Determinants of inappropriate empirical antibiotic treatment: systematic review and meta-analysis.
Int J Antimicrob Agents. 2017 Dec 22;:
Authors: Carrara E, Pfeffer I, Zusman O, Leibovici L, Paul M
OBJECTIVES: To assess study-level determinants of non-covering (inappropriate) empirical antibiotic treatment (IEAT), focusing on the influence of study years and the prevalence of multidrug-resistant organisms (MDROs) in the study.
METHODS: Systematic review of prospective or retrospective observational studies reporting on the association between IEAT and mortality in adult patients with microbiologically documented infections published between 2008-2016. Meta-analysis of IEAT rates was conducted using a random-effects model. Subgroup analyses and mixed-effect single-covariate meta-regression were conducted to identify the association between clinical and methodological study-level covariates and IEAT rates. Heterogeneity was assessed using the I2 measure of inconsistency. Multi-covariate meta-regression was conducted including variables with a p-value <0.1 on single-covariate analysis.
RESULTS: One-hundred-ninety-one studies were included assessing 73,595 patients, most commonly with bacteremia. The pooled IEAT event rate was 32% (95% confidence intervals 30%-35%), with large heterogeneity (I2=97.7%). On multi-covariate analyses, the prevalence of any MDRO (odds ratio per 10% increase in prevalence 1.11, 95% CI 1.07-1.15), Acinetobacter spp. specifically (OR 1.99, 95% CI 1.22-3.25) and advancing study years were associated with IEAT rates (OR 1.03, 95% CI 1.00-1.06 per year). MDRO rates were independently associated with mortality rates in the studies, adjusting to the rate of IEAT.
CONCLUSIONS: The prevalence of MDROs, mainly multi-drug resistant Gram-negative bacteria, is significantly associated with the probability of prescribing IEAT and mortality rates in recent studies. We show how antibiotic resistance impacts patient management and outcomes.
PMID: 29277528 [PubMed - as supplied by publisher]