The benefit of appropriate empirical antibiotic treatment in patients with bloodstream infection
. Leibovici L, Shraga I, Drucker M, Konigsberger H, Samra Z, Pitlik SD (Rabin Medical Center, Petah‐Tiqva, and Tel‐Aviv University, Tel‐Aviv, Israel). The benefit of appropriate empirical antibiotic treatment in patients with bloodstream infection. J Intern Med 1998; 244: 379–86. Objectives To test...
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| Veröffentlicht in: | Journal of internal medicine 1998-11, Vol.244 (5), p.379-386 |
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| creator | LEIBOVICI, L SHRAGA, I DRUCKER, M KONIGSBERGER, H SAMRA, Z PITLIK, S. D |
| description | . Leibovici L, Shraga I, Drucker M, Konigsberger H, Samra Z, Pitlik SD (Rabin Medical Center, Petah‐Tiqva, and Tel‐Aviv University, Tel‐Aviv, Israel). The benefit of appropriate empirical antibiotic treatment in patients with bloodstream infection. J Intern Med 1998; 244: 379–86.
Objectives
To test whether empirical antibiotic treatment that matches the in vitro susceptibility of the pathogen (appropriate treatment) improves survival in patients with bloodstream infections; and to measure the improvement.
Design
Observational, prospective cohort study.
Setting
University hospital in Israel.
Subjects
All patients with bloodstream infections detected during 1988–94.
Interventions
None.
Main outcome measures
In‐hospital fatality rate and length of hospitalization.
Results
Out of 2158 patients given appropriate empirical antibiotic treatment, 436 (20%) died, compared with 432 of 1255 patients (34%) given inappropriate treatment (P = 0.0001). The median durations of hospital stay for patients who survived were 9 days for patients given appropriate treatment and 11 days for patients given inappropriate treatment. For patients who died, the median durations were 5 and 4 days, respectively (P |
| doi_str_mv | 10.1046/j.1365-2796.1998.00379.x |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_70107047</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>70107047</sourcerecordid><originalsourceid>FETCH-LOGICAL-c4209-32b3cf7401ca8ea437c509440e9a546e0fbf62c81c3f024bc4e5a8d2b23398b73</originalsourceid><addsrcrecordid>eNqNkUlvFDEQhS0ECsPAT0CyEOLWTXlpt33ggCKWoKBcwtm4PWXFo95oe5Tk3-POjObAiYtd0vtq0XuEUAY1A6k-7msmVFPx1qiaGaNrANGa-uEZ2ZyF52QDppGV0hxeklcp7QGYAAUX5MJo2ehGbMjv2zukHY4YYqZToG6el2leostIcZjjEr3rqRtz7OKUo6d5QZcHHDONI51djqVM9D7mO9r107RLKzAUMaDPcRpfkxfB9QnfnP4t-fX1y-3l9-r65tvV5efryksOphK8Ez60Eph3Gp0UrW_ASAloXCMVQuiC4l4zLwJw2XmJjdM73nEhjO5asSUfjnPL_X8OmLIdYvLY927E6ZBsCwxakCv47h9wPx2WsdxmmWmN4OoJ0kfIL1NKCwZbPBnc8mgZ2DUBu7er0XY12q4J2KcE7ENpfXuaf-gG3J0bT5YX_f1Jd6l4GxY3-pjOGJdCmfJsyacjdh97fPzv9fbHzdXPUom_iwqiWA</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>197932647</pqid></control><display><type>article</type><title>The benefit of appropriate empirical antibiotic treatment in patients with bloodstream infection</title><source>MEDLINE</source><source>Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals</source><source>Wiley Free Content</source><source>Wiley Online Library All Journals</source><creator>LEIBOVICI, L ; SHRAGA, I ; DRUCKER, M ; KONIGSBERGER, H ; SAMRA, Z ; PITLIK, S. D</creator><creatorcontrib>LEIBOVICI, L ; SHRAGA, I ; DRUCKER, M ; KONIGSBERGER, H ; SAMRA, Z ; PITLIK, S. D</creatorcontrib><description>. Leibovici L, Shraga I, Drucker M, Konigsberger H, Samra Z, Pitlik SD (Rabin Medical Center, Petah‐Tiqva, and Tel‐Aviv University, Tel‐Aviv, Israel). The benefit of appropriate empirical antibiotic treatment in patients with bloodstream infection. J Intern Med 1998; 244: 379–86.
