Sarah E Battle1, P Brandon Bookstaver2,3, Julie Ann Justo2,3, Joseph Kohn3, Helmut Albrecht4,5, Majdi N Al-Hasan5. 1. University of South Carolina School of Medicine, Columbia, SC, USA secain@g.clemson.edu. 2. Department of Clinical Pharmacy and Outcomes Sciences, South Carolina College of Pharmacy, University of South Carolina, Columbia, SC, USA. 3. Department of Pharmacy, Palmetto Health Richland, Columbia, SC, USA. 4. University of South Carolina School of Medicine, Columbia, SC, USA. 5. Department of Medicine, Division of Infectious Diseases, University of South Carolina School of Medicine, Columbia, SC, USA.
Abstract
OBJECTIVES: The potential benefit from appropriate empirical antimicrobial therapy in patients with favourable prognosis at initial presentation with Gram-negative bloodstream infection (BSI) remains unclear. This retrospective cohort study examined the impact of inappropriate empirical antimicrobial therapy on hospital length of stay (HLOS) following Gram-negative BSI after stratification by predicted prognosis using the BSI mortality risk score (BSIMRS). METHODS: Hospitalized adults with first episodes of Gram-negative BSI from 1 January 2010 to 31 December 2013 at Palmetto Health Hospitals in Columbia, SC, USA were identified. Multivariate Cox proportional hazards regression was used to examine the association between inappropriate empirical antimicrobial therapy and HLOS overall and within each predefined BSIMRS category (<5 and ≥5). RESULTS: Among 830 unique patients with Gram-negative BSI, 469 and 361 had BSIMRS <5 and ≥5, respectively. Overall, the median age was 65 years, 448 (54%) were women, Escherichia coli (444; 53%) was the most common bloodstream isolate and 444 (53%) had a urinary source of infection. After adjustments in the multivariate model, BSIMRS (HR = 1.14 per point, 95% CI = 1.11-1.17, P < 0.001) and inappropriate empirical antimicrobial therapy (HR = 1.41, 95% CI = 1.07-1.91, P = 0.01) were independently associated with increased risk of remaining hospitalized following Gram-negative BSI. Median HLOS with appropriate and inappropriate empirical antimicrobial therapy was 7 and 10 days, respectively, in patients with BSIMRS <5 (P = 0.03) and 13 and 17 days, respectively, in those with BSIMRS ≥5 (P = 0.02). CONCLUSIONS: Inappropriate empirical antimicrobial therapy is associated with prolonged HLOS following Gram-negative BSI in patients with both good and guarded prognosis.
OBJECTIVES: The potential benefit from appropriate empirical antimicrobial therapy in patients with favourable prognosis at initial presentation with Gram-negative bloodstream infection (BSI) remains unclear. This retrospective cohort study examined the impact of inappropriate empirical antimicrobial therapy on hospital length of stay (HLOS) following Gram-negative BSI after stratification by predicted prognosis using the BSI mortality risk score (BSIMRS). METHODS: Hospitalized adults with first episodes of Gram-negative BSI from 1 January 2010 to 31 December 2013 at Palmetto Health Hospitals in Columbia, SC, USA were identified. Multivariate Cox proportional hazards regression was used to examine the association between inappropriate empirical antimicrobial therapy and HLOS overall and within each predefined BSIMRS category (<5 and ≥5). RESULTS: Among 830 unique patients with Gram-negative BSI, 469 and 361 had BSIMRS <5 and ≥5, respectively. Overall, the median age was 65 years, 448 (54%) were women, Escherichia coli (444; 53%) was the most common bloodstream isolate and 444 (53%) had a urinary source of infection. After adjustments in the multivariate model, BSIMRS (HR = 1.14 per point, 95% CI = 1.11-1.17, P < 0.001) and inappropriate empirical antimicrobial therapy (HR = 1.41, 95% CI = 1.07-1.91, P = 0.01) were independently associated with increased risk of remaining hospitalized following Gram-negative BSI. Median HLOS with appropriate and inappropriate empirical antimicrobial therapy was 7 and 10 days, respectively, in patients with BSIMRS <5 (P = 0.03) and 13 and 17 days, respectively, in those with BSIMRS ≥5 (P = 0.02). CONCLUSIONS: Inappropriate empirical antimicrobial therapy is associated with prolonged HLOS following Gram-negative BSI in patients with both good and guarded prognosis.
