Antibiotic use and impact on outcome from bacteraemic critical illness: the BActeraemia Study in Intensive Care (BASIC)

Abstract

We could not show an impact of antibiotics on mortality in critically ill patients, despite in vitro activity and early commencement. Randomized, multicentre trials are urgently needed to establish the appropriate duration, timing and combinations of antibiotics that will both optimally treat infection and minimize development of resistance and other complications.

Timing of appropriate empirical antimicrobial administration and outcome of adults with community-onset bacteremia

“…Thus, the clinical outcomes of the patients receiving appropriate antimicrobial therapy at different time points after arrival at the ED could be compared with each other. Fourth, as noted before [4–9], no analyses of source control were performed in the present study. However, taking the cases of urosepsis as the example, in those with or without interventions for source control, such as percutaneous nephrolithotomy or nephrectomy, the 28-day crude mortality rate was not different (4/48, 8.3% vs. 35/700, 5.0%; P  = 0.31), indicative of standard quality of clinical care in the study hospital.…”

“…However, the estimates of potential benefits of appropriate empirical antibiotic treatment vary widely in the literature, from no effect [8, 9] to significant reduction in fatality with an odds ratio of up to 6 [4–7]. Such a controversy may be related to variations in sepsis severity, comorbidities and the immune status of study cohorts, and the distribution of causative microorganisms [24].…”

“…As a result, only 16 patients were excluded and thus the selection bias was expected to be minimal. Third, as previous investigations dealing with the effects of the appropriateness of empirical antimicrobial administration on patient outcome [4–9], no detailed information was available in our study on early resuscitation. However, the majority (1663, 70.8%) of the 2349 patients with community-onset bacteremia received the first dose of appropriate antimicrobials within one hour of arrival at the ED, and the study population were believed to be managed according to the SSC recommendations.…”

“…In addition to early establishment of vascular access, fluid resuscitation, and removal of infection source, particularly in critically ill patients, antimicrobial therapy has been regarded as one of the mainstays of bacteremia treatment [3]. Although most investigations have concluded that early administration of appropriate antimicrobials could be linked to a favorable prognosis in the individuals with bacteremia [4–7], several studies have not identified the survival benefit of early appropriate antimicrobial therapy [8, 9]. Furthermore, the timing of the first dose of appropriate antibiotics remains a controversial point, and thus appropriate empirical antimicrobial therapy has been defined as the interval between bacteremia onset and antimicrobial administration, ranging widely from <24 hours to <48 hours in previous reports [7, 10, 11].…”

Weighted-incidence syndromic combination antibiograms to guide empiric treatment of critical care infections: a retrospective cohort study

“…Although the importance of early adequate treatment is controversial [16-18], we believe that the lack of association with mortality in our study related to insufficient statistical power. The clinical trajectory of only a subset of patients with critical care infection would be expected to benefit from early adequate treatment.…”