title: Does it Matter if we get it right? Impact of appropriateness of empiric antimicrobial therapy among surgical patients.
abstract: Previous studies have shown conflicting evidence regarding the impact of inappropriate, initial antibiotic therapy. The purpose of this study was to evaluate the impact of inappropriate empiric antimicrobial therapy for the treatment of infection among surgical patients. We hypothesized that inappropriate empiric antimicrobial therapy would predict increased mortality risk compared with appropriate therapy. This was a retrospective analysis of a prospectively maintained database of all surgical patients admitted to a tertiary care center from 1996 to 2007 and treated for sepsis. "Appropriate" empiric antibiotic treatment was determined by sensitivity testing. Demographics and comorbidities, infection sites, infection organisms, and outcomes were compared between inappropriately and appropriately treated groups. Multivariable log-binomial regression was performed. There were 2,855 patients (7,158 infectious episodes) identified by culture analysis as either appropriately or inappropriately treated. Three hundred seventeen (15%) inappropriately treated infectious episodes resulted in death compared with 718 (14%) of the appropriately treated infectious episodes. After adjusting for statistically significant variables, inappropriately treated episodes of infection were not found to be associated with an increased risk for mortality compared with appropriately treated episodes of infection (relative risk, 1.0; 95% confidence interval, 0.99 - 1.02; P = 0.36). Our study observed no difference in mortality between appropriately and inappropriately treated infections within a surgical population.
authors.affiliation: *University of Virginia School of Medicine, Department of General Surgery, Charlottesville, Virginia; †Biostatistics Unit, Center for Health Disparities, Brody School of Medicine, East Carolina University, Greenville, North Carolina; ‡University of Texas Southwestern, Department of Surgery, Division of Burn/Trauma/Critical Care, Dallas, Texas; §Cleveland Clinic, Department of Endocrine Surgery, Cleveland, Ohio; and ∥Mercy Clinic General and Specialty Surgery, Colon and Rectal Surgery, Springfield, Missouri.
authors.forename: Stephen W
authors.initials: SW
authors.lastname: Davies
authors.forename: Jimmy T
authors.initials: JT
authors.lastname: Efird
authors.forename: Christopher A
authors.initials: CA
authors.lastname: Guidry
authors.forename: Tjasa
authors.initials: T
authors.lastname: Hranjec
authors.forename: Rosemarie
authors.initials: R
authors.lastname: Metzger
authors.forename: Brian R
authors.initials: BR
authors.lastname: Swenson
authors.forename: Robert G
authors.initials: RG
authors.lastname: Sawyer
mesh_terms: D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D015897:Comorbidity; D005260:Female; D019983:Guideline Adherence; D006801:Humans; D008297:Male; D008508:Medication Errors; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians'; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D018805:Sepsis / Q000175:diagnosis / Q000188:drug therapy* / Q000382:microbiology / Q000401:mortality; D013530:Surgical Wound Infection / Q000175:diagnosis / Q000188:drug therapy* / Q000382:microbiology / Q000401:mortality; D062606:Tertiary Care Centers; D016896:Treatment Outcome; D014768:Virginia
chemical_list: D000900:Anti-Bacterial Agents
references.citation: J Crit Care. 2012 Aug;27(4):414.e1-9
references.pmid: 22516143
references.citation: Shock. 2013 Nov;40(5):358-65
references.pmid: 24088989
references.citation: J Intern Med. 1998 Nov;244(5):379-86
references.pmid: 9845853
references.citation: Crit Care Med. 2013 May;41(5):1167-74
references.pmid: 23442987
references.citation: Clin Infect Dis. 1997 Mar;24(3):387-95
references.pmid: 9114190
references.citation: Crit Care Med. 2009 May;37(5):1612-8
references.pmid: 19325476
references.citation: Crit Care Med. 2013 Feb;41(2):580-637
references.pmid: 23353941
references.citation: Infection. 2013 Jun;41(3):645-53
references.pmid: 23463186
references.citation: Crit Care Med. 1999 Feb;27(2):299-303
references.pmid: 10075053
references.citation: Am J Infect Control. 2008 Jun;36(5):309-32
references.pmid: 18538699
references.citation: Shock. 2008 Oct;30 Suppl 1:23-9
references.pmid: 18704013
references.citation: Intensive Care Med. 2012 Dec;38(12):1930-45
references.pmid: 23011531
references.citation: Br J Clin Pharmacol. 2005 Oct;60(4):438-43
references.pmid: 16187977
references.citation: Clin Infect Dis. 2007 Aug 1;45(3):329-37
references.pmid: 17599310
references.citation: Scand J Infect Dis. 2007;39(11-12):947-55
references.pmid: 17852889
references.citation: Eur J Clin Microbiol Infect Dis. 2004 Sep;23(9):682-7
references.pmid: 15322931
references.citation: J Crit Care. 2008 Mar;23(1):91-100
references.pmid: 18359426
references.citation: Surg Infect (Larchmt). 2007 Jun;8(3):329-36
references.pmid: 17635055
references.citation: Crit Care Med. 2001 Jul;29(7):1303-10
references.pmid: 11445675
references.citation: JAMA. 2003 Jun 4;289(21):2849-56
references.pmid: 12783916
references.citation: Intensive Care Med. 2004 Jul;30(7):1327-33
references.pmid: 15197443
references.citation: Shock. 2004 Feb;21(2):121-5
references.pmid: 14752284
references.citation: Chest. 1992 Jun;101(6):1644-55
references.pmid: 1303622
references.citation: Chemotherapy. 2005 Jul;51(4):171-6
references.pmid: 15980627
references.citation: Clin Infect Dis. 2007 Sep 15;45 Suppl 3:S177-83
references.pmid: 17712744
references.citation: Lancet Infect Dis. 2012 Oct;12(10):774-80
references.pmid: 22951600
references.citation: Intensive Care Med. 1994;20(2):94-8
references.pmid: 8201105
references.citation: Am J Med Qual. 2001 Sep-Oct;16(5):161-5
references.pmid: 11591015
references.citation: J Am Coll Surg. 2002 Apr;194(4):401-6
references.pmid: 11949744
references.citation: BMC Med Res Methodol. 2008 Feb 28;8:9
references.pmid: 18307814
references.citation: Clin Infect Dis. 2008 Sep 15;47 Suppl 1:S3-13
references.pmid: 18713047
references.citation: J Trauma. 1992 Apr;32(4):490-9; discussion 499-500
references.pmid: 1569623
references.citation: Chest. 1999 Feb;115(2):462-74
references.pmid: 10027448