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Risk factors for inadequate antimicrobial treatment in patients with bloodstream infection

Abstract number: 1733_456

Vallés J., Calbo E., Anoro E., Fontanals D., Xercavins M., Espejo E., Serrate G., Morera M., Freixas N., Font B., Bella F., Segura F., Garau X.

Objective: Analyse the risk factors for ineffective antimicrobial therapy in patients with bloodstream infections (BI).

Methods: Prospective cohort study of adults with BI at three hospitals during one year. BI was defined as nosocomial-acquired (NA), community-acquired (CA), and healthcare-associated (HA).

Results: Of 1157 BI, 581 (50.2%) were CA, 295 (25.5%) were NA, and 281 (24.3%) were HA. Patients with NA received inadequate antimicrobial therapy in 28% of episodes, compared with 8% in CA (OR: 4.27; 95% CI, 2.8–6.3; p < 0.001). Patients with HA received inadequate therapy in 16% of episodes compared with 8% in CA (OR: 2.07; 95% CI, 1.3–3.2; p = 0.001). The difference between NA and HA episodes (28% vs 16%) was also different (OR: 2.06; 95% CI, 1.3–3.1; p = 0.001). Mortality among patients with adequate treatment was 18% vs 34% with inadequate treatment (p < 0.001). Multivariate logistic regression using community-acquired status as reference, identified NA episodes (OR, 1.7; 95% CI, 1.1–2.7), and BI of unknown origin (OR, 2.3; 95% CI, 1.4–3.7) as independent predictors of inadequate therapy. C. albicans (OR, 13.9; 95% CI, 3.7–52.2), methicillin-resistant S. aureus (OR, 6.9; 95% CI, 2.4–19.6), P. aeruginosa (OR, 2.4; 95% CI, 1.3–4.3), and coagulase-negative staphylococci (OR, 1.9; 95% CI, 1.06–3.5) were associated with an increased likelihood of receiving inadequate therapy. Infection due to S. pneumoniae (OR, 0.14; 95% CI, 0.03–0.59) and E. coli (OR, 0.2; 95% CI, 0.1–0.3) were associated with a decreased risk of ineffective therapy.

Conclusions: Among patients treated for BI, nosocomial-acquired episodes, unknown origin of infection, and infection due to multiresistant pathogens were an independent predictor of inadequate antimicrobial therapy.

Session Details

Date: 31/03/2007
Time: 00:00-00:00
Session name: European Society of Clinical Microbiology and Infectious Diseases
Subject:
Location: ICC, Munich, Germany
Presentation type:
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