Gradel Kim O, Jensen Ulrich S, Schønheyder Henrik C, Østergaard Christian, Knudsen Jenny D, Wehberg Sonja, Søgaard Mette
Center for Clinical Epidemiology, South, OUH Odense University Hospital, Kløvervænget 30, Entrance 216, DK-5000, Odense C, Denmark.
Research Unit of Clinical Epidemiology, Institute of Clinical Research, University of Southern Denmark, Odense, Denmark.
BMC Infect Dis. 2017 Feb 6;17(1):122. doi: 10.1186/s12879-017-2233-z.
Data on the impact of empirical antibiotic treatment (EAT) on patient outcome in a population-based setting are sparse. We assessed the association between EAT and the risk of recurrence within one year, short-term- (2-30 days) and long-term (31-365 days) mortality in a Danish cohort of bacteraemia patients.
A cohort study including all patients hospitalized with incident bacteraemia during 2007-2008 in the Copenhagen City and County areas and the North Denmark Region. EAT was defined as the antibiotic treatment given at the 1 notification of a positive blood culture. The definition of recurrence took account of pathogen species, site of infection, and time frame and was not restricted to homologous pathogens. The vital status was determined through the civil registration system. Association estimates between EAT and the outcomes were estimated by Cox and logistic regression models.
In 6483 eligible patients, 712 (11%) had a recurrent episode. A total of 3778 (58%) patients received appropriate EAT, 1290 (20%) received inappropriate EAT, while EAT status was unrecorded for 1415 (22%) patients. The 2-30 day mortality was 15.1%, 17.4% and 19.2% in patients receiving appropriate EAT, inappropriate EAT, and unknown EAT, respectively. Among patients alive on day 30, the 31-365 day mortality was 22.3% in patients given appropriate EAT compared to 30.7% in those given inappropriate EAT. Inappropriate EAT was independently associated with recurrence (HR 1.25; 95% CI = 1.03-1.52) and long-term mortality (OR 1.35; 95% CI = 1.10-1.60), but not with short-term mortality (OR 0.85; 95% CI = 0.70-1.02) after bacteraemia.
Our data indicate that appropriate EAT is associated with reduced incidence of recurrence and lower long-term mortality following bacteraemia.
关于经验性抗生素治疗（EAT）对基于人群的患者预后影响的数据很少。我们评估了丹麦菌血症患者队列中EAT与一年内复发风险、短期（2 - 30天）和长期（31 - 365天）死亡率之间的关联。
一项队列研究，纳入了2007 - 2008年期间在哥本哈根市及周边地区和北丹麦地区因初发菌血症住院的所有患者。EAT定义为在首次报告血培养阳性时给予的抗生素治疗。复发的定义考虑了病原体种类、感染部位和时间框架，并不局限于同源病原体。通过民事登记系统确定生命状态。通过Cox和逻辑回归模型估计EAT与结局之间的关联。
在6483例符合条件的患者中，712例（11%）有复发事件。共有3778例（58%）患者接受了适当的EAT，1290例（20%）接受了不适当的EAT，而1415例（22%）患者的EAT状态未记录。接受适当EAT、不适当EAT和EAT状态未知的患者2 - 30天死亡率分别为15.1%、17.4%和19.2%。在第30天存活的患者中，接受适当EAT的患者31 - 365天死亡率为22.3%，而接受不适当EAT的患者为30.7%。菌血症后，不适当的EAT与复发（风险比1.25；95%置信区间 = 1.03 - 1.52）和长期死亡率（比值比1.35；95%置信区间 = 1.10 - 1.60）独立相关，但与短期死亡率无关（比值比0.85；95%置信区间 = 0.70 - 1.02）。
我们的数据表明，适当的EAT与菌血症后复发率降低和长期死亡率降低相关。
