Impact of Delayed Appropriate Antibiotic Therapy on Patient Outcomes by Antibiotic Resistance Status From Serious Gram-negative Bacterial Infections
Impact of Delayed Appropriate Antibiotic Therapy on Patient Outcomes by Antibiotic Resistance Status From Serious Gram-negative Bacterial Infections
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DOI：
10.1016/j.amjms.2018.11.009
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发表时间：
2019-02-01
影响因子：
3.1
通讯作者：
Lodise, Thomas
中科院分区：
文献类型：
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作者：
Bonine, Nicole Gidaya;Berger, Ariel;Lodise, Thomas
背景资料：研究临床和经济负担与延迟接受适当的治疗革兰氏阴性菌（GNB）感染的患者，分层抗生素耐药status.Materials和方法：回顾性分析使用总理医院数据库。对有复杂性尿路感染、复杂性腹腔内感染、医院相关性肺炎或血流感染证据、住院时间（LOS）≥ 1天且来自与感染类型一致的部位的GNB培养阳性（培养抽取日期=索引日期）的成人住院患者（2011年7月至2014年9月）进行鉴定，并按索引病原体的抗生素敏感性进行分层。延迟适当治疗定义为在索引日期当天或索引日期后2天内未接受具有相关微生物活性的抗生素。逆概率加权和多元回归分析被用来估计延迟适当的治疗和结果之间的关联。广义线性模型用于评估索引后抗生素治疗的持续时间，LOS和总住院费用。Logistic模型被用来评估出院目的地和住院死亡率/出院到Hospice.Results：总共有56,357例GNB感染的患者被确定（耐药，n=6,055;敏感，n=50,302）。2，800例（46.2%）耐药患者和16，585例（33.0%）敏感感染患者接受了延迟的适当治疗。使用多变量分析，延迟适当的治疗与更差的结局相关，包括类似于LOS增加70%，类似于住院总费用增加65%，以及类似于住院死亡/出院到临终关怀的风险增加20%，无论易感性状态如何。我们的研究结果表明，GNB感染患者的结果，无论耐药状态如何，如果能够及时提供适当的治疗，则会显着改善。
Background: To examine the clinical and economic burdens associated with delayed receipt of appropriate therapy among patients with Gram-negative bacteria (GNB) infections, stratified by antibiotic resistance status.Materials and Methods: Retrospective analysis using the Premier Hospital Database. Adult admissions (July 2011-September 2014) with evidence of complicated urinary tract infection, complicated intra-abdominal infection, hospital-associated pneumonia, or bloodstream infection, length of stay (LOS) >= 1 days and a positive GNB culture from a site consistent with infection type (culture draw date=index date) were identified and stratified by antibiotic susceptibility to index pathogens. Delayed appropriate therapy was defined as no receipt of antibiotic(s) with relevant microbiological activity on or within 2 days of index date. Inverse probability weighting and multivariate regression analyses were used to estimate the association between delayed appropriate therapy and outcomes. Generalized linear models were used to evaluate postindex duration of antibiotic therapy, LOS and total in-hospital costs. Logistic models were used to evaluate discharge destination and in-hospital mortality/discharge to hospice.Results: A total of 56,357 patients with GNB infections were identified (resistant, n=6,055; susceptible, n=50,302). Delayed appropriate therapy was received by 2,800 (46.2%) patients with resistant and 16,585 (33.0%) patients with susceptible infections. Using multivariate analysis, delayed appropriate therapy was associated with worse outcomes including similar to 70% increase in LOS, similar to 65% increase in total in-hospital costs and similar to 20% increase in the risk of in-hospital mortality/discharge to hospice, regardless of susceptibility status.Conclusions: Our results suggest that outcomes in patients with GNB infections, regardless of resistance status, significantly improve if timely appropriate therapy can be provided.