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Research
Risk factors of initial inappropriate antibiotic therapy and the impacts on outcomes of neonates with gram-negative bacteremia
Ming-Horng Tsai
Chang Gung Memorial Hospital Yunlin Branch
Corresponding Author
ORCiD: https://orcid.org/0000-0003-0343-2370
License:
This work is licensed under a CC BY 4.0 License. Read Full License
Background
Timely appropriate empirical antibiotic plays an important role in critically ill patients with gram-negative bacteremia. However, the relevant data and significant impacts have not been well studied in the neonatal intensive care unit (NICU).
Methods
An 8-year (1 January 2007-31 December 2014) cohort study of all NICU patients with gram-negative bacteremia in a tertiary-care medical center was performed. Inadequate empirical antibiotic therapy was defined when a patient didn’t receive any antimicrobial agent to which the causative microorganisms were susceptible within 24 hour of blood culture sampling.
Results
Among 376 episodes of Gram-negative bacteremia, 75 (19.9%) received inadequate empirical antibiotic therapy. The cause of inadequate treatment was mostly due to the pathogen resistant to prescribed antibiotics (88.0%), and Pseudomonas aeruginosa (Odds ratio [OR]: 20.8, P < 0.001) and ESBL-producing bacteria (OR: 18.4, P < 0.001) had the highest risk. Previous exposure with 3rd generation cephalosporin was identified as the only independent risk factor (OR: 2.52, 95% CI: 1.18-5.37, P = 0.018). Empirically inadequately treated bacteremias were significantly more likely to have worse outcomes than those with adequate therapy, including more prolonged illness, higher rate of infectious complications (25.3% versus 9.3%, P < 0.001) and overall mortality (22.7% versus 11.0%, P = 0.013).
Conclusions
Inadequate empirical antibiotic therapy occurs in one-fifth of Gram-negative bacteremias in the NICU, and is associated with worse outcomes. Further effort to decrease emergence of antibiotic resistance and highly suspicion of infection by drug-resistant bacteria clinically is important to reduce rates of inadequacy.
Keywords
mortality, antimicrobial therapy, septicemia, late-onset sepsis, antibiotic resistance
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This is a preprint. It has not completed peer review.
Research
Risk factors of initial inappropriate antibiotic therapy and the impacts on outcomes of neonates with gram-negative bacteremia
Ming-Horng Tsai
Chang Gung Memorial Hospital Yunlin Branch
Corresponding Author
ORCiD: https://orcid.org/0000-0003-0343-2370
Badges
Prescreen
This manuscript passed our Prescreen assessment
Complete author information
Appropriate declaration statements
Potential risks to human health
Prescreen
History
CURRENT STATUS: Posted
Version 1
Posted 27 Dec, 2019
No community comments so far
Metrics
Comments: 0
PDF Downloads: ...
HTML Views: ...
Subject Areas
General Microbiology
License:
This work is licensed under a CC BY 4.0 License. Read Full License
Background
Timely appropriate empirical antibiotic plays an important role in critically ill patients with gram-negative bacteremia. However, the relevant data and significant impacts have not been well studied in the neonatal intensive care unit (NICU).
Methods
An 8-year (1 January 2007-31 December 2014) cohort study of all NICU patients with gram-negative bacteremia in a tertiary-care medical center was performed. Inadequate empirical antibiotic therapy was defined when a patient didn’t receive any antimicrobial agent to which the causative microorganisms were susceptible within 24 hour of blood culture sampling.
Results
Among 376 episodes of Gram-negative bacteremia, 75 (19.9%) received inadequate empirical antibiotic therapy. The cause of inadequate treatment was mostly due to the pathogen resistant to prescribed antibiotics (88.0%), and Pseudomonas aeruginosa (Odds ratio [OR]: 20.8, P < 0.001) and ESBL-producing bacteria (OR: 18.4, P < 0.001) had the highest risk. Previous exposure with 3rd generation cephalosporin was identified as the only independent risk factor (OR: 2.52, 95% CI: 1.18-5.37, P = 0.018). Empirically inadequately treated bacteremias were significantly more likely to have worse outcomes than those with adequate therapy, including more prolonged illness, higher rate of infectious complications (25.3% versus 9.3%, P < 0.001) and overall mortality (22.7% versus 11.0%, P = 0.013).
Conclusions
Inadequate empirical antibiotic therapy occurs in one-fifth of Gram-negative bacteremias in the NICU, and is associated with worse outcomes. Further effort to decrease emergence of antibiotic resistance and highly suspicion of infection by drug-resistant bacteria clinically is important to reduce rates of inadequacy.
Figure 1