Beneficial effects of early empirical administration of appropriate antimicrobials on survival and defervescence in adults with community-onset bacteremia

doi:10.1186/s13054-019-2632-1

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Title:	Beneficial effects of early empirical administration of appropriate antimicrobials on survival and defervescence in adults with community-onset bacteremia
Authors:	Lee, Ching-Chi Lee, Chung-Hsun Yang, Chao-Yung Hsieh, Chih-Chia Hung-Jen Tang(湯宏仁) Ko, Wen-Chien
Contributors:	Madou Sin Lau Hosp, Dept Internal Med Chang Jung Christian Univ, Grad Inst Med Sci, Coll Hlth Sci Natl Cheng Kung Univ, Natl Cheng Kung Univ Hosp, Dept Internal Med, Coll Med Natl Cheng Kung Univ, Dept Med, Coll Med Natl Cheng Kung Univ Hosp, Dept Emergency Med Chi Mei Med Ctr, Div Infect Dis, Dept Med Chia Nan Univ Pharm & Sci, Dept Hlth & Nutr
Keywords:	Empirical Antimicrobial therapy Community-onset Bloodstream infection Febrile Mortality
Date:	2019-11
Issue Date:	2020-07-29 13:50:21 (UTC+8)
Publisher:	BMC
Abstract:	Background Bloodstream infections are associated with high morbidity and mortality, both of which contribute substantially to healthcare costs. The effects of early administration of appropriate antimicrobials on the prognosis and timing of defervescence of bacteremic patients remain under debate. Methods In a 6-year retrospective, multicenter cohort, adults with community-onset bacteremia at the emergency departments (EDs) were analyzed. The period from ED arrival to appropriate antimicrobial administration and that from appropriate antimicrobial administration to defervescence was regarded as the time-to-appropriate antibiotic (TtAa) and time-to-defervescence (TtD), respectively. The primary study outcome was 30-day mortality after ED arrival. The effects of TtAa on 30-day mortality and delayed defervescence were examined after adjustment for independent predictors of mortality, which were recognized by a multivariate regression analysis. Results Of the total 3194 patients, a TtAa-related trend in the 30-day crude (gamma = 0.919, P = 0.01) and sepsis-related (gamma = 0.909, P = 0.01) mortality rate was evidenced. Each hour of TtAa delay was associated with an average increase in the 30-day crude mortality rate of 0.3% (adjusted odds ratio [AOR], 1.003; P < 0.001) in the entire cohort and 0.4% (AOR, 1.004; P < 0.001) in critically ill patients, respectively, after adjustment of independent predictors of 30-day crude mortality. Of 2469 febrile patients, a TtAa-related trend in the TtD (gamma = 0.965, P = 0.002) was exhibited. Each hour of TtAa delay was associated with an average 0.7% increase (AOR, 1.007; P < 0.001) in delayed defervescence (TtD of >= 7 days) after adjustment of independent determinants of delayed defervescence. Notably, the adverse impact of the inappropriateness of empirical antimicrobial therapy (TtAa > 24 h) on the TtD was noted, regardless of bacteremia severity, bacteremia sources, or causative microorganisms. Conclusions The delay in the TtAa was associated with an increasing risk of delayed defervescence and 30-day mortality for adults with community-onset bacteremia, especially for critically ill patients. Thus, for severe bacteremia episodes, early administration of appropriate empirical antimicrobials should be recommended.
Relation:	Critical Care, v.23, n.1, pp.363
Appears in Collections:	[Dept. of Health and Nutrition (including master's program)] Periodical Articles

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