Objectives
To test whether empirical antibiotic treatment that matches the in vitro susceptibility of the pathogen (appropriate treatment) improves survival in patients with bloodstream infections; and to measure the improvement.
Design
Observational, prospective cohort study.
Setting
University hospital in Israel.
Subjects
All patients with bloodstream infections detected during 1988–94.
Interventions
None.
Main outcome measures
In‐hospital fatality rate and length of hospitalization.
Results
Out of 2158 patients given appropriate empirical antibiotic treatment, 436 (20%) died, compared with 432 of 1255 patients (34%) given inappropriate treatment (P = 0.0001). The median durations of hospital stay for patients who survived were 9 days for patients given appropriate treatment and 11 days for patients given inappropriate treatment. For patients who died, the median durations were 5 and 4 days, respectively (P < 0.05), for both comparisons.
In a stratified analysis, fatality was higher in patients given inappropriate treatment than in those given appropriate treatment in all strata but two: patients with infections caused by streptococci other than Streptococcus gr. A and Streptoccocus pneumoniae (odds ratio (OR) of 1.0, 95% confidence interval (95% CI) 0.4–2.5); and hypothermic patients (OR = 0.9, 95% CI = 0.3–2.4). Even in patients with septic shock, inappropriate empirical treatment was associated with higher fatality rate (OR = 1.6, 95% CI = 1.0–2.7). The highest benefit associated with appropriate treatment was observed in paediatric patients (OR = 5.1, 95% CI = 2.4– 10.7); intra‐abdominal infections (OR = 3.8, 95% CI = 2.0–7.1); infections of the skin and soft tissues (OR = 3.1, 95% CI = 1.8–5.6); and infections caused by Klebsiella pneumoniae (OR = 3.0, 95% CI = 1.7–5.1) and S. pneumoniae (OR = 2.6, 95% C = 1.1–5.9).
On a multivariable logistic regression analysis, the contribution of inappropriate empirical treatment to fatality was independent of other risk factors (multivariable adjusted OR = 1.6, 95% CI = 1.3–1.9).
Conclusion
Appropriate empirical antibiotic treatment was associated with a significant reduction in fatality in patients with bloodstream infection.</description><identifier>ISSN: 0954-6820</identifier><identifier>EISSN: 1365-2796</identifier><identifier>DOI: 10.1046/j.1365-2796.1998.00379.x</identifier><identifier>PMID: 9845853</identifier><language>eng</language><publisher>Oxford BSL: Blackwell Science Ltd</publisher><subject>Adolescent ; Adult ; Aged ; Aged, 80 and over ; Anti-Bacterial Agents - therapeutic use ; Antibacterial agents ; antibiotic treatment ; Antibiotics. Antiinfectious agents. Antiparasitic agents ; bacteraemia ; Biological and medical sciences ; bloodstream infection ; Child ; Child, Preschool ; empirical ; fatality rate ; Female ; Humans ; Infant ; Infant, Newborn ; Logistic Models ; Male ; Medical sciences ; Middle Aged ; Pharmacology. Drug treatments ; Prospective Studies ; Risk Factors ; Sepsis - drug therapy ; Sepsis - mortality ; Treatment Outcome</subject><ispartof>Journal of internal medicine, 1998-11, Vol.244 (5), p.379-386</ispartof><rights>Blackwell Science Ltd, 1997</rights><rights>1998 INIST-CNRS</rights><rights>Copyright Blackwell Scientific Publications Ltd. Nov 