Assessing the efficacy of empiric antibiotic therapy for selected infections in patients with and without malignancy

Guidelines for the selection of empirical antibiotics aim to improve patient outcomes, reduce unnecessary antibiotic use and reduce development of antimicrobial resistance.

To assess the adherence to guidelines for the selection of parenteral empirical antibiotics for three infections in patients with and without malignancies, to determine whether the national guidelines reflect the current bacterial susceptibility patterns of selected infections, and to determine the appropriateness of the selected parenteral empirical antibiotics for the selected infections.

The study included bacterial isolates from adults with and without malignancy who had a positive culture for lower respiratory tract infection, skin and soft tissue infection, or urinary tract infection, and who were prescribed parenteral empirical antibiotic. Antibiotic susceptibility was determined by standard micro-biological methods. Adherence to guidelines was defined as prescribing the empiric antibiotic concordant with national guidelines.

The analysis included 155 bacterial isolates from each population. The selection of empirical antibiotics was guideline-concordant in 92.4% without and 67.5% with cancers. Resistance to recommended empirical antibiotics was seen in 29.5% and 41.2% of the bacterial isolates in those without and with cancers respectively. Only 47.5% and 20.6% of isolates from those without and with cancers respectively were sensitive to the empirical antibiotic prescribed and therefore considered as appropriate antibiotic prescriptions.

Empirical antibiotic guidelines should be updated to reflect the prevailing bacterial sensitivity patterns to ensure optimum outcomes. Prescribing pat-terns and guideline concordance should be periodically evaluated to ensure that the antimicrobial stewardship programs are moving in the right direction.