Impact of appropriate empirical antibiotic treatment on recurrence and mortality in patients with bacteraemia: a population-based cohort study

BMC Infectious Diseases

Research Article

Kim O. Gradel¹  Sonja Wehberg¹  Mette Søgaard²  Henrik C. Schønheyder³  Jenny D. Knudsen⁴  Christian Østergaard⁴  Ulrich S. Jensen⁵ 

[1] 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;Department of Clinical Epidemiology, Institute of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark;Department of Clinical Microbiology, Aalborg University Hospital, Aalborg, Denmark;Department of Clinical Medicine, Aalborg University, Aalborg, Denmark;Department of Clinical Microbiology, Copenhagen University Hospital, Hvidovre, Denmark;Department of Clinical Microbiology, Slagelse Hospital, Slagelse, Denmark;

关键词: Bacteraemia;    Recurrence;    Mortality;    Population-based;    Epidemiology;   

DOI  :  10.1186/s12879-017-2233-z

 received in 2016-11-16, accepted in 2017-01-31,  发布年份 2017

来源: Springer

【 摘 要 】

BackgroundData 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.MethodsA 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 1st notification 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.ResultsIn 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.ConclusionsOur data indicate that appropriate EAT is associated with reduced incidence of recurrence and lower long-term mortality following bacteraemia.

【 授权许可】

CC BY   
© The Author(s). 2017