1998</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c4209-32b3cf7401ca8ea437c509440e9a546e0fbf62c81c3f024bc4e5a8d2b23398b73</citedby><cites>FETCH-LOGICAL-c4209-32b3cf7401ca8ea437c509440e9a546e0fbf62c81c3f024bc4e5a8d2b23398b73</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://onlinelibrary.wiley.com/doi/pdf/10.1046%2Fj.1365-2796.1998.00379.x$$EPDF$$P50$$Gwiley$$H</linktopdf><linktohtml>$$Uhttps://onlinelibrary.wiley.com/doi/full/10.1046%2Fj.1365-2796.1998.00379.x$$EHTML$$P50$$Gwiley$$H</linktohtml><link.rule.ids>314,780,784,1416,1432,27923,27924,45573,45574,46408,46832</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=2436924$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/9845853$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>LEIBOVICI, L</creatorcontrib><creatorcontrib>SHRAGA, I</creatorcontrib><creatorcontrib>DRUCKER, M</creatorcontrib><creatorcontrib>KONIGSBERGER, H</creatorcontrib><creatorcontrib>SAMRA, Z</creatorcontrib><creatorcontrib>PITLIK, S. D</creatorcontrib><title>The benefit of appropriate empirical antibiotic treatment in patients with bloodstream infection</title><title>Journal of internal medicine</title><addtitle>J Intern Med</addtitle><description>. Leibovici L, Shraga I, Drucker M, Konigsberger H, Samra Z, Pitlik SD (Rabin Medical Center, Petah‐Tiqva, and Tel‐Aviv University, Tel‐Aviv, Israel). The benefit of appropriate empirical antibiotic treatment in patients with bloodstream infection. J Intern Med 1998; 244: 379–86.
Objectives
To test whether empirical antibiotic treatment that matches the in vitro susceptibility of the pathogen (appropriate treatment) improves survival in patients with bloodstream infections; and to measure the improvement.
Design
Observational, prospective cohort study.
Setting
University hospital in Israel.
Subjects
All patients with bloodstream infections detected during 1988–94.
Interventions
None.
Main outcome measures
In‐hospital fatality rate and length of hospitalization.
Results
Out of 2158 patients given appropriate empirical antibiotic treatment, 436 (20%) died, compared with 432 of 1255 patients (34%) given inappropriate treatment (P = 0.0001). The median durations of hospital stay for patients who survived were 9 days for patients given appropriate treatment and 11 days for patients given inappropriate treatment. For patients who died, the median durations were 5 and 4 days, respectively (P < 0.05), for both comparisons.
In a stratified analysis, fatality was higher in patients given inappropriate treatment than in those given appropriate treatment in all strata but two: patients with infections caused by streptococci other than Streptococcus gr. A and Streptoccocus pneumoniae (odds ratio (OR) of 1.0, 95% confidence interval (95% CI) 0.4–2.5); and hypothermic patients (OR = 0.9, 95% CI = 0.3–2.4). Even in patients with septic shock, inappropriate empirical treatment was associated with higher fatality rate (OR = 1.6, 95% CI = 1.0–2.7). The highest benefit associated with appropriate treatment was observed in paediatric patients (OR = 5.1, 95% CI = 2.4– 10.7); intra‐abdominal infections (OR = 3.8, 95% CI = 2.0–7.1); infections of the skin and soft tissues (OR = 3.1, 95% CI = 1.8–5.6); and infections caused by Klebsiella pneumoniae (OR = 3.0, 95% CI = 1.7–5.1) and S. pneumoniae (OR = 2.6, 95% C = 1.1–5.9).
On a multivariable logistic regression analysis, the contribution of inappropriate empirical treatment to fatality was independent of other risk factors (multivariable adjusted OR = 1.6, 95% CI = 1.3–1.9).
