Effect of delay in the administration of adequate antibiotic treatment in Streptococcus pneumoniae bacteraemia
Abstract number: P1819
García-Cabrera E., Diaz-Martin A., Gonzalez-Galan V., Revuelto-Rey J., Jimenez-Alvarez R., Lepe J., Aldabó-Pallas T., Aznar Martin J., Garnacho Montero J.
Objective: To determine risk factors associated with mortality in patients admitted to the hospital with Streptococcus pneumoniae bacteraemia, particularly analysing the impact of delayed adequate antibiotic administration.
Methods: All adult patients with community-acquired Streptococcus pneumoniae bacteraemia admitted to the hospital from January 2005 to November 2007 were enrolled in this protocol study. The following variables were registered: age, gender, source of bacteraemia, severity of illness at hospital admission evaluated by APACHE II score, degree of organ dysfunction (SOFA scale), underlying disease, Charlson comorbidity index, time from the hospital admission to first antibiotic dose, time from the hospital admission to first dose of adequate antibiotic treatment, ICU admission, development of septic shock, and in-hospital mortality. For statistical analysis, categorical variables were evaluated using the chi-square test and Fisher's test when appropriate. Continuous variables were compared using the unpaired Student's t-test and the Mann-Whitney U when appropriate. A multivariate regression model was performed to determine the independent effect of the variables on survival.
Results: One hundred and seventy-five patients were included; 86 of them (71%) were male. The median of Charlson comorbidity index was 6. The source of bacteraemia was pneumonia (n = 144), meningitis (n = 20), others (n = 12). The mortality rate was 19.3% (34 patients). Overall, the median delay of adequate antibiotic treatment was 5 h (15 min 96 h). In patients with pneumonia, the median delay of adequate antibiotic therapy was 4 h (15 min 96 h) in survivors and 6.5 h (15 min 72 h) in non-survivors (p = 0.159). The mortality rate in pneumonia was 25/144 (17.4%) vs 9/32 (28%) (p = NS). In the entire group, the independent risk factors associated with mortality were: age OR 1.05 CI 95% (1.0061.095), Charlson comorbidity index OR 1.274 (1.0291.577) and SOFA score 1.319 (1.1681.490). In patients with Streptococcus pneumoniae bacteremic pneumonia age OR 1.067 IC 95% (1.0111.125); Apache II OR 1.162 (1.0141.331), time to adequate antibiotic treatment OR 1.122 (1.0021.255), and septic shock OR 8.27 (1.31751.94) were the independent predictors of mortality.
Conclusions: After controlling for confounding variables, a delay in the administration of adequate antibiotic treatment is an independent risk factor of mortality in Streptococcus pneumoniae bacteraemia of pulmonary source.
|Session name:||18th European Congress of Clinical Microbiology and Infectious Diseases|
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