Delay of Adequate Empiric Antibiotic Therapy Is Associated with Increased Mortality among Solid‐Organ Transplant Patients

• Published in: American journal of transplantation Vol. 9; no. 7; pp. 1657 - 1665
• Main Authors: Hamandi, B., Holbrook, A. M., Humar, A., Brunton, J., Papadimitropoulos, E. A., Wong, G. G., Thabane, L.
• Format: Journal Article
• Language: English
• Published: Malden, USA Blackwell Publishing Inc 01.07.2009; Wiley
• Subjects: Adult; Anti-Bacterial Agents - administration & dosage; Antibacterial agents; Antibiotics; Antibiotics. Antiinfectious agents. Antiparasitic agents; Bacteremia - drug therapy; Bacteremia - etiology; Bacterial Infections - drug therapy; Bacterial Infections - etiology; Biological and medical sciences; Cohort Studies; Epidemiology; Female; General aspects; Humans; infection; logistic analysis; Logistic Models; Male; Medical sciences; Middle Aged; Odds Ratio; organ transplantation; Organ Transplantation - adverse effects; Organ Transplantation - mortality; Pharmacology. Drug treatments; Public health. Hygiene; Public health. Hygiene-occupational medicine; Retrospective Studies; retrospective study; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Treatment Outcome; Human; Graft(material); Prognosis; Mortality; Solid organ; Patient; logistic analysis; Transplantation; Retrospective study; Homotransplantation; Epidemiology; Delay; Infection; Antibiotic; Association; Antibiotics; organ transplantation; Surgery; Analysis; Graft; Antibacterial agent; Logistics
• ISSN: 1600-6135; 1600-6143
• DOI: 10.1111/j.1600-6143.2009.02664.x

Empiric antibiotic therapy is often prescribed prior to the availability of bacterial culture results. In some cases, the organism isolated may not be susceptible to initial empiric therapy (inadequate empiric therapy or IET). In solid‐organ transplant recipients, the overall incidence and clinical importance of IET is unknown. We performed a retrospective cohort study of patients admitted from 2002 to 2004. Multiple logistic regression analyses were conducted to determine associations between potential determinants and mortality. IET was administered in 169/312 (54%) patients, with a hospital mortality rate that was significantly greater than those receiving adequate therapy (24.9% vs. 7.0%; relative risk [RR] 3.55; 95% confidence interval [CI], 1.85–6.83; p < 0.001). Regression analysis demonstrated that an increasing duration of IET (adjusted odds ratio [OR] at 24 h: 1.33; 95% CI: 1.15–1.53; p < 0.001), ICU‐associated infections (adjusted OR: 6.27; 95% CI: 2.79–14.09; p < 0.001), prior antibiotic use (adjusted OR: 3.56; 95% CI: 1.51–8.41; p = 0.004) and increasing APACHE‐II scores (adjusted OR: 1.26; 95% CI: 1.16–1.34; p < 0.001) were independently correlated with hospital mortality. IET is common and appears to be associated with an increased hospital mortality rate in the solid‐organ transplant population. A retrospective cohort study revealed that more than half of solid‐organ transplant recipients received delayed adequate empiric antibiotic therapy, which was found to be associated with increased hospital mortality compared to patients receiving timely adequate therapy.