Unidad Clínica de Enfermedades Infecciosas y Microbiología, Hospital Universitario Virgen Macarena, Seville, Spain.
Antimicrob Agents Chemother. 2012 Jan;56(1):472-8. doi: 10.1128/AAC.00462-11. Epub 2011 Oct 17.
The impact of the adequacy of empirical therapy on outcome for patients with bloodstream infections (BSI) is key for determining whether adequate empirical coverage should be prioritized over other, more conservative approaches. Recent systematic reviews outlined the need for new studies in the field, using improved methodologies. We assessed the impact of inadequate empirical treatment on the mortality of patients with BSI in the present-day context, incorporating recent methodological recommendations. A prospective multicenter cohort including all BSI episodes in adult patients was performed in 15 hospitals in Andalucía, Spain, over a 2-month period in 2006 to 2007. The main outcome variables were 14- and 30-day mortality. Adjusted analyses were performed by multivariate analysis and propensity score-based matching. Eight hundred one episodes were included. Inadequate empirical therapy was administered in 199 (24.8%) episodes; mortality at days 14 and 30 was 18.55% and 22.6%, respectively. After controlling for age, Charlson index, Pitt score, neutropenia, source, etiology, and presentation with severe sepsis or shock, inadequate empirical treatment was associated with increased mortality at days 14 and 30 (odds ratios [ORs], 2.12 and 1.56; 95% confidence intervals [95% CI], 1.34 to 3.34 and 1.01 to 2.40, respectively). The adjusted ORs after a propensity score-based matched analysis were 3.03 and 1.70 (95% CI, 1.60 to 5.74 and 0.98 to 2.98, respectively). In conclusion, inadequate empirical therapy is independently associated with increased mortality in patients with BSI. Programs to improve the quality of empirical therapy in patients with suspicion of BSI and optimization of definitive therapy should be implemented.
经验性治疗的充分性对血流感染（BSI）患者的结局有重要影响，这对于确定是否应优先考虑充分的经验性覆盖，而不是采取其他更保守的方法至关重要。最近的系统综述概述了在该领域开展新研究的必要性，采用了改进的方法学。我们评估了在当前背景下，经验性治疗不充分对 BSI 患者死亡率的影响，同时纳入了最近的方法学建议。在 2006 年至 2007 年期间，西班牙安达卢西亚的 15 家医院进行了一项前瞻性多中心队列研究，纳入了所有成人 BSI 患者。主要结局变量为 14 天和 30 天死亡率。采用多变量分析和倾向评分匹配进行调整分析。共纳入 801 例血培养阳性的 BSI 患者。199 例（24.8%）患者接受了不充分的经验性治疗；第 14 天和第 30 天的死亡率分别为 18.55%和 22.6%。在校正年龄、Charlson 指数、Pitt 评分、中性粒细胞减少症、感染源、病因和严重脓毒症或感染性休克表现后，经验性治疗不充分与第 14 天和第 30 天的死亡率增加相关（比值比 [ORs]，2.12 和 1.56；95%置信区间 [95%CI]，1.34 至 3.34 和 1.01 至 2.40）。基于倾向评分匹配分析调整后的 OR 分别为 3.03 和 1.70（95%CI，1.60 至 5.74 和 0.98 至 2.98）。总之，经验性治疗不充分与 BSI 患者的死亡率增加独立相关。应实施旨在提高疑似 BSI 患者经验性治疗质量和优化确定性治疗的计划。