Conclusion
Appropriate empirical antibiotic treatment was associated with a significant reduction in fatality in patients with bloodstream infection.</description><subject>Adolescent</subject><subject>Adult</subject><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Anti-Bacterial Agents - therapeutic use</subject><subject>Antibacterial agents</subject><subject>antibiotic treatment</subject><subject>Antibiotics. Antiinfectious agents. Antiparasitic agents</subject><subject>bacteraemia</subject><subject>Biological and medical sciences</subject><subject>bloodstream infection</subject><subject>Child</subject><subject>Child, Preschool</subject><subject>empirical</subject><subject>fatality rate</subject><subject>Female</subject><subject>Humans</subject><subject>Infant</subject><subject>Infant, Newborn</subject><subject>Logistic Models</subject><subject>Male</subject><subject>Medical sciences</subject><subject>Middle Aged</subject><subject>Pharmacology. Drug treatments</subject><subject>Prospective Studies</subject><subject>Risk Factors</subject><subject>Sepsis - drug therapy</subject><subject>Sepsis - mortality</subject><subject>Treatment Outcome</subject><issn>0954-6820</issn><issn>1365-2796</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>1998</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNqNkUlvFDEQhS0ECsPAT0CyEOLWTXlpt33ggCKWoKBcwtm4PWXFo95oe5Tk3-POjObAiYtd0vtq0XuEUAY1A6k-7msmVFPx1qiaGaNrANGa-uEZ2ZyF52QDppGV0hxeklcp7QGYAAUX5MJo2ehGbMjv2zukHY4YYqZToG6el2leostIcZjjEr3rqRtz7OKUo6d5QZcHHDONI51djqVM9D7mO9r107RLKzAUMaDPcRpfkxfB9QnfnP4t-fX1y-3l9-r65tvV5efryksOphK8Ez60Eph3Gp0UrW_ASAloXCMVQuiC4l4zLwJw2XmJjdM73nEhjO5asSUfjnPL_X8OmLIdYvLY927E6ZBsCwxakCv47h9wPx2WsdxmmWmN4OoJ0kfIL1NKCwZbPBnc8mgZ2DUBu7er0XY12q4J2KcE7ENpfXuaf-gG3J0bT5YX_f1Jd6l4GxY3-pjOGJdCmfJsyacjdh97fPzv9fbHzdXPUom_iwqiWA</recordid><startdate>199811</startdate><enddate>199811</enddate><creator>LEIBOVICI, L</creator><creator>SHRAGA, I</creator><creator>DRUCKER, M</creator><creator>KONIGSBERGER, H</creator><creator>SAMRA, Z</creator><creator>PITLIK, S. D</creator><general>Blackwell Science Ltd</general><general>Blackwell Science</general><general>Blackwell Publishing Ltd</general><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7QL</scope><scope>C1K</scope><scope>K9.</scope><scope>7X8</scope></search><sort><creationdate>199811</creationdate><title>The benefit of appropriate empirical antibiotic treatment in patients with bloodstream infection</title><author>LEIBOVICI, L ; SHRAGA, I ; DRUCKER, M ; KONIGSBERGER, H ; SAMRA, Z ; PITLIK, S. D</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c4209-32b3cf7401ca8ea437c509440e9a546e0fbf62c81c3f024bc4e5a8d2b23398b73</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>1998</creationdate><topic>Adolescent</topic><topic>Adult</topic><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Anti-Bacterial Agents - therapeutic use</topic><topic>Antibacterial agents</topic><topic>antibiotic treatment</topic><topic>Antibiotics. Antiinfectious agents. Antiparasitic agents</topic><topic>bacteraemia</topic><topic>Biological and medical sciences</topic><topic>bloodstream infection</topic><topic>Child</topic><topic>Child, Preschool</topic><topic>empirical</topic><topic>fatality rate</topic><topic>Female</topic><topic>Humans</topic><topic>Infant</topic><topic>Infant, Newborn</topic><topic>Logistic Models</topic><topic>Male</topic><topic>Medical sciences</topic><topic>Middle Aged</topic><topic>Pharmacology. Drug treatments</topic><topic>Prospective Studies</topic><topic>Risk Factors</topic><topic>Sepsis - drug therapy</topic><topic>Sepsis - mortality</topic><topic>Treatment Outcome</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>LEIBOVICI, L</creatorcontrib><creatorcontrib>SHRAGA, I</creatorcontrib><creatorcontrib>DRUCKER, M</creatorcontrib><creatorcontrib>KONIGSBERGER, H</creatorcontrib><creatorcontrib>SAMRA, Z</creatorcontrib><creatorcontrib>PITLIK, S. D</creatorcontrib><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Bacteriology Abstracts (Microbiology B)</collection><collection>Environmental Sciences and Pollution Management</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>MEDLINE - Academic</collection><jtitle>Journal of internal medicine</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>LEIBOVICI, L</au><au>SHRAGA, I</au><au>DRUCKER, M</au><au>KONIGSBERGER, H</au><au>SAMRA, Z</au><au>PITLIK, S. D</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>The benefit of appropriate empirical antibiotic treatment in patients with bloodstream infection</atitle><jtitle>Journal of internal medicine</jtitle><addtitle>J Intern Med</addtitle><date>1998-11</date><risdate>1998</risdate><volume>244</volume><issue>5</issue><spage>379</spage><epage>386</epage><pages>379-386</pages><issn>0954-6820</issn><eissn>1365-2796</eissn><abstract>. Leibovici L, Shraga I, Drucker M, Konigsberger H, Samra Z, Pitlik SD (Rabin Medical Center, Petah‐Tiqva, and Tel‐Aviv University, Tel‐Aviv, Israel). The benefit of appropriate empirical antibiotic treatment in patients with bloodstream infection. J Intern Med 1998; 244: 379–86.
