The benefit of appropriate empirical antibiotic treatment in patients with bloodstream infection

Abstract

Appropriate empirical antibiotic treatment was associated with a significant reduction in fatality in patients with bloodstream infection.

Etiology, clinical features and outcomes of pre-engraftment and post-engraftment bloodstream infection in hematopoietic SCT recipients

“…However, the proportion of patients who received an appropriate empirical antibiotic therapy was similar in both periods, as was the time to initial adequate antibiotic therapy. Although inadequate empirical antibiotic therapy has been associated with poor outcome in patients with BSI, 38 we did not find this relationship. A plausible explanation for this finding is that the great majority of patients (50%) who received inappropriate empirical antibiotic therapy had catheter-related Abbreviations: CI = confidence interval; HSCT = hematopoietic SCT; MDRGNB = multidrug-resistant Gram-negative bacilli; OR = odds ratios; VGS = viridians group streptococci.…”

Vancomycin use in a hospital with high prevalence of Methicillin-Resistant Staphylococcus aureus: comparison with Hospital Infection Control Practices Advisory Committe Guidelines (HICPAC)

“…and meningitis) are improved by early therapy with active agents against the organisms which are subsequently identified by appropriate culture. Subsequently testing and provision of inadequate therapy is closely correlated with adverse patient outcomes, including increased rates of hospital mortality [39][40][41][42]. Solomkin et al (2004) affirmed that hospitals with more than 20% of MRSA should use vancomycin in empiric treatment [43].…”

Evidence‐based sepsis therapy: A hospitalist perspective

“…Only 63% of 3413 subjects received an antibiotic active against the infecting pathogen, and their mortality was 20%, 14% lower than that in the group that received ineffective antibiotics (P ϭ .0001). 25 Other authors have reported even worse outcomes with ineffective therapy: 62% mortality among inadequately treated bacteremic or fungemic ICU patients, compared with 28.4% among those who were adequately treated 26 and an odds ratio of dying of 8.14 for the 46 of 270 septic ICU patients who received inadequate initial antibiotics, 27 making inadequate antibiotic therapy the strongest risk factor for death. Finally, Kollef et al reported that 26% of 655 infected ICU patients received inadequate antibiotics and suffered an infection-related mortality rate of 40.2%, more than twice the 17.7% rate among adequately treated patients (P Ͻ .001).…”

“…74 Figure 3 compares the corresponding NNT values to save 1 life; according to the available data, a hospitalist is 5-8 times more likely to save a life with EGDT than with fibrinolysis. Because the literature supporting several major sepsis therapies have been limited to retrospective studies [18][19][20][21][22][23][24][25][26][27][28] and single randomized, controlled trials 29,36 and because key trials are still underway (CORTICUS, NICE-SUGAR), the benefits of sepsis therapies are less certain than are those for the treatment of MI. This was underscored by the finding that the benefit in reduced mortality of intensive insulin in the surgical ICU 57 did not extend to all patients in the medical ICU.…”