title: Patients at risk for inappropriate antibiotic treatment of bacteraemia.
abstract: In order to define patients at high risk for inappropriate antibiotic treatment of bacteraemia, we compared 682 bacteraemic patients, treated with an antibiotic drug to which the infecting micro-organism was susceptible, with 419 patients who were inappropriately treated. On a multivariate logistic regression analysis including only clinical variables, four factors were found to be both significantly and independently associated with inappropriate antibiotic treatment: hospital-acquired bacteraemia (odds-ratio (OR) of 1.9), antibiotic treatment in the month prior to the bacteraemia (OR 1.9), residence in a nursing home (OR 1.8), and the presence of a central line (OR 1.7). A second model, including bacteriological data, showed four micro-organisms to be independently associated with inappropriate antibiotic treatment: Candida sp. (OR 14.2), Acinetobacter sp. (OR 5.0), Enterococcus sp. (OR 3.6) and Pseudomonas sp. (OR 2.2). In this model, only two clinical features were included: hospital-acquired infection and previous antibiotic treatment. Special efforts should be made to improve empirical antibiotic treatment in the groups defined above, and to facilitate early laboratory diagnosis of the micro-organisms associated with inappropriate treatment.
authors.affiliation: Department of Internal Medicine, Beilinson Medical Center, Petah Tiqva, Israel.
authors.forename: L
authors.initials: L
authors.lastname: Leibovici
authors.forename: H
authors.initials: H
authors.lastname: Konisberger
authors.forename: S D
authors.initials: SD
authors.lastname: Pitlik
authors.forename: Z
authors.initials: Z
authors.lastname: Samra
authors.forename: M
authors.initials: M
authors.lastname: Drucker
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D016470:Bacteremia / Q000188:drug therapy* / Q000453:epidemiology; D002405:Catheterization, Central Venous; D003428:Cross Infection / Q000453:epidemiology; D005260:Female; D006801:Humans; D008297:Male; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D009735:Nursing Homes; D016017:Odds Ratio; D012044:Regression Analysis; D012307:Risk Factors
chemical_list: D000900:Anti-Bacterial Agents