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Effect of antibiotic streamlining on patient outcome in pneumococcal bacteraemia

Amelieke J H Cremers1, Tom Sprong2, Jeroen A Schouten3

  • 1Department of Paediatrics, Radboud university medical center, 6500 HB Nijmegen, The Netherlands Nijmegen Institute for Infection, Inflammation & Immunity (N4i), Radboud university medical center, 6500 HB Nijmegen, The Netherlands.

The Journal of Antimicrobial Chemotherapy
|April 15, 2014
PubMed
Abstract

Insights

Streamlining antibiotic therapy for pneumococcal infections to monotherapy is safe and associated with lower mortality rates. This approach reduces broad-spectrum antibiotic use without harming patients, even those with pneumonia.

Area of Science:

  • Infectious Diseases
  • Clinical Pharmacology
  • Internal Medicine

Background:

  • International guidelines recommend streamlining empirical antibiotic therapy to monotherapy with penicillin for blood culture-proven pneumococcal infections to minimize broad-spectrum antibiotic use.
  • Adherence to these recommendations is suboptimal, and the potential impact of antibiotic streamlining on individual patient outcomes remains unclear.
  • Investigating the association between antibiotic streamlining and mortality in pneumococcal infections is crucial for clinical practice.

Purpose of the Study:

  • To determine if streamlining antibiotic therapy in patients with bacteraemic pneumococcal infections is associated with a reduction in mortality.
  • To assess the safety of antibiotic streamlining in eligible pneumococcal bacteraemia cases.

Main Methods:

  • Retrospective analysis of adult patients with bacteraemic pneumococcal infections admitted to two Dutch hospitals between 2001 and 2011.
  • Collection of detailed clinical data, including patient characteristics, comorbidities, disease severity, and antibiotic treatment.
  • Selection of patients eligible for streamlining for further analysis.

Main Results:

  • Antibiotic treatment was streamlined in 45.8% of cases, with a significantly lower observed mortality rate (6.3% vs. 15.4%, P=.021).
  • The decision to streamline was only marginally explained by 38 accounted determinants.
  • After adjusting for confounders, the odds ratio for death during streamlining was 0.45 (95% CI: 0.18-1.11) overall and 0.35 (95% CI: 0.12-0.99) specifically in pneumonia cases.

Conclusions:

  • The study suggests that streamlining antibiotic therapy in eligible cases of pneumococcal bacteraemia is safe.
  • This safety is maintained irrespective of patient characteristics, disease severity, or the empirical treatment regimen used.
  • Findings support the adherence to international recommendations for antibiotic streamlining in pneumococcal infections.
Keywords:
S. pneumoniaeStreptococcus pneumoniaemortality

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