Canadian Antibiotic Prescribing for Sepsis (CAPS) Study: A Analysis of the FABLED Cohort Study.

BACKGROUND

Understanding the microbiology and optimal pharmacotherapy of patients with community-onset sepsis is key to improving outcomes. Yet, empiric therapies prescribed in Canadian emergency departments as they relate to microbial etiology and focus of infection are inadequately described.

METHODS

We performed a analysis of the FABLED cohort study, which quantified the effect of antimicrobials on blood culture yield in septic patients. Patients presenting with sepsis were enrolled in six Canadian emergency departments between 2013 and 2018. We characterized the appropriateness of empiric therapies relative to the pathogens isolated and focus of infection identified.

RESULTS

The data of 315 patients with sepsis was analyzed. Broad-spectrum antibiotics were used in 68.6% of the cohort. Despite this, was never isolated in any blood cultures, and drug-resistant organisms were only encountered in 4.8% of the cohort. Among patients with bacteremia (n = 100), 28% of patients received appropriate antibiotic therapy whereas the remainder received therapies that were either overly narrow (16%) or unnecessarily broad (56%) in spectrum. Among patients with an identified focus of infection (n = 266), 30.5% received appropriate empiric antibiotics. Prescribing patterns that were overly broad, overly narrow, or a combination of the two were observed in 39.8%, 7.5%, and 22.2% of patients, respectively. Thirty-day mortality was lowest among patients receiving appropriate therapy relative to the final pathogen isolated and presumed infectious focus.

CONCLUSIONS

Empiric therapies for septic patients in Canada were overly broad given the rare isolation of drug-resistant pathogens. Though likely confounded by severity of illness, optimal outcomes were observed when therapy was appropriate relative to the causative pathogen and infectious focus.