title: Factors associated with suitability of empiric antibiotic therapy in hospitalized patients with bloodstream infections.
abstract: BACKGROUND
  Bacteremia is associated with high morbidity and mortality rates. Initiation of inadequate empiric antibiotic therapy is associated with a worse outcome. The aim of this study was to establish the prevalence and the factors associated with inappropriate empiric antibiotic therapy in patients hospitalized with bacteremia.
  
  
  METHODS
  A cross-sectional study was conducted during January 2010-December 2011 at the medical wards of the Chaim Sheba Medical Center, Israel. The records of all patients with bacteremia were reviewed. Clinical and laboratory characteristics, bacteremic pathogens and antimicrobial agents were retrieved from the medical records. Factors associated with appropriateness of empiric antibiotic therapy were assessed.
  
  
  RESULTS
  A total of 681 eligible adults were included in the study. Antibiotic therapy was found to be inappropriate in 138 (20.2%) patients (95% C.I. 17.2-23.2). The rate of appropriateness was not related to the type of antibiotic regimen and the type of bacteria. Patients with healthcare-associated infections were more likely to be administrated inappropriate antibiotic therapy. Patients with primary bloodstream infections were also more likely to be administrated inappropriate antibiotic therapy. Empiric combination therapy was more likely to be appropriate than monotherapy, except for an aminoglycosides-based combination.
  
  
  CONCLUSIONS
  Combination empiric antibiotic therapy should be considered in patients with healthcare-associated infections and in those with primary bloodstream infections.
authors.affiliation: a Internal Medicine F and the Rheumatology Unit , The Chaim Sheba Medical Center , Ramat-Gan , Israel.
authors.forename: Chagai
authors.initials: C
authors.lastname: Grossman
authors.affiliation: b Infectious Disease Unit/Microbiology Laboratory , The Chaim Sheba Medical Center , Ramat-Gan , Israel.
authors.forename: Nathan
authors.initials: N
authors.lastname: Keller
authors.affiliation: c Internal Medicine D , The Chaim Sheba Medical Center , Ramat-Gan , Israel.
authors.forename: Gil
authors.initials: G
authors.lastname: Bornstein
authors.affiliation: a Internal Medicine F and the Rheumatology Unit , The Chaim Sheba Medical Center , Ramat-Gan , Israel.
authors.forename: Ilan
authors.initials: I
authors.lastname: Ben-Zvi
authors.affiliation: d Department of Epidemiology and Preventive Medicine, Tel Aviv University affiliated to Sackler Faculty of Medicine , Tel-Aviv University , Tel-Aviv , Israel.
authors.forename: Nira
authors.initials: N
authors.lastname: Koren-Morag
authors.affiliation: b Infectious Disease Unit/Microbiology Laboratory , The Chaim Sheba Medical Center , Ramat-Gan , Israel.
authors.forename: Galia
authors.initials: G
authors.lastname: Rahav
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000009:adverse effects / Q000627:therapeutic use*; D016470:Bacteremia / Q000175:diagnosis / Q000188:drug therapy* / Q000453:epidemiology / Q000382:microbiology; D015331:Cohort Studies; D015897:Comorbidity; D003428:Cross Infection / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology / Q000382:microbiology; D003430:Cross-Sectional Studies; D024881:Drug Resistance, Bacterial; D024901:Drug Resistance, Multiple, Bacterial; D004359:Drug Therapy, Combination / Q000009:adverse effects; D042241:Early Diagnosis; D019348:Empiricism; D005260:Female; D006786:Hospitals, Urban; D006801:Humans; D007557:Israel / Q000453:epidemiology; D008297:Male; D008508:Medication Errors / Q000009:adverse effects / Q000517:prevention & control*; D008875:Middle Aged; D010818:Practice Patterns, Physicians'
chemical_list: D000900:Anti-Bacterial Agents
keywords: Appropriateness; Bacteremia; Empiric antibiotic therapy