title: Delay of adequate empiric antibiotic therapy is associated with increased mortality among solid-organ transplant patients.
abstract: Empiric antibiotic therapy is often prescribed prior to the availability of bacterial culture results. In some cases, the organism isolated may not be susceptible to initial empiric therapy (inadequate empiric therapy or IET). In solid-organ transplant recipients, the overall incidence and clinical importance of IET is unknown. We performed a retrospective cohort study of patients admitted from 2002 to 2004. Multiple logistic regression analyses were conducted to determine associations between potential determinants and mortality. IET was administered in 169/312 (54%) patients, with a hospital mortality rate that was significantly greater than those receiving adequate therapy (24.9% vs. 7.0%; relative risk [RR] 3.55; 95% confidence interval [CI], 1.85-6.83; p < 0.001). Regression analysis demonstrated that an increasing duration of IET (adjusted odds ratio [OR] at 24 h: 1.33; 95% CI: 1.15-1.53; p < 0.001), ICU-associated infections (adjusted OR: 6.27; 95% CI: 2.79-14.09; p < 0.001), prior antibiotic use (adjusted OR: 3.56; 95% CI: 1.51-8.41; p = 0.004) and increasing APACHE-II scores (adjusted OR: 1.26; 95% CI: 1.16-1.34; p < 0.001) were independently correlated with hospital mortality. IET is common and appears to be associated with an increased hospital mortality rate in the solid-organ transplant population.
authors.affiliation: Pharmaceutical Sciences, University of Toronto, Toronto, Ontario, Canada. mailto:bassem.hamandi@uhn.on.ca
authors.forename: B
authors.initials: B
authors.lastname: Hamandi
authors.forename: A M
authors.initials: AM
authors.lastname: Holbrook
authors.forename: A
authors.initials: A
authors.lastname: Humar
authors.forename: J
authors.initials: J
authors.lastname: Brunton
authors.forename: E A
authors.initials: EA
authors.lastname: Papadimitropoulos
authors.forename: G G
authors.initials: GG
authors.lastname: Wong
authors.forename: L
authors.initials: L
authors.lastname: Thabane
mesh_terms: D000328:Adult; D000900:Anti-Bacterial Agents / Q000008:administration & dosage*; D016470:Bacteremia / Q000188:drug therapy / Q000209:etiology; D001424:Bacterial Infections / Q000188:drug therapy / Q000209:etiology; D015331:Cohort Studies; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D016377:Organ Transplantation / Q000009:adverse effects / Q000401:mortality*; D012189:Retrospective Studies; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents