Inappropriate empirical antibiotic therapy for bloodstream infections based on discordant in-vitro susceptibilities: a retrospective cohort analysis of prevalence, predictors, and mortality risk in US hospitals.
Inappropriate empirical antibiotic therapy for bloodstream infections based on discordant in-vitro susceptibilities: a retrospective cohort analysis of prevalence, predictors, and mortality risk in US hospitals.
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基于不一致的体外敏感性对血流感染进行不适当的经验性抗生素治疗：对美国医院患病率、预测因素和死亡风险的回顾性队列分析。
DOI：
10.1016/s1473-3099(20)30477-1
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发表时间：
2021-03
期刊：
影响因子：
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通讯作者：
forming the National Insititutes of Health Antimicrobial Resistance Outcomes Research Initiative (NIH-ARORI)
中科院分区：
文献类型：
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作者：
Kadri SS;Lai YL;Warner S;Strich JR;Babiker A;Ricotta EE;Demirkale CY;Dekker JP;Palmore TN;Rhee C;Klompas M;Hooper DC;Powers JH 3rd;Srinivasan A;Danner RL;Adjemian J;forming the National Insititutes of Health Antimicrobial Resistance Outcomes Research Initiative (NIH-ARORI)
不适当经验性抗生素治疗血流感染（BSI）的患病率和影响尚不清楚。我们的目的是确定BSI患者体外敏感性不一致经验性抗生素治疗（DEAT）的人群水平负担、预测因素和死亡风险。接受全身性抗生素治疗的BSI住院患者当天进行血培养或第二天进行鉴定。如果分离物对血液培养采样日施用的抗生素不敏感，则发生DEAT。采用回归树分析法计算不同医院类型的DEAT患病率，并采用广义估计方程确定预测因子。采用logistic回归确定住院死亡率的调整优势比（aOR）。2005-2014年间，在131家医院，26,036名可评估的BSI患者在第一次血培养采集当天或次日接受了经验性治疗。17%（4428人）在血培养日未接受抗生素治疗。在剩余的21,608例患者中，4,165例（19% - 3%）接受了DEAT治疗[按医院类型调整的信度范围：16.6 (95% CI, 15.0 - 18.5)%至21.1 (95% CI, 20.1 - 22.1)%]。耐药表型可预测DEAT [a0R= 9.09 (95% CI, 7.68 ~ 10.76);p< 0.001]。大多数DEAT事件（73%）和相关死亡（76.8%）发生在金黄色葡萄球菌和肠杆菌科BSIs患者中。DEAT与较高的死亡率独立相关（aOR= 1.5 [95% CI, 1·1·7];p< 0.001），这种关系不受是否存在耐药性、败血症或感染性休克的影响。在美国医院，大约五分之一的BSI患者接受了DEAT治疗，这与耐抗生素病原体密切相关。即使在没有败血症的患者中，死亡也会降低生存率。早期识别血液病原体和耐药性可能会改善人群水平的结果。Nih，美国cdc， ahrq
The prevalence and impact of inappropriate empiric antibiotic therapy for bloodstream infections (BSI) is unclear. We aimed to determine the population-level burden, predictors, and mortality risk of in vitro susceptibility-discordant empiric antibiotic therapy (DEAT) among BSI patients. Inpatients with BSI treated with systemic antibiotics on the day blood cultures were drawn or the following day were identified. DEAT occurred if the isolate was not susceptible in vitro to antibiotic(s) administered on blood culture sampling day. DEAT prevalence by hospital type was calculated using regression tree analysis and predictors were identified using Generalized Estimating Equations. Adjusted odds ratio (aOR) of in-hospital mortality was determined using logistic regression. At 131 hospitals between 2005–2014, 26,036 assessable BSI patients received empiric therapy on the day of or day after first blood culture collection. Seventeen percent (4,428) received no antibiotics on blood culture day. Of the remaining 21,608 patients, 4,165(19–3%) received DEAT [reliability-adjusted range by hospital type: 16·6(95% CI, 15·0–18·5)% to 21·1(95% CI, 20·1–22·1)%]. Antibiotic-resistant phenotypes strongly predicted DEAT [a0R=9·09(95% CI, 7·68–10·76);p<0·001]. Most DEAT events (73%) and associated deaths (76·8%) occurred among patients with S. aureus and Enterobacteriaceae BSIs. DEAT was independently associated with higher mortality (aOR=1·5[95% CI, 1·4–1·7];p<0·001), a relationship that was unaffected by the presence or absence of resistance or sepsis or septic shock. Approximately one in five BSI patients in U.S. hospitals received DEAT, which was closely associated with antibiotic-resistant pathogens. DEAT decreased survival even among those presenting without sepsis. Earlier identification of bloodstream pathogens and resistance is likely to improve population-level outcomes. NIH, U.S. CDC, AHRQ