Time is of the Essence: the Impact of Delayed Antibiotic Therapy on Patient Outcomes in Hospital-Onset Enterococcal Bloodstream Infections.
Clin Infect Dis. 2016 Mar 3;
Authors: Zasowski EJ, Claeys KC, Lagnf AM, Davis SL, Rybak MJ
Abstract
BACKGROUND: With increasing prevalence of vancomycin-resistant enterococci (VRE), appropriate antibiotic therapy for enterococcal bloodstream infections (EBSI) can be delayed. Data regarding the impact of delayed therapy on EBSI outcomes are conflicting and the time-delay most strongly associated with poor outcomes has not been defined.
METHODS: Single center, retrospective cohort study of adult, non-neutropenic patients with hospital-onset EBSI from 2010-2014. Classification and regression tree (CART) analysis was used to determine the delay in appropriate therapy most predictive of 30-day mortality. Appropriate therapy was defined as antibiotic therapy to which the enterococci and co-pathogen, where applicable, were susceptible. Outcomes and clinical characteristics were compared between patients receiving early or delayed therapy, defined by CART time-point. Poisson regression was employed to determine the independent association of delayed therapy on 30-day mortality and predictors of delayed therapy.
RESULTS: Overall, 190 patients were included. A breakpoint in time to appropriate therapy was identified at 48.1 hours, where 30-day mortality was substantially increased (14.6 vs. 45.3%; P<0.001). Patients receiving appropriate therapy after 48.1 hours also experienced higher in-hospital mortality and longer EBSI duration. After adjustment for severity of illness and comorbidity, delayed therapy≥48.1 hours was associated with a 3-foHld increase in 30-day mortality (RR, 3.1; 95% CI, 1.88-5.12). Vancomycin resistance was the only independent predictor of delayed therapy.
CONCLUSIONS: In patients with hospital-onset EBSI, receipt of appropriate therapy within the first 48 hours was associated with reduced mortality, underscoring the potential role of rapid diagnostic testing for early identification of VRE.
PMID: 26945013 [PubMed - as supplied by publisher]