Effect of adequacy of empirical antibiotic therapy for hospital-acquired bloodstream infections on intensive care unit patient prognosis: a causal inference approach using data from the Eurobact2 study
Küçük Resim Yok
Tarih
2024
Dergi Başlığı
Dergi ISSN
Cilt Başlığı
Yayıncı
Elsevier B.V.
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
Objectives: Hospital-acquired bloodstream infections (HA-BSI) in the intensive care unit (ICU) are common life-threatening events. We aimed to investigate the association between early adequate antibiotic therapy and 28-day mortality in ICU patients who survived at least 1 day after the onset of HA-BSI. Methods: We used individual data from a prospective, observational, multicentre, and intercontinental cohort study (Eurobact2). We included patients who were followed for ≥1 day and for whom time-to-appropriate treatment was available. We used an adjusted frailty Cox proportional-hazard model to assess the effect of time-to-treatment-adequacy on 28-day mortality. Infection- and patient-related variables identified as confounders by the Directed Acyclic Graph were used for adjustment. Adequate therapy within 24 hours was used for the primary analysis. Secondary analyses were performed for adequate therapy within 48 and 72 hours and for identified patient subgroups. Results: Among the 2418 patients included in 330 centres worldwide, 28-day mortality was 32.8% (n = 402/1226) in patients who were adequately treated within 24 hours after HA-BSI onset and 40% (n = 477/1192) in inadequately treated patients (p < 0.01). Adequacy within 24 hours was more common in young, immunosuppressed patients, and with HA-BSI due to Gram-negative pathogens. Antimicrobial adequacy was significantly associated with 28-day survival (adjusted Hazard Ratio (aHR), 0.83; 95% CI, 0.72–0.96; p 0.01). The estimated population attributable fraction of 28-day mortality of inadequate therapy was 9.15% (95% CI, 1.9–16.2%). Discussion: In patients with HA-BSI admitted to the ICU, the population attributable fraction of 28-day mortality of inadequate therapy within 24 hours was 9.15%. This estimate should be used when hypothesizing the possible benefit of any intervention aiming at reducing the time-to-appropriate antimicrobial therapy in HA-BSI. © 2025 Elsevier B.V., All rights reserved.
Açıklama
Anahtar Kelimeler
Adequacy, Critically Ill, Directed Acyclic Graph, Hospital-acquired Bloodstream Infection, Mediation Analysis, Sepsis, Time-to-antibiotic, Colistin, Echinocandin, Piperacillin Plus Tazobactam, Vancomycin, Anti-bacterial Agents, Carbapenem Derivative, Colistin, Echinocandin, Piperacillin Plus Tazobactam, Vancomycin, Antiinfective Agent, Adult, Aged, Antibiotic Therapy, Article, Bloodstream Infection, Cohort Analysis, Comparative Study, Controlled Study, Directed Acyclic Graph, Female, Hospital Admission, Hospital Infection, Hospitalization, Human, Intensive Care Unit, Major Clinical Study, Male, Mortality, Multicenter Study, Observational Study, Patient Selection, Prognosis, Proportional Hazards Model, Prospective Study, Secondary Analysis, Time To Treatment, Treatment Guideline, Undertreatment, Bacteremia, Clinical Trial, Cross Infection, Drug Therapy, Microbiology, Middle Aged, Very Elderly, Aged, Aged, 80 And Over, Anti-bacterial Agents, Bacteremia, Cross Infection, Female, Humans, Intensive Care Units, Male, Middle Aged, Prognosis, Proportional Hazards Models, Prospective Studies
Kaynak
Clinical Microbiology and Infection
WoS Q Değeri
Scopus Q Değeri
Q1
Cilt
30
Sayı
12