Objectives
To test whether empirical antibiotic treatment that matches the in vitro susceptibility of the pathogen (appropriate treatment) improves survival in patients with bloodstream infections; and to measure the improvement.
Design
Observational, prospective cohort study.
Setting
University hospital in Israel.
Subjects
All patients with bloodstream infections detected during 1988–94.
Interventions
None.
Main outcome measures
In‐hospital fatality rate and length of hospitalization.
Results
Out of 2158 patients given appropriate empirical antibiotic treatment, 436 (20%) died, compared with 432 of 1255 patients (34%) given inappropriate treatment (P = 0.0001). The median durations of hospital stay for patients who survived were 9 days for patients given appropriate treatment and 11 days for patients given inappropriate treatment. For patients who died, the median durations were 5 and 4 days, respectively (P < 0.05), for both comparisons.
In a stratified analysis, fatality was higher in patients given inappropriate treatment than in those given appropriate treatment in all strata but two: patients with infections caused by streptococci other than Streptococcus gr. A and Streptoccocus pneumoniae (odds ratio (OR) of 1.0, 95% confidence interval (95% CI) 0.4–2.5); and hypothermic patients (OR = 0.9, 95% CI = 0.3–2.4). Even in patients with septic shock, inappropriate empirical treatment was associated with higher fatality rate (OR = 1.6, 95% CI = 1.0–2.7). The highest benefit associated with appropriate treatment was observed in paediatric patients (OR = 5.1, 95% CI = 2.4– 10.7); intra‐abdominal infections (OR = 3.8, 95% CI = 2.0–7.1); infections of the skin and soft tissues (OR = 3.1, 95% CI = 1.8–5.6); and infections caused by Klebsiella pneumoniae (OR = 3.0, 95% CI = 1.7–5.1) and S. pneumoniae (OR = 2.6, 95% C = 1.1–5.9).
On a multivariable logistic regression analysis, the contribution of inappropriate empirical treatment to fatality was independent of other risk factors (multivariable adjusted OR = 1.6, 95% CI = 1.3–1.9).
Conclusion
Appropriate empirical antibiotic treatment was associated with a significant reduction in fatality in patients with bloodstream infection.</abstract><cop>Oxford BSL</cop><pub>Blackwell Science Ltd</pub><pmid>9845853</pmid><doi>10.1046/j.1365-2796.1998.00379.x</doi><tpages>8</tpages></addata></record> |
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| ispartof | Journal of internal medicine, 1998-11, Vol.244 (5), p.379-386 |
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| source | MEDLINE; Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals; Wiley Free Content; Wiley Online Library All Journals |
| subjects | Adolescent Adult Aged Aged, 80 and over Anti-Bacterial Agents - therapeutic use Antibacterial agents antibiotic treatment Antibiotics. Antiinfectious agents. Antiparasitic agents bacteraemia Biological and medical sciences bloodstream infection Child Child, Preschool empirical fatality rate Female Humans Infant Infant, Newborn Logistic Models Male Medical sciences Middle Aged Pharmacology. Drug treatments Prospective Studies Risk Factors Sepsis - drug therapy Sepsis - mortality Treatment Outcome |
| title | The benefit of appropriate empirical antibiotic treatment in patients with bloodstream infection |
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