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Bloodstream infections caused by antibiotic-resistant gram-negative bacilli: risk factors for mortality and impact of inappropriate initial antimicrobial therapy on outcome

Cited 400 time in Web of Science Cited 425 time in Scopus
Authors
Kang, Cheol-In; Kim, Sung-Han; Park, Wan Beom; Lee, Ki-Deok; Kim, Hong-Bin; Kim, Eui-Chong; Oh, Myoung-Don; Choe, Kang-Won
Issue Date
2005-01-28
Publisher
American Diabetes Association
Citation
Antimicrob Agents Chemother. 2005 Feb;49(2):760-6.
Keywords
AdolescentAdultAgedAged, 80 and overAnti-Infective Agents/*therapeutic useBacteremia/*drug therapy/*mortalityCohort StudiesDrug Resistance, BacterialFemaleGram-Negative Bacteria/drug effectsGram-Negative Bacterial Infections/*drug therapy/*mortalityHumansLogistic ModelsMaleMedical ErrorsMiddle AgedPredictive Value of TestsRetrospective StudiesRisk FactorsTreatment Outcome
Abstract
The marked increase in the incidence of infections due to antibiotic-resistant gram-negative bacilli in recent years is of great concern, as patients infected by those isolates might initially receive antibiotics that are inactive against the responsible pathogens. To evaluate the effect of inappropriate initial antimicrobial therapy on survival, a total of 286 patients with antibiotic-resistant gram-negative bacteremia, 61 patients with Escherichia coli bacteremia, 65 with Klebsiella pneumoniae bacteremia, 74 with Pseudomonas aeruginosa bacteremia, and 86 with Enterobacter bacteremia, were analyzed retrospectively. If a patient received at least one antimicrobial agent to which the causative microorganisms were susceptible within 24 h of blood culture collection, the initial antimicrobial therapy was considered to have been appropriate. High-risk sources of bacteremia were defined as the lung, peritoneum, or an unknown source. The main outcome measure was 30-day mortality. Of the 286 patients, 135 (47.2%) received appropriate initial empirical antimicrobial therapy, and the remaining 151 (52.8%) patients received inappropriate therapy. The adequately treated group had a 27.4% mortality rate, whereas the inadequately treated group had a 38.4% mortality rate (P = 0.049). Multivariate analysis showed that the significant independent risk factors of mortality were presentation with septic shock, a high-risk source of bacteremia, P. aeruginosa infection, and an increasing APACHE II score. In the subgroup of patients (n = 132) with a high-risk source of bacteremia, inappropriate initial antimicrobial therapy was independently associated with increased mortality (odds ratio, 3.64; 95% confidence interval, 1.13 to 11.72; P = 0.030). Our data suggest that inappropriate initial antimicrobial therapy is associated with adverse outcome in antibiotic-resistant gram-negative bacteremia, particularly in patients with a high-risk source of bacteremia.
ISSN
0066-4804 (Print)
Language
English
URI
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=15673761

http://hdl.handle.net/10371/11591
DOI
https://doi.org/10.1128/AAC.49.2.760-766.2005
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College of Medicine/School of Medicine (의과대학/대학원)Laboratory Medicine (검사의학전공)Journal Papers (저널논문_검사의학전공)
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