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Secular trends in the appropriateness of empirical antibiotic treatment in patients with bacteremia: a comparison between three prospective cohorts

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Abstract

The objective of this study was to explore whether the percentage of inappropriate empirical antibiotic treatment in patients with bacteremia changed over time and to understand the factors that brought on the change. Three prospective cohorts of patients with bacteremia in three different periods (January 1st, 1988 to December 31st, 1989; May 1st, 2004 to November 30, 2004; May 1st, 2010 to April 30, 2011) were compared. Analysis was performed on a total of 811 patients. In 2010–2011, 55.9% (76/136) of patients with bacteremia received inappropriate empirical treatment, compared with 34.5% (170/493) and 33.5% (55/164) in the first and second periods, respectively, in a significant upward trend (p = 0.001). Resistance to antibiotics increased significantly during the study period. The following variables were included in the multivariate analysis assessing risk factors for inappropriate empirical treatment: study period (third period) [odds ratio, OR = 2.766 (95% confidence interval, CI, 1.655–4.625)], gender (male) [OR = 1.511 (1.014–2.253)], pathogen carrying extended-spectrum beta-lactamases [OR = 10.426 (4.688–23.187)], multidrug-resistant Acinetobacter baumannii [OR = 5.428 (2.181–13.513)], and skin/soft infections [OR = 3.23 (1.148–9.084)]. A model excluding microbiological data included: gender (male) [OR = 1.648 (1.216–2.234)], study period (third period) [OR = 2.446 (1.653–3.620)], hospital-acquired infection [OR = 1.551 (1.060–2.270)], previous use of antibiotics [OR = 1.815 (1.247–2.642)], bedridden patient [OR = 2.019 (1.114–3.658)], and diabetes mellitus [OR = 1.620 (1.154–2.274)]. We have observed a worrisome increase in the rate of inappropriate empirical treatment of bacteremia. We need tools that will allow us better prediction of the pathogen and its susceptibilities during the first hours of managing a patient suspected of a severe bacterial infection.

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Acknowledgements

LL and MP are active members of the European Society of Clinical Microbiology and Infectious Diseases—Study Group for Infections in the Elderly (ESGIE) and acknowledge the ESGIE’s contribution to the conception of this study.

Funding

This work was supported by ‘The Israel National Institute for Health Policy Research’.

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Authors and Affiliations

  1. Infectious Diseases University Research Center, Rabin Medical Center, Beilinson Hospital, Petah Tikva, Israel

    Vered Daitch & Leonard Leibovici

  2. Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel

    Vered Daitch, Noa Eliakim-Raz, Leonard Leibovici & Dafna Yahav

  3. Department of Medicine E, Rabin Medical Center, Beilinson Hospital, Petah Tikva, Israel

    Vered Daitch, Yulia Akayzen, Yasmin Abu-Ghanem, Noa Eliakim-Raz & Leonard Leibovici

  4. Petach Tikva, Israel

    Vered Daitch

  5. Infectious Diseases Institute, Rambam Health Care Campus, Haifa, Israel

    Mical Paul

  6. Ruth and Bruce Rappaport Faculty of Medicine, Technion—Israel Institute of Technology, Haifa, Israel

    Mical Paul

  7. Unit of Infectious Diseases, Rabin Medical Center, Beilinson Hospital, Petah Tikva, Israel

    Dafna Yahav

Authors
  1. Vered Daitch
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  2. Yulia Akayzen
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  3. Yasmin Abu-Ghanem
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  4. Noa Eliakim-Raz
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  5. Mical Paul
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  6. Leonard Leibovici
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  7. Dafna Yahav
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Correspondence to Vered Daitch.

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The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. For this type of study, formal consent is not required.

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Daitch, V., Akayzen, Y., Abu-Ghanem, Y. et al. Secular trends in the appropriateness of empirical antibiotic treatment in patients with bacteremia: a comparison between three prospective cohorts. Eur J Clin Microbiol Infect Dis 37, 455–462 (2018). https://doi.org/10.1007/s10096-018-3190-1

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  • DOI: https://doi.org/10.1007/s10096-018-3190-1

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