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Multiplex Therapeutic Drug Monitoring by Isotope-dilution HPLC-MS/MS of Antibiotics in Critical Illnesses
Published on: August 30, 2018
Characteristics of surgical patients receiving inappropriate empiric antimicrobial therapy
Stephen W Davies1, Jimmy T Efird, Christopher A Guidry
1From the Department of General Surgery (S.W.D., C.A.G., R.G.S.), School of Medicine, University of Virginia, Charlottesville, Virginia; Biostatistics Unit (J.T.E.), Center for Health Disparities, Brody School of Medicine, East Carolina University, Greenville, North Carolina; Department of Surgery (T.H.), Division of Burn/Trauma/Critical Care, University of Texas Southwestern, Dallas, Texas; Department of Endocrine Surgery (R.M.), Cleveland Clinic, Cleveland, Ohio; and (B.R.S.), Mercy Clinic General and Specialty Surgery, Springfield, Missouri.
Background:
Inappropriate antibiotics have been observed to result in an increased duration of antibiotic treatment and hospital length of stay, development of multidrug-resistant organisms, and mortality rate compared with appropriate antibiotic treatment. Few studies have evaluated independent risk factors associated with inappropriateness. The purpose of this study was to identify independent predictors of inappropriate, empiric antimicrobial therapy for the treatment of severe sepsis.
Methods:
This was a retrospective analysis of a prospectively maintained database of all surgical/trauma patients admitted to a tertiary care center from 1996 to 2007 and treated for sepsis. "Appropriate" empiric antibiotic treatment was determined by sensitivity testing. Demographics and comorbidities, infection sites, infection organisms, and outcomes between strata were compared. Differences in outcome were estimated using relative risk and 95% confidence intervals for correlated data.
Results:
A total of 2,855 patients (7,158 infections) were identified. Independent predictors of inappropriate, empiric antimicrobial therapy for the treatment of severe sepsis included site of infection and organism type. Severity of illness, age, medical conditions, and community versus health care-associated infections were not associated with inappropriate therapy. Although inappropriate empiric therapy was associated with a longer length of stay and duration of antimicrobial use, it did not result in higher mortality.
Conclusion:
Our study observed that inappropriate empiric antibiotic selection is related to site of infection and pathogen. Other clinical variables do not appear to predict inappropriateness of antibiotic treatment. Efforts should be focused on early broad-spectrum therapy and more rapid microbiologic methods.
Level Of Evidence:
Therapeutic/care management study, level II.
Insights
Inappropriate antibiotic selection for severe sepsis is linked to infection site and pathogen, not patient factors. Early broad-spectrum therapy and faster diagnostics are recommended to improve treatment outcomes.
Area of Science:
- Infectious Diseases
- Pharmacology
- Critical Care Medicine
Background:
- Inappropriate antibiotic use increases treatment duration, hospital stay, multidrug-resistant organisms, and mortality.
- Few studies have identified independent risk factors for inappropriate antibiotic therapy.
- Severe sepsis management requires effective antimicrobial strategies.
Purpose of the Study:
- To identify independent predictors of inappropriate empiric antimicrobial therapy in severe sepsis patients.
- To analyze factors influencing the appropriateness of initial antibiotic selection.
- To guide optimization of sepsis treatment protocols.
Main Methods:
- Retrospective analysis of a prospectively maintained database (1996-2007) of surgical/trauma patients with sepsis.
- Defined "appropriate" empiric antibiotic treatment based on sensitivity testing.
- Compared demographics, comorbidities, infection sites, organisms, and outcomes.
Main Results:
- Site of infection and organism type were independent predictors of inappropriate empiric therapy.
- Severity of illness, age, comorbidities, and infection source did not predict inappropriateness.
- Inappropriate therapy correlated with longer hospital stay and antibiotic use but not increased mortality.
Conclusions:
- Inappropriate empiric antibiotic selection is primarily associated with infection site and pathogen.
- Clinical variables like age and comorbidities do not reliably predict inappropriate antibiotic choices.
- Focus should be on early broad-spectrum therapy and accelerated microbiologic identification methods.
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