Inappropriate Empirical Antibiotic Treatment in High-risk Neutropenic Patients With Bacteremia in the Era of Multidrug Resistance. (25th April 2019)

• Record Type: Journal Article
• Authors: Martinez-Nadal, Gemma; Puerta-Alcalde, Pedro; Gudiol, Carlota; Cardozo, Celia; Albasanz-Puig, Adaia; Marco, Francesc; Laporte-Amargós, Júlia; Moreno-García, Estela; Domingo-Doménech, Eva; Chumbita, Mariana; Martínez, José Antonio; Soriano, Alex; Carratalà, Jordi; Garcia-Vidal, Carolina
• Is Part Of: Clinical infectious diseases. Volume 70:Number 6(2020)
• Page Start: 1068
• Page End: 1074
• Publication Date: 2019-04-25
• Subjects: inappropriate treatment -- multidrug resistance -- bacteremia -- neutropenia -- mortality; Communicable diseases -- Periodicals; 616.905
• DOI: 10.1093/cid/ciz319
• Languages: English
• ISSNs: 1058-4838

Abstract

Abstract: Background: We aimed to describe the current rates of inappropriate empirical antibiotic treatment (IEAT) in oncohematological patients with febrile neutropenia (FN) and its impact on mortality. Methods: This was a multicenter prospective study of all episodes of bloodstream infection (BSI) in high-risk FN patients (2006–2017). Episodes receiving IEAT were compared with episodes receiving appropriate empirical therapy. Adherence to Infectious Diseases Society of America (IDSA) recommendations was evaluated. Multivariate analysis was performed to identify independent risk factors for mortality in Pseudomonas aeruginosa episodes. Results: Of 1615 episodes, including Escherichia coli (24%), coagulase-negative staphylococci (21%), and P. aeruginosa (16%), 394 (24%) received IEAT despite IDSA recommendations being followed in 87% of cases. Patients with multidrug-resistant gram-negative bacilli (MDR-GNB), accounting for 221 (14%) of all isolates, were more likely to receive IEAT (39% vs 7%, P < .001). Overall mortality was higher in patients with GNB BSI who received IEAT (36% vs 24%, P = .004); when considering individual microorganisms, only patients with infection caused by P. aeruginosa experienced a significant increase in mortality when receiving IEAT (48% vs 31%, P = .027). Independent risk factors for mortality in PA BSI (odds ratio [95% confidence interval] were IEAT (2.41 [1.19–4.91]), shock at onset (4.62 [2.49–8.56]), and pneumonia (3.01 [1.55–5.83]). Conclusions: IEAT is frequent in high-risk patients with FN and BSI, despite high adherence to guidelines. This inappropriate treatment primarily impacts patients with P. aeruginosa –related BSI mortality and in turn is the only modifiable factor to improve outcomes. Abstract : Despite high adherence to clinical guidelines, inappropriate antibiotic treatment is frequent in high-risk neutropenic patients with bacteremia caused by multidrug-resistant gram-negative bacilli. Improving empirical treatment is the only modifiable factor to improve outcomes in patients with Pseudomonas aeruginosa bacteremia.