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Stratification of the Impact of Inappropriate Empirical Antimicrobial Therapy for Gram-Negative Bloodstream Infections by Predicted Prognosis.
Antimicrob Agents Chemother. 2014 Oct 27;
Authors: Cain SE, Kohn J, Bookstaver PB, Albrecht H, Al-Hasan MN
Abstract
The Bloodstream Infection Mortality Risk Score (BSIMRS) predicts the outcome of patients with gram-negative bloodstream infections (BSI) with high discrimination. This retrospective cohort study examined the impact of inappropriate antimicrobial therapy on mortality in adult patients with gram-negative BSI admitted to Palmetto Health Hospitals in Columbia, SC, USA from 1 January 2011 to 31 December 2012 after stratification by predicted prognosis at initial presentation using BSIMRS. Multivariate Cox regression model was used to identify independent risk factors for 28-day mortality overall and within each predefined BSIMRS category (<5, 5-9 and ≥10). Relative risk reduction (RRR), absolute risk reduction (ARR), and number needed to treat (NNT) were calculated from predictive logistic regression model of mortality. Overall, 390 unique patients with first episodes of gram-negative BSI were identified. Median age was 66 years and 229 (59%) were women. There was significant association between inappropriate antimicrobial therapy and mortality in patients with BSIMRS 5-9 (adjusted hazard ratio [aHR] 3.55, 95% confidence intervals [CI] 1.22-8.31, p=0.02) and BSIMRS ≥10 (aHR 4.99, 95% CI 1.09-22.87, p=0.04), but not in those with BSIMRS <5 (aHR 3.34, 95% CI 0.17-22.77, p=0.34). RRR, ARR and NNT were 0.25, 0.02 and 63 for BSIMRS <5; 0.56, 0.32 and 3 for BSIMRS 5-9; and 0.39, 0.39 and 3 for BSIMRS ≥10, respectively. There is significant benefit from appropriate antimicrobial therapy in patients with gram-negative BSI with guarded (BSIMRS 5-9) and poor predicted prognosis (BSIMRS ≥10). Survival difference remains unclear among those with good predicted prognosis (BSIMRS <5) at initial presentation.
PMID: 25348527 [PubMed - as supplied by publisher]