The relationship between clinical outcomes and empirical antibiotic therapy in patients with community-onset Gram-negative bloodstream infections: a cohort study from a large teaching hospital

Aryee, Anna; Rockenschaub, Patrick; Gill, Martin J.; Hayward, Andrew; Shallcross, Laura

doi:10.1017/s0950268820002083

Cited by 8 publications

(7 citation statements)

References 22 publications

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“…Discordant empirical antimicrobial therapy was defined as active antimicrobial therapy not administered within 48 hours after obtaining blood culture samples. 27 28 …”

Section: Methodsmentioning

confidence: 99%

Antimicrobial Susceptibility Trends and Risk Factors for Antimicrobial Resistance inPseudomonas aeruginosaBacteremia: 12-Year Experience in a Tertiary Hospital in Korea

et al. 2021

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Background Infections caused by multidrug-resistant Pseudomonas aeruginosa (MDRPA) have been on the rise worldwide, and delayed active antimicrobial therapy is associated with high mortality. However, few studies have evaluated increases in P. aeruginosa infections with antimicrobial resistance and risk factors for such antimicrobial resistance in Korea. Here, we analyzed changes in antimicrobial susceptibility associated with P. aeruginosa bacteremia and identified risk factors of antimicrobial resistance. Methods The medical records of patients with P. aeruginosa bacteremia who were admitted to a tertiary hospital between January 2009 and October 2020 were retrospectively reviewed. Antibiotic resistance rates were compared among the time periods of 2009–2012, 2013–2016, and 2017–2020 and between the intensive care unit (ICU) and non-ICU setting. Empirical antimicrobial therapy was considered concordant, if the organism was susceptible to antibiotics in vitro, and discordant, if resistant. Results During the study period, 295 patients with P. aeruginosa bacteremia were identified. The hepatobiliary tract (26.8%) was the most common primary site of infection. The rates of carbapenem-resistant P. aeruginosa (CRPA), MDRPA, and extensively drug-resistant P. aeruginosa (XDRPA) were 24.7%, 35.9%, and 15.9%, respectively. XDRPA showed an increasing trend, and CRPA, MDRPA, and XDRPA were also gradually increasing in non-ICU setting. Previous exposure to fluoroquinolones and glycopeptides and urinary tract infection were independent risk factors associated with CRPA, MDRPA, and XDRPA. Previous exposure to carbapenems was an independent risk factor of CRPA. CRPA, MDRPA, and XDRPA were associated with discordant empirical antimicrobial therapy. Conclusion The identification of risk factors for antimicrobial resistance and analysis of antimicrobial susceptibility might be important for concordant empirical antimicrobial therapy in patients with P. aeruginosa bacteremia.

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“…Discordant empirical antimicrobial therapy was defined as active antimicrobial therapy not administered within 48 hours after obtaining blood culture samples. 27 28 …”

Section: Methodsmentioning

confidence: 99%

Antimicrobial Susceptibility Trends and Risk Factors for Antimicrobial Resistance inPseudomonas aeruginosaBacteremia: 12-Year Experience in a Tertiary Hospital in Korea

et al. 2021

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“…We speculate that this may be due to the fact that patients received AUEAT were worse off, as they were older and had a higher proportion of fever, treat with vasopressor, and use mechanical ventilation. Illness severity and age were independent predictors of mortality 29,30 . Actually, age and illness severity are correlated.…”

Section: Discussionmentioning

confidence: 95%

Appropriateness of Empirical Antibiotic Therapy in Bacterial Culture-Positive Inpatients: A Retrospective Cohort Study

Luo

Guo

Liu

et al. 2022

Preprint

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Objectives We aimed to evaluate the prevalence, relative factors, and outcomes of different empirical antibiotic therapy (EAT) prescriptions in infected inpatients. Methods We performed a retrospective cohort analysis of inpatients a tertiary hospital in China between October 1, 2019 and September 30, 2020. Bacterial culture-positive patients received EAT were enrolled in this study. We initially assessed the prevalence of different EAT prescriptions by univariate analysis, and then used an enter multivariable logistic regression model to calculate adjusted odds ratios for assessing relative factors and outcomes of them. Results 1,257 infected patients received EAT on the day of sampling culture. 31.7% (398/1257) received appropriate but unnecessarily broad-spectrum empirical antibiotic therapy (AUEAT), and 37.3% (469/1257) received inappropriate empirical antibiotic therapy (IEAT). Age was a correlated factor of receiving AUEAT and IEAT. The odds of receiving AUEAT and IEAT increased with age (adjusted OR 1.023 [95% CI, 1.013 ~ 1.032]; p < 0.001; 1.009 [95% CI, 1.001 ~ 1.018]; p = 0.033). Patients who received AUEAT and IEAT had higher rates of ICU care and increased hospital costs. AUEAT has a higher proportion of poor prognosis (29.4%, 117/398, p < 0.001). Respiratory tract was the most common infection site (418/1257, 33.3%). The common pathogens were Escherichia coli (315/1257, 25.1%), Klebsiella species (208/1257, 16.5%), Staphylococcus aureus (204/1257, 16.2%), and Pseudomonas species (167/1257, 13.3%). 45.3% (570/1257) patients were infected with multidrug-resistant organism (MDRO), of which 53.5% (305/570) received IEAT. Among 305 MDRO infected patients with IEAT, 71.5% (218/305) were infected with Gram-negative bacteria. The majority of Gram-negative bacteria was Enterobacteriaceae (178/218, 81.7%), among which E. coli (116/178, 65.2%) and Klebsiella (38/178, 21.3%) strains accounted for high proportions. Conclusions Inappropriate or unnecessarily broad-spectrum use of antibiotics is widely prevalent in hospital. AUEAT and IEAT were bound to increase antimicrobial resistance, rates of ICU care, and health care costs. AUEAT was associated with increased risk of poor prognosis. Near half of inpatients infected with MDRO, and these patients were more likely to receive IEAT. Early identification of infectious pathogens and resistance can provide the basis for rational use of antibiotics and improve the current situation of antibiotic abuse and antimicrobial resistance.

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“…However, the relationship between inappropriate empiric treatment and outcome is conflicting. Aryee et al [62] found that 14.6% of patients with community-acquired GNBSI received inappropriate empiric treatment. Inappropriate treatment was associated with in-hospital mortality for K. pneumoniae BSI but not for Escherichia coli BSI, the latter mostly from a urinary source.…”

Section: Empiric Treatmentmentioning

confidence: 99%

New evidence for managing Gram-negative bloodstream infections

Nutman

Tellapragada

Giske

et al. 2021

Current Opinion in Infectious Diseases

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Purpose of reviewGram-negative bloodstream infections (GNBSI) are common and carry considerable mortality. Treatment is complicated by increasing antimicrobial resistance, posing a challenge for timely appropriate antibiotics and limiting the choices of effective definitive therapy. The present review aims to summarize recent studies addressing the management of GNBSI. Recent findingsNew rapid diagnostic tests (RDT) for pathogen identification and antibiotic susceptibility are associated with improved antimicrobial stewardship and reduced length of stay. No mortality benefit or patient-related outcomes are reported. Data regarding the use of new beta-lactam beta-lactamase inhibitors (BLBLIs) for treating multidrug resistance Gram-negative bacteria is supportive, though questions regarding combinations, optimal dosing, mode of administration, and resistance emergence remain to be clarified. Current data regarding cefiderocol necessitates further studies in order to support its use in GNBSI. Shortened ( 7 days) duration of therapy and early oral step down for GNBSI are supported by the literature. The role of repeated blood cultures should be further defined. SummaryRDTs should be implemented to improve antibiotic stewardship. Clinical implications on patient-related outcomes should be evaluated. New BLBLIs show promise in the treatment of GNBSI. Additional data are needed regarding the use of cefiderocol. Antibiotic therapy should be shortened and early oral step down should be considered.

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The relationship between clinical outcomes and empirical antibiotic therapy in patients with community-onset Gram-negative bloodstream infections: a cohort study from a large teaching hospital

Abstract: The relationship between clinical outcomes and empirical antibiotic therapy in patients with community-onset Gram-negative bloodstream infections: a cohort study from a large teaching hospital. Epidemiology and Infection 148, e225, 1-8.

Cited by 8 publications

References 22 publications

Antimicrobial Susceptibility Trends and Risk Factors for Antimicrobial Resistance inPseudomonas aeruginosaBacteremia: 12-Year Experience in a Tertiary Hospital in Korea

Antimicrobial Susceptibility Trends and Risk Factors for Antimicrobial Resistance inPseudomonas aeruginosaBacteremia: 12-Year Experience in a Tertiary Hospital in Korea

Appropriateness of Empirical Antibiotic Therapy in Bacterial Culture-Positive Inpatients: A Retrospective Cohort Study

New evidence for managing Gram-negative bloodstream infections

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