Assessment of De-Escalation of Empirical Antimicrobial Therapy in Medical Wards with Recognized Prevalence of Multi-Drug-Resistant Pathogens: A Multicenter Prospective Cohort Study in Non-ICU Patients with Microbiologically Documented Infection
Abstract
:1. Introduction
2. Results
3. Discussion
4. Materials and Methods
4.1. Study Setting
4.2. Study Population and Data Collection
4.3. Definitions
4.4. Outcomes
4.5. Statistical Analysis
4.6. Ethical Issues
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
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Variables | ADE Group n = 76 | Non-ADE Group n = 66 | Overall n = 142 | p-Value |
---|---|---|---|---|
Baseline Characteristics | ||||
Mean age, years (SD) | 74.5 (14.7) | 72.8, (16.5) | 73.7 (15.5) | 0.664 |
Gender | 0.024 | |||
Male (%) | 33 (43.4) | 42 (63.6) | 75 (52.8) | |
CCI (median, IQR) | 5 (4, 7) | 5 (3,7) | 5 (3, 7) | 0.542 |
Residence type, n (%) | 0.068 | |||
Home | 52 (68.4) | 30 (45.5) | 82 (57.7) | |
Medical Ward | 2 (2.6) | 3 (4.5) | 5 (3.5) | |
ICU | 0 (0) | 1 (1.5) | 1 (0.7) | |
Healthcare facility | 2 (2.6) | 5(7.6) | 7 (4.9) | |
Long-term care facility | 4 (5.3) | 9 (13.6) | 13 (9.2) | |
Home with at least 1 hospitalization > 48 h since the last trimester | 16 (21.1) | 18 (27.3) | 34 (24) | |
Receipt of antimicrobials in the past trimester (%) | 26 (34.2) | 20 (30.3) | 46 (32.4) | 0.193 |
Times of antimicrobials receipt (median, IQR) | 2.5 (2, 6) | 2 (1, 6) | 2 (1, 6) | 0.378 |
Symptoms on admission, n (%) | ||||
Fever | 54 (71) | 46 (69.7) | 100 (70.4) | 0.860 |
Disorder of Consciousness | 19 (25) | 11 (16.7) | 30 (21.1) | 0.681 |
Other symptoms | 47 (61.8) | 29 (43.9) | 76 (53.5) | 0.033 |
Illness severity on admission | ||||
SOFA score (median, IQR) | 3 (2, 4) | 2 (1, 3.5) | 3 (1, 4) | 0.028 |
q-SOFA Score (median, IQR) | 1 (0, 1) | 1 (0, 1) | 1 (0, 1) | 0.603 |
Patients with sepsis, n (%) | 44 (57.9) | 36 (54.5) | 80 (56.3) | 0.622 |
Patients in septic shock, n (%) | 11 (14.5) | 7 (10.6) | 18 (12.7) | 0.452 |
Type of Infection, n (%) | ||||
UTI | 60 (78.9) | 35 (53) | 95 (66.9) | 0.001 |
LRTI | 3 (3.9) | 6 (9.1) | 9 (6.3) | 0.196 |
CAP | 4 (5.3) | 5 (7.6) | 9 (6.3) | 0.580 |
HAP | 0 | 1 (1.5) | 1 (0.7) | 0.283 |
Osteomyelitis | 0 | 2 (3) | 2 (1.4) | 0.122 |
SSTI | 3 (3.9) | 3 (4.5) | 6 (4.2) | 0.840 |
Abdominal | 5 (6.6) | 3 (4.5) | 8 (5.6) | 0.606 |
BSI | 39 (51.3) | 27 (40.9) | 66 (46.5) | 0.139 |
Primary | 3 (3.9) | 7 (10.6) | 10 (7) | 0.233 |
Secondary | 36 (47.4) | 20 (30.3) | 56 (39.4) | 0.027 |
CLABSI | 2 (2.6) | 3 (4.5) | 5 (3.5) | 0.881 |
Pathogen, n (%) | ||||
Escherichia coli | 46 (60.5) | 26 (39.4) | 72 (50.7) | 0.012 |
Klebsiella pneumoniae | 8 (10.5) | 11 (16.7) | 19 (13.4) | 0.284 |
Pseudomonas aeruginosa | 4 (5.3) | 7 (10.6) | 11 (7.8) | 0.235 |
Proteus mirabilis | 4 (5.3) | 4 (6) | 8 (5.6) | 0.837 |
Acinetobacter baumannii | 0 | 5 (7.6) | 5 (3.5) | 0.015 |
Other | 16 (21) | 13 (19.7) | 29 (20.4) | 0.842 |
Clinical specimens of pathogen isolation, n (%) | ||||
Blood | 42 (58.3) | 29 (45.3) | 71 (52.2) | 0.129 |
Urine | 47 (61.8) | 39 (59) | 86 (60.6) | 0.738 |
Sputum | 1 (1.4) | 3 (4.6) | 4 (2.9) | 0.257 |
Skin and soft-tissue | 0 | 2 (3.1) | 2 (1.4) | 0.129 |
Other | 5 (6.6) | 3 (4.5) | 8 (5.6) | 0.600 |
Empirical antimicrobial therapy | 0.064 | |||
Ampicillin-sulbactam or Ampicillin/sulbactam- based antimicrobial therapy | 3 (3.9) | 8 (12.1) | 11 (7.7) | |
Fluoroquinolones monotherapy or Fluoroquinolones-based antimicrobial therapy | 6 (7.9) | 12 (18.2) | 18 (12.7) | |
