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Delay of adequate empiric antibiotic therapy is associated with increased mortality among solid-organ transplant

B Hamandi1, A M Holbrook, A Humar

  • 1Pharmaceutical Sciences, University of Toronto, Toronto, Ontario, Canada. mailto:bassem.hamandi@uhn.on.ca

American Journal of Transplantation : Official Journal of the American Society of Transplantation and the American Society of Transplant Surgeons
|May 23, 2009
PubMed

Insights

Inadequate empiric therapy (IET) is common in solid-organ transplant recipients. This study found IET significantly increases hospital mortality, highlighting the need for optimized antibiotic strategies in this vulnerable patient group.

Area of Science:

  • Infectious Diseases
  • Transplant Medicine
  • Clinical Pharmacy

Background:

  • Empiric antibiotic therapy is a common practice before definitive pathogen identification.
  • Inadequate empiric therapy (IET), where initial antibiotics are not effective against the isolated organism, poses a clinical challenge.
  • The incidence and impact of IET in solid-organ transplant (SOT) recipients remain largely uncharacterized.

Purpose of the Study:

  • To determine the incidence of IET in SOT recipients.
  • To investigate the clinical significance and impact of IET on hospital mortality in SOT patients.
  • To identify factors associated with mortality in SOT patients receiving IET.

Main Methods:

  • Retrospective cohort study design.
  • Inclusion of SOT patients admitted between 2002 and 2004.
  • Application of multiple logistic regression analyses to identify mortality determinants.

Main Results:

  • IET was administered to 54% of the studied SOT patients.
  • Hospital mortality was significantly higher in patients receiving IET (24.9%) compared to those with adequate therapy (7.0%).
  • Factors independently correlated with increased hospital mortality included longer duration of IET, ICU-associated infections, prior antibiotic use, and higher APACHE-II scores.

Conclusions:

  • Inadequate empiric therapy is prevalent in the SOT population.
  • IET is associated with a substantially increased risk of hospital mortality in SOT recipients.
  • These findings underscore the critical need for timely and effective empiric antibiotic selection in SOT patients to improve outcomes.

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