AJM Theme Issue: Infectious Disease
Clinical research study
Benefit of Appropriate Empirical Antibiotic Treatment: Thirty-day Mortality and Duration of Hospital Stay

https://doi.org/10.1016/j.amjmed.2006.03.034Get rights and content

Abstract

Purpose

We evaluated the effect of inappropriate antibiotic treatment on mortality and duration of hospital stay in medical inpatients with bacterial infections.

Subjects and methods

Two cohorts of febrile adult patients (excluding patients with acquired immune deficiency syndrome and organ transplant recipients), hospitalized in three medical centers in Israel, Italy, and Germany, were included. Patients’ data were collected prospectively. Initial empirical treatment was defined as appropriate if an antibiotic prescribed within 24 hours of the first encounter with the patient matched the in vitro susceptibility of a pathogen deemed to be the likely cause of infection. The results of cultures and serologic or direct tests, and data on outcomes were collected 30 days after initiation of empirical treatment.

Results

A total of 920 patients (26% of 3529 included patients) had microbiologically documented infections, and mortality data were available for 895 patients (97%). Inappropriate initial antibiotic treatment was prescribed in 36% of patients (N = 319). All-cause 30-day mortality rates were 20.1% (N = 64) and 11.8% (N = 68) in patients who received inappropriate and appropriate treatment, respectively (odds ratio = 1.88, 95% confidence interval [CI], 1.29-2.72, P = .001). When adjustment was made for medical center and other variables, the association between inappropriate with mortality was significant (odds ratio = 1.58, 95% CI, 0.99-2.54, P = .058). In all 3 medical centers, the mean duration of hospital stay was at least 2 days longer for patients who were prescribed inappropriate antibiotic treatment (overall P = .002). This association was consistent after adjusting for other variables (P = .006).

Conclusion

Appropriate empirical antibiotic treatment is associated with a better survival and shortened duration of hospital stay in medical patients with bacterial infections.

Section snippets

Study Sample

We analyzed a multinational database of patients from 3 medical centers: Rabin Medical Center, Beilinson Campus (Israel): 6 departments of internal medicine (240 beds); University Hospital of Freiburg (Germany): 2 gastroenterology, 2 nephrology, and 2 intensive care wards (94 beds); and A. Gemelli University Hospital (Italy): 3 infectious disease wards (60 beds). Patients were enrolled as part of a 2-phase study (observational and interventional) designed to evaluate the effectiveness of TREAT,

Results

Of the 3529 recruited patients, 920 (26%) had microbiologically documented infections and mortality data were available for 895 (97.3% of 920). A total of 560 patients were enrolled in Israel, 180 patients were enrolled in Germany, and 155 patients were enrolled in Italy. A total of 435 patients were female (49%). The mean age was 66.7 ± 18.2 years (standard deviation). A total of 182 infections were hospital acquired (20%). The most common sites of infection were the urinary tract (315 patients,

Discussion

We found inappropriate empirical antibiotic treatment to be associated with an increased risk for all-cause 30-day mortality in adult patients with bacterial infections hospitalized in three medical centers in three different countries (OR = 1.58, 95% CI, 0.99-2.54). Although this association has been found in subsets of patients (critically ill patients3, 4, 6, 8, 9and patients with bloodstream infections2, 5, 7), our results demonstrate that this association is also true of inpatients with

Treat study group

Leonard Leibovici and Steen Andreassen conceived the TREAT project and basic concepts.

Mical Paul, Leonard Leibovici, Brian Kristensen, Elad Goldberg, Anders D. Nielsen, Alina Zalounina, and Steen Andreassen built the model.

Leif E. Kristensen, Karsten Falborg, Alina Zalounina, and Anders D. Nielsen built the interface, database, and supporting software.

Abigail Fraser, Mical Paul, and Leonard Leibovici planned this study and analyzed data.

Abigail Fraser, Mical Paul, Nadja Almanasreh, Evelina

References (19)

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