Impact of appropriate empirical antibiotic treatment on recurrence and mortality in patients with bacteraemia: a population-based cohort study.
Data on the impact of empirical antibiotic treatment (EAT) on patient outcome in a population-based setting are sparse. We assessed the association between EAT and the risk of recurrence within one year, short-term- (2-30 days) and long-term (31-365 days) mortality in a Danish cohort of bacteraemia patients.



A cohort study including all patients hospitalized with incident bacteraemia during 2007-2008 in the Copenhagen City and County areas and the North Denmark Region. EAT was defined as the antibiotic treatment given at the 1stnotification of a positive blood culture. The definition of recurrence took account of pathogen species, site of infection, and time frame and was not restricted to homologous pathogens. The vital status was determined through the civil registration system. Association estimates between EAT and the outcomes were estimated by Cox and logistic regression models.



In 6483 eligible patients, 712 (11%) had a recurrent episode. A total of 3778 (58%) patients received appropriate EAT, 1290 (20%) received inappropriate EAT, while EAT status was unrecorded for 1415 (22%) patients. The 2-30 day mortality was 15.1%, 17.4% and 19.2% in patients receiving appropriate EAT, inappropriate EAT, and unknown EAT, respectively. Among patients alive on day 30, the 31-365 day mortality was 22.3% in patients given appropriate EAT compared to 30.7% in those given inappropriate EAT. Inappropriate EAT was independently associated with recurrence (HR 1.25; 95% CI = 1.03-1.52) and long-term mortality (OR 1.35; 95% CI = 1.10-1.60), but not with short-term mortality (OR 0.85; 95% CI = 0.70-1.02) after bacteraemia.



Our data indicate that appropriate EAT is associated with reduced incidence of recurrence and lower long-term mortality following bacteraemia.
Center for Clinical Epidemiology, South, OUH Odense University Hospital, Kløvervænget 30, Entrance 216, DK-5000, Odense C, Denmark. kim.gradel@rsyd.dk.|Research Unit of Clinical Epidemiology, Institute of Clinical Research, University of Southern Denmark, Odense, Denmark. kim.gradel@rsyd.dk.
Kim O
KO
Gradel
Department of Clinical Microbiology, Slagelse Hospital, Slagelse, Denmark.
Ulrich S
US
Jensen
Department of Clinical Microbiology, Aalborg University Hospital, Aalborg, Denmark.|Department of Clinical Medicine, Aalborg University, Aalborg, Denmark.
Henrik C
HC
Schønheyder
Department of Clinical Microbiology, Copenhagen University Hospital, Hvidovre, Denmark.
Christian
C
Østergaard
Department of Clinical Microbiology, Copenhagen University Hospital, Hvidovre, Denmark.
Jenny D
JD
Knudsen
Center for Clinical Epidemiology, South, OUH Odense University Hospital, Kløvervænget 30, Entrance 216, DK-5000, Odense C, Denmark.|Research Unit of Clinical Epidemiology, Institute of Clinical Research, University of Southern Denmark, Odense, Denmark.
Sonja
S
Wehberg
Department of Clinical Epidemiology, Institute of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark.
Mette
M
Søgaard
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000494:pharmacology / Q000627:therapeutic use*; D016470:Bacteremia / Q000188:drug therapy* / Q000453:epidemiology / Q000382:microbiology / Q000401:mortality; D001419:Bacteria / Q000187:drug effects / Q000302:isolation & purification; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D015897:Comorbidity; D003718:Denmark / Q000453:epidemiology; D005260:Female; D006801:Humans; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D016017:Odds Ratio; D016016:Proportional Hazards Models; D012008:Recurrence; D015996:Survival Rate; D055815:Young Adult
D000900:Anti-Bacterial Agents
Bacteraemia; Epidemiology; Mortality; Population-based; Recurrence