Infectious Diseases University Research Center, Rabin Medical Center, Beilinson Hospital, Petah Tikva, Israel.
Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
Eur J Clin Microbiol Infect Dis. 2018 Mar;37(3):455-462. doi: 10.1007/s10096-018-3190-1. Epub 2018 Jan 20.
The objective of this study was to explore whether the percentage of inappropriate empirical antibiotic treatment in patients with bacteremia changed over time and to understand the factors that brought on the change. Three prospective cohorts of patients with bacteremia in three different periods (January 1st, 1988 to December 31st, 1989; May 1st, 2004 to November 30, 2004; May 1st, 2010 to April 30, 2011) were compared. Analysis was performed on a total of 811 patients. In 2010-2011, 55.9% (76/136) of patients with bacteremia received inappropriate empirical treatment, compared with 34.5% (170/493) and 33.5% (55/164) in the first and second periods, respectively, in a significant upward trend (p = 0.001). Resistance to antibiotics increased significantly during the study period. The following variables were included in the multivariate analysis assessing risk factors for inappropriate empirical treatment: study period (third period) [odds ratio, OR = 2.766 (95% confidence interval, CI, 1.655-4.625)], gender (male) [OR = 1.511 (1.014-2.253)], pathogen carrying extended-spectrum beta-lactamases [OR = 10.426 (4.688-23.187)], multidrug-resistant Acinetobacter baumannii [OR = 5.428 (2.181-13.513)], and skin/soft infections [OR = 3.23 (1.148-9.084)]. A model excluding microbiological data included: gender (male) [OR = 1.648 (1.216-2.234)], study period (third period) [OR = 2.446 (1.653-3.620)], hospital-acquired infection [OR = 1.551 (1.060-2.270)], previous use of antibiotics [OR = 1.815 (1.247-2.642)], bedridden patient [OR = 2.019 (1.114-3.658)], and diabetes mellitus [OR = 1.620 (1.154-2.274)]. We have observed a worrisome increase in the rate of inappropriate empirical treatment of bacteremia. We need tools that will allow us better prediction of the pathogen and its susceptibilities during the first hours of managing a patient suspected of a severe bacterial infection.
本研究旨在探讨血培养中经验性抗生素治疗不合理的比例是否随时间发生变化，并了解导致这种变化的因素。比较了三个不同时期（1988 年 1 月 1 日至 1989 年 12 月 31 日；2004 年 5 月 1 日至 2004 年 11 月 30 日；2010 年 5 月 1 日至 2011 年 4 月 30 日）的三组血培养患者的前瞻性队列。共分析了 811 名患者。2010-2011 年，55.9%（76/136）的血培养患者接受了不合理的经验性治疗，而第一和第二期分别为 34.5%（170/493）和 33.5%（55/164），呈明显上升趋势（p=0.001）。研究期间抗生素耐药性显著增加。多变量分析评估了经验性治疗不合理的危险因素，包括：研究期间（第三期）[比值比（OR）=2.766（95%置信区间，CI，1.655-4.625)]、性别（男性）[OR=1.511（1.014-2.253)]、携带扩展β-内酰胺酶的病原体[OR=10.426（4.688-23.187)]、多重耐药鲍曼不动杆菌[OR=5.428（2.181-13.513)]和皮肤/软组织感染[OR=3.23（1.148-9.084)]。排除微生物学数据的模型包括：性别（男性）[OR=1.648（1.216-2.234)]、研究期间（第三期）[OR=2.446（1.653-3.620)]、医院获得性感染[OR=1.551（1.060-2.270)]、既往使用抗生素[OR=1.815（1.247-2.642)]、卧床患者[OR=2.019（1.114-3.658)]和糖尿病[OR=1.620（1.154-2.274)]。我们观察到血培养中经验性抗生素治疗不合理的比例令人担忧地增加。我们需要能够在管理疑似严重细菌感染患者的最初几小时内更好地预测病原体及其敏感性的工具。
