Risk factors associated with inappropriate empirical antimicrobial treatment in bloodstream infections. A cohort study

• Published in: Frontiers in pharmacology Vol. 14; p. 1132530
• Main Authors: Dietl, Beatriz, Boix-Palop, Lucía, Gisbert, Laura, Mateu, Aina, Garreta, Gemma, Xercavins, Mariona, Badía, Cristina, López-Sánchez, María, Pérez, Josefa, Calbo, Esther
• Format: Journal Article
• Language: English
• Published: Switzerland Frontiers Media S.A 24.03.2023
• Subjects: anti-bacterial agents-therapeutic use; antimicrobial stewardship (ASP) intervention; antimicrobial therapy; bacteremia; bloodstream infections (BSI); Pharmacology; risk factors; anti-bacterial agents-therapeutic use; antimicrobial therapy; bloodstream infections (BSI); risk factors; antimicrobial stewardship (ASP) intervention; bacteremia
• ISSN: 1663-9812; 1663-9812
• DOI: 10.3389/fphar.2023.1132530

Bloodstream infections (BSI) are a major cause of mortality all over the world. Inappropriate empirical antimicrobial treatment (i-EAT) impact on mortality has been largely reported. However, information on related factors for the election of i-EAT in the treatment of BSI in adults is lacking. The aim of the study was the identification of risk-factors associated with the use of i-EAT in BSI. A retrospective, observational cohort study, from a prospective database was conducted in a 400-bed acute-care teaching hospital including all BSI episodes in adult patients between January and December 2018. The main outcome variable was EAT appropriation. Multivariate analysis using logistic regression was performed. 599 BSI episodes were included, 146 (24%) received i-EAT. Male gender, nosocomial and healthcare-associated acquisition of infection, a high Charlson Comorbidity Index (CCI) score and the isolation of multidrug resistant (MDR) microorganisms were more frequent in the i-EAT group. Adequation to local guidelines' recommendations on EAT resulted in 91% of appropriate empirical antimicrobial treatment (a-EAT). Patients receiving i-EAT presented higher mortality rates at day 14 and 30 when compared to patients with a-EAT (14% vs. 6%, = 0.002 and 22% vs. 9%, < 0.001 respectively). In the multivariate analysis, a CCI score ≥3 (OR 1.90 (95% CI 1.16-3.12) 0.01) and the isolation of a multidrug resistant (MDR) microorganism (OR 3.79 (95% CI 2.28-6.30), 0.001) were found as independent risk factors for i-EAT. In contrast, female gender (OR 0.59 (95% CI 0.35-0.98), 0.04), a correct identification of clinical syndrome prior to antibiotics administration (OR 0.26 (95% CI 0.16-0.44), < 0.001) and adherence to local guidelines (OR 0.22 (95% CI 0.13-0.38), 0.001) were identified as protective factors against i-EAT. One quarter of BSI episodes received i-EAT. Some of the i-EAT related factors were unmodifiable (male gender, CCI score ≥3 and isolation of a MDR microorganism) but others (incorrect identification of clinical syndrome before starting EAT or the use of local guidelines for EAT) could be addressed to optimize the use of antimicrobials.