Patients who received an appropriate initial antibiotic for bloodstream infections (BSIs) had a lower risk of death compared with those who received an inappropriate antibiotic, U.S. researchers reported in JAMA Network Open.
The multicenter cross-sectional study, which included more than 32,000 patients who had been hospitalized with BSIs, found that receipt of appropriate initial empiric antibiotic therapy was associated with lower risk of in-hospital death for three pathogen groups compared with those whose initial antibiotic was inappropriate. For all three groups, the risk of in-hospital death was more than or nearly cut in half for patients who received the right antibiotic.
"Given these findings, it is important for clinicians to carefully choose empirical antimicrobial agents to improve outcomes in patients with BSIs," the study authors wrote.
'Delicate balance'
For the study, a team led by researchers with Duke University Medical Center analyzed data from the Premier Healthcare database from 2016 through 2020, including data from a subset of U.S. hospitals that reported laboratory and microbiologic data. The study included adults who had positive results from the first blood cultures taken during hospitalization and received treatment with at least one systemic antibiotic.
BSIs are severe bacterial infections that can lead to sepsis and can be deadly in 10% to 30% of cases, which makes the choice of initial antibiotic therapy—before the results of antibiotic susceptibility tests have been obtained—a critical one. Broad-spectrum antibiotics are typically used when a patient is suspected of having a severe infection.
The aim of the study was to examine the pathogens causing BSIs, their antibiotic resistance profile, and in-hospital mortality associated with appropriate versus inappropriate empirical antibiotic therapy. Previous studies that looked at associations between empirical antibiotic therapy and outcomes in BSI patients have shown conflicting results.
