSI are crucial to improve patient survival [ 2 , 3 ]. The importance of follow up blood cultures (FUBC) has been well established in Staphylococcus aureus BSI where obtaining FUBC has been associated with improved clinical outcomes [ 4 , 5 ].…”

Section: Introductionmentioning

confidence: 99%

Impact of follow up blood cultures on outcomes of patients with community-onset gram-negative bloodstream infection

Amipara¹,

Winders²,

Justo³

et al. 2021

EClinicalMedicine

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Background: The role of follow up blood cultures (FUBC) in the management of gram-negative bloodstream infection (GN-BSI) remains controversial. This retrospective cohort study examines the association between obtaining FUBC and mortality in GN-BSI. Methods: Hospitalized adults with community-onset GN-BSI at Prisma Health-Midlands hospitals in South Carolina, USA from January 1, 2010 to June 30, 2015 were identified. Patients who died or were discharged from hospital within 72 h were excluded to minimize impact of survival and selection biases on results, respectively. Multivariate Cox proportional hazards regression was used to examine association between obtaining FUBC and 28-day all-cause mortality after adjustment for the propensity to obtain FUBC. Findings: Among 766 patients with GN-BSI, 219 (28.6%) had FUBC obtained and 15 of 219 (6.8%) FUBC were persistently positive. Overall, median age was 67 years, 438 (57%) were women, 457 (60%) had urinary source of infection, and 426 (56%) had BSI due to Escherichia coli. Mortality was significantly lower in patients who had FUBC obtained than in those who did not have FUBC (6.3% vs. 11.7%, log-rank p = 0.03). Obtaining FUBC was independently associated with reduced mortality (hazards ratio 0.47, 95% confidence intervals: 0.23À0.87; p = 0.02) after adjustments for age, chronic comorbidities, acute severity of illness, appropriateness of empirical antimicrobial therapy, and propensity to obtain FUBC. Interpretation: Improved survival in hospitalized patients with GN-BSI who had FUBC is consistent with the results of recent publications from Italy and North Carolina supporting utilization of FUBC in management of GN-BSI. Funding: This study had no funding source.

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“…GN-BSI accounts for 279,000 cases and 33,500–41,900 deaths annually in the USA based on the current population. Source control and early initiation of appropriate empirical antimicrobial therapy remain the most important modifiable variables for improving the clinical outcomes of patients with GN-BSI [ 4 , 5 , 6 ]. However, increasing antimicrobial resistance rates of Gram-negative bloodstream isolates continues to pose serious challenges to patients, clinicians, and researchers.…”

mentioning

confidence: 99%

Gram-Negative Bloodstream Infection: Implications of Antimicrobial Resistance on Clinical Outcomes and Therapy

Al-Hasan

2020

Antibiotics

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Inappropriate empirical antibiotic therapy for bloodstream infections based on discordant in-vitro susceptibilities: a retrospective cohort analysis of prevalence, predictors, and mortality risk in US hospitals

Cited by 180 publications

References 31 publications

Local audit of empiric antibiotic therapy in bacteremia: A retrospective cohort study

Local audit of empiric antibiotic therapy in bacteremia: A retrospective cohort study

Impact of follow up blood cultures on outcomes of patients with community-onset gram-negative bloodstream infection

Gram-Negative Bloodstream Infection: Implications of Antimicrobial Resistance on Clinical Outcomes and Therapy

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