title: Appropriate empirical antibiotic use and 30-d mortality in cirrhotic patients with bacteremia.
abstract: OBJECTIVE
  To analyze whether prompt and appropriate empirical antibiotic (AEA) use is associated with mortality in cirrhotic patients with bacteremia.
  
  
  METHODS
  A total of 102 episodes of bacteremia in 72 patients with cirrhosis were analyzed. AEA was defined as a using or starting an antibiotic appropriate to the isolated pathogen at the time of bacteremia. The primary endpoint was 30-d mortality.
  
  
  RESULTS
  The mortality rate at 30 d was 30.4% (31/102 episodes). Use of AEA was associated with better survival at 30 d (76.5% vs 46.9%, P = 0.05), and inappropriate empirical antibiotic (IEA) use was an independent factor associated with increased mortality (OR = 3.24; 95%CI: 1.50-7.00; P = 0.003, adjusted for age, sex, Child-Pugh Class, gastrointestinal bleeding, presence of septic shock). IEA use was more frequent when the isolated pathogen was a multiresistant pathogen, and when infection was healthcare-related or hospital-acquired.
  
  
  CONCLUSIONS
  AEA use was associated with increased survival of cirrhotic patients who developed bacteremia. Strategies for AEA use, tailored according to the local epidemiological patterns, are needed to improve survival of cirrhotic patients with bacteremia.
authors.affiliation: Hyun Park, Ki Jun Jang, Won Jang, Sang Hoon Park, Ji Young Park, Tae Joo Jeon, Tae Hoon Oh, Won Chang Shin, Won-Choong Choi, Department of Internal Medicine, Sanggye Paik Hospital, Inje University, Seoul 135-710, South Korea.
authors.forename: Hyun
authors.initials: H
authors.lastname: Park
authors.affiliation: Hyun Park, Ki Jun Jang, Won Jang, Sang Hoon Park, Ji Young Park, Tae Joo Jeon, Tae Hoon Oh, Won Chang Shin, Won-Choong Choi, Department of Internal Medicine, Sanggye Paik Hospital, Inje University, Seoul 135-710, South Korea.
authors.forename: Ki Jun
authors.initials: KJ
authors.lastname: Jang
authors.affiliation: Hyun Park, Ki Jun Jang, Won Jang, Sang Hoon Park, Ji Young Park, Tae Joo Jeon, Tae Hoon Oh, Won Chang Shin, Won-Choong Choi, Department of Internal Medicine, Sanggye Paik Hospital, Inje University, Seoul 135-710, South Korea.
authors.forename: Won
authors.initials: W
authors.lastname: Jang
authors.affiliation: Hyun Park, Ki Jun Jang, Won Jang, Sang Hoon Park, Ji Young Park, Tae Joo Jeon, Tae Hoon Oh, Won Chang Shin, Won-Choong Choi, Department of Internal Medicine, Sanggye Paik Hospital, Inje University, Seoul 135-710, South Korea.
authors.forename: Sang Hoon
authors.initials: SH
authors.lastname: Park
authors.affiliation: Hyun Park, Ki Jun Jang, Won Jang, Sang Hoon Park, Ji Young Park, Tae Joo Jeon, Tae Hoon Oh, Won Chang Shin, Won-Choong Choi, Department of Internal Medicine, Sanggye Paik Hospital, Inje University, Seoul 135-710, South Korea.
authors.forename: Ji Young
authors.initials: JY
authors.lastname: Park
authors.affiliation: Hyun Park, Ki Jun Jang, Won Jang, Sang Hoon Park, Ji Young Park, Tae Joo Jeon, Tae Hoon Oh, Won Chang Shin, Won-Choong Choi, Department of Internal Medicine, Sanggye Paik Hospital, Inje University, Seoul 135-710, South Korea.
authors.forename: Tae Joo
authors.initials: TJ
authors.lastname: Jeon
authors.affiliation: Hyun Park, Ki Jun Jang, Won Jang, Sang Hoon Park, Ji Young Park, Tae Joo Jeon, Tae Hoon Oh, Won Chang Shin, Won-Choong Choi, Department of Internal Medicine, Sanggye Paik Hospital, Inje University, Seoul 135-710, South Korea.
authors.forename: Tae Hoon
authors.initials: TH
authors.lastname: Oh
authors.affiliation: Hyun Park, Ki Jun Jang, Won Jang, Sang Hoon Park, Ji Young Park, Tae Joo Jeon, Tae Hoon Oh, Won Chang Shin, Won-Choong Choi, Department of Internal Medicine, Sanggye Paik Hospital, Inje University, Seoul 135-710, South Korea.
authors.forename: Won Chang
authors.initials: WC
authors.lastname: Shin
authors.affiliation: Hyun Park, Ki Jun Jang, Won Jang, Sang Hoon Park, Ji Young Park, Tae Joo Jeon, Tae Hoon Oh, Won Chang Shin, Won-Choong Choi, Department of Internal Medicine, Sanggye Paik Hospital, Inje University, Seoul 135-710, South Korea.
authors.forename: Won-Choong
authors.initials: WC
authors.lastname: Choi
authors.affiliation: Hyun Park, Ki Jun Jang, Won Jang, Sang Hoon Park, Ji Young Park, Tae Joo Jeon, Tae Hoon Oh, Won Chang Shin, Won-Choong Choi, Department of Internal Medicine, Sanggye Paik Hospital, Inje University, Seoul 135-710, South Korea.
authors.forename: Dong Hyun
authors.initials: DH
authors.lastname: Sinn
mesh_terms: D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D016470:Bacteremia / Q000175:diagnosis / Q000188:drug therapy* / Q000382:microbiology / Q000401:mortality; D024901:Drug Resistance, Multiple, Bacterial; D005260:Female; D006801:Humans; D057970:Inappropriate Prescribing; D053208:Kaplan-Meier Estimate; D008103:Liver Cirrhosis / Q000150:complications* / Q000175:diagnosis / Q000401:mortality; D008297:Male; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D011237:Predictive Value of Tests; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents
keywords: Appropriate antibiotics; Bacteremia; Liver cirrhosis; Multiresistant pathogen; Survival
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