Impact of inadequate empirical therapy on the mortality of patients with bloodstream infections: a propensity score-based analysis.
Antimicrob Agents Chemother. 2011 Oct 17;
Authors: Retamar P, Portillo MM, López-Prieto MD, Rodríguez-López F, de Cueto M, García MV, Gómez MJ, Del Arco A, Muñoz A, Sánchez-Porto A, Torres-Tortosa M, Martín-Aspas A, Arroyo A, García-Figueras C, Acosta F, Corzo JE, León-Ruiz L, Escobar-Lara T, Rodríguez-Baño J,
Abstract
The impact of the adequacy of empirical therapy on the outcome of patients with bloodstream infections (BSI) is key to determine whether adequate empirical coverage should be prioritized over other more conservative approaches. Recent systematic reviews outlined the need for new studies in the field with improve methodologies. We assessed the impact of inadequate empirical treatment on the mortality of patients with BSI in the present-day context, incorporating recent methodological recommendations. A prospective multicenter cohort including all BSI episodes in adult patients was performed in 15 hospitals in Andalucía, Spain, over a 2-month period in 2006-2007. The main outcome variables were 14 and 30-day mortality. Adjusted analyses were performed by multivariate analysis and propensity score-based matching. Eight hundred and one episodes were included. Inadequate empirical therapy was administered in 199 (24.8%) episodes; mortality at days 14 and 30 were 18.55% and 22.6%, respectively. After controlling for age, Charlson index, Pitt score, neutropenia, source, etiology and presentation with severe sepsis or shock, inadequate empirical treatment was associated with increased mortality at days 14 and 30 (ORs: 2.12 and 1.56; 95% CI: 1.34-3.34 and 1.01-2.40, respectively). The adjusted ORs after a propensity score-based matched analysis were: 3.03 and 1.70; 95% CI: 1.60-5.74 and 0.98-2.98, respectively. In conclusion, inadequate empirical therapy is independently associated with increased mortality in patients with BSI. Programs to improve the quality of empirical therapy in patients with suspicion of BSI and optimization of definitive therapy should be implemented.
PMID: 22005999 [PubMed - as supplied by publisher]