Authors: Sarah E Battle; Matthew R Augustine; Christopher M Watson; P Brandon Bookstaver; Joseph Kohn; William B Owens; Larry M Baddour; Majdi N Al-Hasan Journal: Infection Date: 2019-02-08 Impact factor: 3.553
Authors: Avery N Nelson; Julie Ann Justo; P Brandon Bookstaver; Joseph Kohn; Helmut Albrecht; Majdi N Al-Hasan Journal: Infection Date: 2017-05-06 Impact factor: 3.553
Authors: Massimo Sartelli; Francesco M Labricciosa; Pamela Barbadoro; Leonardo Pagani; Luca Ansaloni; Adrian J Brink; Jean Carlet; Ashish Khanna; Alain Chichom-Mefire; Federico Coccolini; Salomone Di Saverio; Addison K May; Pierluigi Viale; Richard R Watkins; Luigia Scudeller; Lilian M Abbo; Fikri M Abu-Zidan; Abdulrashid K Adesunkanmi; Sara Al-Dahir; Majdi N Al-Hasan; Halil Alis; Carlos Alves; André R Araujo da Silva; Goran Augustin; Miklosh Bala; Philip S Barie; Marcelo A Beltrán; Aneel Bhangu; Belefquih Bouchra; Stephen M Brecher; Miguel A Caínzos; Adrian Camacho-Ortiz; Marco Catani; Sujith J Chandy; Asri Che Jusoh; Jill R Cherry-Bukowiec; Osvaldo Chiara; Elif Colak; Oliver A Cornely; Yunfeng Cui; Zaza Demetrashvili; Belinda De Simone; Jan J De Waele; Sameer Dhingra; Francesco Di Marzo; Agron Dogjani; Gereltuya Dorj; Laurent Dortet; Therese M Duane; Mutasim M Elmangory; Mushira A Enani; Paula Ferrada; J Esteban Foianini; Mahir Gachabayov; Chinmay Gandhi; Wagih Mommtaz Ghnnam; Helen Giamarellou; Georgios Gkiokas; Harumi Gomi; Tatjana Goranovic; Ewen A Griffiths; Rosio I Guerra Gronerth; Julio C Haidamus Monteiro; Timothy C Hardcastle; Andreas Hecker; Adrien M Hodonou; Orestis Ioannidis; Arda Isik; Katia A Iskandar; Hossein S Kafil; Souha S Kanj; Lewis J Kaplan; Garima Kapoor; Aleksandar R Karamarkovic; Jakub Kenig; Ivan Kerschaever; Faryal Khamis; Vladimir Khokha; Ronald Kiguba; Hong B Kim; Wen-Chien Ko; Kaoru Koike; Iryna Kozlovska; Anand Kumar; Leonel Lagunes; Rifat Latifi; Jae G Lee; Young R Lee; Ari Leppäniemi; Yousheng Li; Stephen Y Liang; Warren Lowman; Gustavo M Machain; Marc Maegele; Piotr Major; Sydney Malama; Ramiro Manzano-Nunez; Athanasios Marinis; Isidro Martinez Casas; Sanjay Marwah; Emilio Maseda; Michael E McFarlane; Ziad Memish; Dominik Mertz; Cristian Mesina; Shyam K Mishra; Ernest E Moore; Akutu Munyika; Eleftherios Mylonakis; Lena Napolitano; Ionut Negoi; Milica D Nestorovic; David P Nicolau; Abdelkarim H Omari; Carlos A Ordonez; José-Artur Paiva; Narayan D Pant; Jose G Parreira; Michal Pędziwiatr; Bruno M Pereira; Alfredo Ponce-de-Leon; Garyphallia Poulakou; Jacobus Preller; Céline Pulcini; Guntars Pupelis; Martha Quiodettis; Timothy M Rawson; Tarcisio Reis; Miran Rems; Sandro Rizoli; Jason Roberts; Nuno Rocha Pereira; Jesús Rodríguez-Baño; Boris Sakakushev; James Sanders; Natalia Santos; Norio Sato; Robert G Sawyer; Sandro Scarpelini; Loredana Scoccia; Nusrat Shafiq; Vishalkumar Shelat; Costi D Sifri; Boonying Siribumrungwong; Kjetil Søreide; Rodolfo Soto; Hamilton P de Souza; Peep Talving; Ngo Tat Trung; Jeffrey M Tessier; Mario Tumbarello; Jan Ulrych; Selman Uranues; Harry Van Goor; Andras Vereczkei; Florian Wagenlehner; Yonghong Xiao; Kuo-Ching Yuan; Agnes Wechsler-Fördös; Jean-Ralph Zahar; Tanya L Zakrison; Brian Zuckerbraun; Wietse P Zuidema; Fausto Catena Journal: World J Emerg Surg Date: 2017-08-01 Impact factor: 5.469
Authors: Jack G Schneider; James B Wood; Bryan H Schmitt; Christopher L Emery; Thomas E Davis; Nathan W Smith; Sarah Blevins; Jon Hiles; Armisha Desai; Justin Wrin; Brittany Bocian; John J Manaloor Journal: J Antimicrob Chemother Date: 2019-01-01 Impact factor: 5.790