title: Effect of antibiotic streamlining on patient outcome in pneumococcal bacteraemia.
abstract: OBJECTIVE
  In blood culture-proven pneumococcal infections, streamlining empirical therapy to monotherapy with a penicillin is preferred in order to reduce the use of broad-spectrum antibiotics. However, adherence to this international recommendation is poor, and curiously it is unclear whether antibiotic streamlining may be harmful to individual patients. We investigated whether streamlining in bacteraemic pneumococcal infections is associated with mortality.
  
  
  METHODS
  Adults admitted to two Dutch hospitals between 2001 and 2011 with bacteraemic pneumococcal infections were retrospectively included. Detailed clinical data on patient characteristics, comorbidities and severity and outcome of disease were obtained in addition to data on antibiotic treatment. Those eligible for streamlining were selected for further analyses.
  
  
  RESULTS
  In the 45.8% of cases (126 of 275) where antibiotic treatment was streamlined, a lower mortality rate was observed (6.3% versus 15.4%, P = 0.021). The decision to streamline was only marginally explained by the 38 determinants accounted for. After correction for potential confounders, the OR for death while streamlining was 0.45 (95% CI: 0.18-1.11, P = 0.082) in all cases and 0.35 (95% CI: 0.12-0.99, P = 0.048) specifically in pneumonia cases.
  
  
  CONCLUSIONS
  Our results suggest that streamlining in eligible pneumococcal bacteraemia cases is safe, irrespective of patient characteristics, severity of disease or empirical treatment regimen.
authors.affiliation: Department of Paediatrics, Radboud university medical center, 6500 HB Nijmegen, The Netherlands Nijmegen Institute for Infection, Inflammation & Immunity (N4i), Radboud university medical center, 6500 HB Nijmegen, The Netherlands.
authors.forename: Amelieke J H
authors.initials: AJ
authors.lastname: Cremers
authors.affiliation: Department of Medical Microbiology and Infectious Diseases, Canisius Wilhelmina Hospital, 6500 GS Nijmegen, The Netherlands.
authors.forename: Tom
authors.initials: T
authors.lastname: Sprong
authors.affiliation: Department of Intensive Care, Canisius Wilhelmina Hospital, 6500 GS Nijmegen, The Netherlands.
authors.forename: Jeroen A
authors.initials: JA
authors.lastname: Schouten
authors.affiliation: Department of Paediatrics, Radboud university medical center, 6500 HB Nijmegen, The Netherlands Nijmegen Institute for Infection, Inflammation & Immunity (N4i), Radboud university medical center, 6500 HB Nijmegen, The Netherlands.
authors.forename: Grietje
authors.initials: G
authors.lastname: Walraven
authors.affiliation: Department of Paediatrics, Radboud university medical center, 6500 HB Nijmegen, The Netherlands Nijmegen Institute for Infection, Inflammation & Immunity (N4i), Radboud university medical center, 6500 HB Nijmegen, The Netherlands Nijmegen Centre for Molecular Life Sciences (NCMLS), Radboud university medical center, 6500 HB Nijmegen, The Netherlands.
authors.forename: Peter W M
authors.initials: PW
authors.lastname: Hermans
authors.affiliation: Department of Medical Microbiology and Infectious Diseases, Canisius Wilhelmina Hospital, 6500 GS Nijmegen, The Netherlands Department of Medical Microbiology, Radboud university medical center, 6500 HB Nijmegen, The Netherlands.
authors.forename: Jacques F
authors.initials: JF
authors.lastname: Meis
authors.affiliation: Department of Paediatrics, Radboud university medical center, 6500 HB Nijmegen, The Netherlands Nijmegen Institute for Infection, Inflammation & Immunity (N4i), Radboud university medical center, 6500 HB Nijmegen, The Netherlands gerben.ferwerda@radboudumc.nl.
authors.forename: Gerben
authors.initials: G
authors.lastname: Ferwerda
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D016470:Bacteremia / Q000188:drug therapy* / Q000382:microbiology / Q000401:mortality*; D015897:Comorbidity; D005260:Female; D006801:Humans; D008297:Male; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D009426:Netherlands; D010406:Penicillins / Q000627:therapeutic use*; D011008:Pneumococcal Infections / Q000188:drug therapy* / Q000382:microbiology / Q000401:mortality*; D011018:Pneumonia, Pneumococcal / Q000188:drug therapy; D012189:Retrospective Studies; D013296:Streptococcus pneumoniae / Q000187:drug effects; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents; D010406:Penicillins
keywords: S. pneumoniae; Streptococcus pneumoniae; mortality