Benefit of appropriate empirical antibiotic treatment: 30-day mortality and duration of hospital stay
Abstract number: o440
Fraser A., Paul M., Almanasreh N., Tacconelli E., Frank U., Cauda R., Borok S., Andreassen S., Nielsen A.D., Leibovici L.,
To evaluate the effect of inappropriate antibiotic treatment on mortality and duration of hospital stay in a relatively low-risk study population of medical inpatients with bacterial infections.
Two cohorts of febrile patients, hospitalized in 3 medical centers in Israel, Italy and Germany were included. Patients' data were collected prospectively. Initial empirical treatment was defined as appropriate if an antibiotic prescribed within 24 hours of the first encounter with the patient, matched the in-vitro susceptibility of a pathogen deemed to be the likely cause of infection. Results of cultures and serological or direct tests as well as data on outcomes were collected 30 days after initiation of empirical treatment. A multiple logistic regression model was constructed to assess the impact of inappropriate antibiotic treatment on mortality while adjusting for medical center and other variables. A General Linear Model (GLM) was used to examine the association between inappropriate antibiotic treatment and duration of hospitalization while controlling for medical center and other variables.
Nine hundred and twenty patients (26% of 3529 included patients) had microbiologically documented infections and mortality data were available for 895 patients (97%). Inappropriate initial antibiotic treatment was prescribed in 36% of patients (N = 319), with similar proportions in all 3 participating centers (p = 0.33). All-cause 30-day mortality rates were 20.1% (N = 64) and 11.8% (N = 68) in patients who received inappropriate and appropriate treatment, respectively (OR = 1.88, 95%CI: 1.292.72, p = 0.001). When adjusting for medical center and other clinical variables, the association between inappropriate antibiotic treatment and mortality was OR = 1.58 (95%CI: 0.992.54, p = 0.058) (Table). In all 3 medical centers, mean duration of hospital stay was at least 2 days longer for patients prescribed inappropriate antibiotic treatment (overall p = 0.002). This association was consistent after adjusting for other clinical variables (p = 0.006).
Appropriate empirical antibiotic treatment is associated with a better survival and shortened duration of hospital stay in medical patients.
|Session name:||XXIst ISTH Congress|
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