Piperacillin/tazobactam monotherapy or Piperacillin/tazobactam-based antimicrobial therapy | 39 (51.3) | 17 (25.7) | 56 (39.4) | |
Meropenem or Meropenem-based antimicrobial therapy | 11 (14.5) | 5 (7.6) | 16 (11.3) | |
Other | 17 (22.4) | 24 (36.4) | 41 (28.9) | |
Amikacin co-administration | 29 (38.1) | 15 (22.7) | 44 (31) | |
Vancomycin co-administration | 15 (19.7) | 8 (12.1) | 23 (16.2) | |
Metronidazole co-administration | 4 (5.3) | 1 (1.5) | 5 (3.5) | |
Exploratory end-points | ||||
Mortality (n, %) | 14 (18.4) | 20 (30.3) | 34 (23.9) | <0.1 |
LOS (median, IQR) | 11 (7–15) | 14 (8–19) | 12.5 (8, 6) | 0.047 |
Duration of antibiotic treatment (median, IQR) | 12 (10, 14) | 13 (9, 15) | 12.5 (10, 15) | 0.9 |
Antibiotic-free days (median, IQR) | 4 (0, 14) | 4(0, 14) | 4 (0, 14) | 0.8 |
Hydrocortisone administration (median, IQR) | 0 (0, 0) | 0(0, 0) | 3.5 (3, 3.5) | 0.7 |
Vasopressors administration (median, IQR) | 0 (0, 0) | 0(0, 0) | 3.5 (2, 4.5) | 0.3 |
AKI | 3 (3.9) | 6 (9.1) | 9 (6.3) | 0.6 |
Multi-organ failure | 4 (5.3) | 2 (3) | 6 (4.2) | 0.5 |
Superinfection | 5 (6.6) | 4 (6.1) | 9 (6.3) | 0.3 |
Clostridium difficile infection | 1 (1.3) | 1 (1.5) | 2 (1.4) | 0.9 |
XDR bacteria colonization | 1 (1.3) | 1 (1.5) | 2 (1.4) | 0.9 |
OR | 95% CI | p-Value | |
---|---|---|---|
Females vs. males | 2.65 | 1.09–6.43 | 0.031 |
Symptoms on admission other than fever and disorder of consciousness | 3.44 | 1.37–8.67 | 0.009 |
Previously been at home | 2.43 | 0.10–5.92 | 0.051 |
SOFA on admission | 1.22 | 1.00–1.51 | 0.064 |
UTI | 10.04 | 2.91–34.57 | <0.001 |
SSTI | 16.28 | 1.68–158.08 | 0.016 |
Abdominal Infection | 5.50 | 0.82–36.74 | 0.078 |
BSI | 2.52 | 1.00–6.36 | 0.05 |
HR | 95% CI | p-Value | |
---|---|---|---|
0.0002 | |||
Age | 1.01 | 1.00–1.09 | 0.031 |
ADE performance | 1.49 | 0.55–4.01 | 0.432 |
Moxifloxacin administration | 36.50 | 2.39–556.6 | 0.010 |
Piperacillin/Tazobactam administration | 4.36 | 1.47–12.99 | 0.008 |
Cefuroxime administration | 26.49 | 5.75–122 | <0.001 |
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Rapti, V.; Poulakou, G.; Mousouli, A.; Kakasis, A.; Pagoni, S.; Pechlivanidou, E.; Masgala, A.; Sympardi, S.; Apostolopoulos, V.; Giannopoulos, C.; et al. Assessment of De-Escalation of Empirical Antimicrobial Therapy in Medical Wards with Recognized Prevalence of Multi-Drug-Resistant Pathogens: A Multicenter Prospective Cohort Study in Non-ICU Patients with Microbiologically Documented Infection. Antibiotics 2024, 13, 812. https://doi.org/10.3390/antibiotics13090812
Rapti V, Poulakou G, Mousouli A, Kakasis A, Pagoni S, Pechlivanidou E, Masgala A, Sympardi S, Apostolopoulos V, Giannopoulos C, et al. Assessment of De-Escalation of Empirical Antimicrobial Therapy in Medical Wards with Recognized Prevalence of Multi-Drug-Resistant Pathogens: A Multicenter Prospective Cohort Study in Non-ICU Patients with Microbiologically Documented Infection. Antibiotics. 2024; 13(9):812. https://doi.org/10.3390/antibiotics13090812
Chicago/Turabian StyleRapti, Vasiliki, Garyfallia Poulakou, Anastasia Mousouli, Athanasios Kakasis, Stamata Pagoni, Evmorfia Pechlivanidou, Aikaterini Masgala, Styliani Sympardi, Vasileios Apostolopoulos, Charalampos Giannopoulos, and et al. 2024. "Assessment of De-Escalation of Empirical Antimicrobial Therapy in Medical Wards with Recognized Prevalence of Multi-Drug-Resistant Pathogens: A Multicenter Prospective Cohort Study in Non-ICU Patients with Microbiologically Documented Infection" Antibiotics 13, no. 9: 812. https://doi.org/10.3390/antibiotics13090812