title: Impact of inadequate empirical therapy on the mortality of patients with bloodstream infections: a propensity score-based analysis.
abstract: The impact of the adequacy of empirical therapy on outcome for patients with bloodstream infections (BSI) is key for determining whether adequate empirical coverage should be prioritized over other, more conservative approaches. Recent systematic reviews outlined the need for new studies in the field, using improved methodologies. We assessed the impact of inadequate empirical treatment on the mortality of patients with BSI in the present-day context, incorporating recent methodological recommendations. A prospective multicenter cohort including all BSI episodes in adult patients was performed in 15 hospitals in Andalucía, Spain, over a 2-month period in 2006 to 2007. The main outcome variables were 14- and 30-day mortality. Adjusted analyses were performed by multivariate analysis and propensity score-based matching. Eight hundred one episodes were included. Inadequate empirical therapy was administered in 199 (24.8%) episodes; mortality at days 14 and 30 was 18.55% and 22.6%, respectively. After controlling for age, Charlson index, Pitt score, neutropenia, source, etiology, and presentation with severe sepsis or shock, inadequate empirical treatment was associated with increased mortality at days 14 and 30 (odds ratios [ORs], 2.12 and 1.56; 95% confidence intervals [95% CI], 1.34 to 3.34 and 1.01 to 2.40, respectively). The adjusted ORs after a propensity score-based matched analysis were 3.03 and 1.70 (95% CI, 1.60 to 5.74 and 0.98 to 2.98, respectively). In conclusion, inadequate empirical therapy is independently associated with increased mortality in patients with BSI. Programs to improve the quality of empirical therapy in patients with suspicion of BSI and optimization of definitive therapy should be implemented.
authors: Unidad Clínica de Enfermedades Infecciosas y Microbiología, Hospital Universitario Virgen Macarena, Seville, Spain.
authors: Pilar
authors: P
authors: Retamar
authors: María M
authors: MM
authors: Portillo
authors: María Dolores
authors: MD
authors: López-Prieto
authors: Fernando
authors: F
authors: Rodríguez-López
authors: Marina
authors: M
authors: de Cueto
authors: María V
authors: MV
authors: García
authors: María J
authors: MJ
authors: Gómez
authors: Alfonso
authors: A
authors: Del Arco
authors: Angel
authors: A
authors: Muñoz
authors: Antonio
authors: A
authors: Sánchez-Porto
authors: Manuel
authors: M
authors: Torres-Tortosa
authors: Andrés
authors: A
authors: Martín-Aspas
authors: Ascensión
authors: A
authors: Arroyo
authors: Carolina
authors: C
authors: García-Figueras
authors: Federico
authors: F
authors: Acosta
authors: Juan E
authors: JE
authors: Corzo
authors: Laura
authors: L
authors: León-Ruiz
authors: Trinidad
authors: T
authors: Escobar-Lara
authors: Jesús
authors: J
authors: Rodríguez-Baño
mesh_terms: D000368:Aged; D000900:Anti-Bacterial Agents / Q000008:administration & dosage*; D016470:Bacteremia / Q000188:drug therapy / Q000382:microbiology / Q000401:mortality*; D024881:Drug Resistance, Bacterial; D005260:Female; D006090:Gram-Negative Bacteria / Q000187:drug effects / Q000254:growth & development; D006094:Gram-Positive Bacteria / Q000187:drug effects / Q000254:growth & development; D006801:Humans; D016015:Logistic Models; D008297:Male; D019300:Medical Errors; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D057216:Propensity Score; D011446:Prospective Studies; D012307:Risk Factors; D013030:Spain; D015996:Survival Rate; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents