Benchmarking inappropriate empirical antibiotic treatment

Kariv, Galia; Shani, Vered; Muchtar, Eli; Leibovici, Leonard

doi:10.1111/j.1469-0691.2012.03965.x

Cited by 27 publications

(18 citation statements)

References 14 publications

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“…According to fi ndings in this study, death outcome in patients receiving appropriate EAT was as frequent as in those receiving inappropriate EAT. According to Kariv et al, the pooled rate of inappropriate EAT is about 30%, although the rates in individual studies were highly variable (calculated from 87 prospective studies with more than 27,000 patients) [20]. However, the frequency of inappropriate EAT in this study is very high, close to 70%.…”

Section: Discussionmentioning

confidence: 45%

Empirical use of antibiotics in adult intensive care unit: a real-life approach

Protić¹,

Stojković²,

Marković-Denić³

et al. 2019

Hosp Pharm Int Multi J

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Introduction: Infection is the leading cause of complications in critically ill, and its presence signifi cantly infl uences the treatment outcome. Empirical antibiotic therapy (EAT) is justifi ed if limited to the time required for isolation and identifi cation of pathogen, which is considered not to exceed 72 hours. Aim: The aim of this study was to determine the rate of prolonged empirical antibiotic therapy (PEAT) in adult intensive care unit (ICU) -treated patients at the third level hospital and to assess factors infl uencing the antibiotic prescription practice in the hospital. The study also aimed to assess in-hospital mortality in patients treated with empirical antibiotic therapy (EAT) and to fi nd parameters that were associated with fatal outcome. Subjects and Methods: Prospective observational study involved 51 consecutive patient who underwent EAT. Demographic, clinical and laboratory data were collected. The rate of PEAT was determined as the ratio of the total number of patients who received EAT longer than 72 hours divided by the total number of patients who received EAT regardless the length of its duration. Results: The rate of PEAT was 80%. In patients with diagnosed infection, length of EAT depended on the time needed for bacteria isolation. However, EAT was introduced and even prolonged in 33% of patients, in which infection was never confi rmed. In-hospital mortality was 20%, and factors associated with death outcome were ongoing sepsis and longer EAT. Conclusions: The practice of prescribing prolonged antibiotic therapy is very common in this study. This is associated with higher mortality, so it is necessary to fi nd the cost-eff ective diagnostic method that helps in adjustment of rational empirical antibiotic treatment in ICU. Age of patients (years), M (IQR 25-75%)1 68 (63.75-83) 64 (54-74) Length of EAT 2 (days), M (IQR 25-75%) 1 5.5 (3.75-8) 6 (5-8) Length of hospitalization (days), M (IQR 25-75%) 1 14 (9.75-19) 10 (8.5-16.5) Biomarkers of bacterial infection, N (%) 26 (70.47) * 5 (29.41) Clinical features, N (%) 27 (79.41) 14 (82.35) Appropriate EAT 2 , N (%) 13 (38.24) 5 (29.41) Sepsis, N (%) 11 (32.35) ** 0 (0.00) Critically ill patients, N (%) 26 (70.47) 11 (64.71) The most signifi cant comorbidities, N (%) Cardiac arrhythmia 4 (11.76) 3 (17.65) Hypertension 26 (70.47) 9 (52.94) Diabetes mellitus 9 (26.47) 2 (11.76) Malignancy 9 (26.47) 4 (23.53) Age of patients (years), M (IQR 25-75%) 1 73.5 (66.5-83) 68 (62.25-80.25) Length of EAT 2 (days), M (IQR 25-75%) 1 7.5 (5.5-11)* 5 (3-7) Length of hospitalization (days), M (IQR 25-75%) 1 16 (10.5-21) 13 (9-17) Length of hospitalization before isolation of bacteria (days), M (IQR 25-75%) 1 7.5 (6-10.5)* 5 (3-6.25) Biomarkers of bacterial infection, N (%) 10 (100.0) 16 (66.67) Clinical features, N (%) 10 (100.0) 17 (70.83) Appropriate EAT 2 , N (%) 4 (40.0) 9 (37.5) Sepsis, N (%) 7 (70.0)** 4 (16.67) Critically ill patients, N (%) 9 (90.0) 17 (70.83) The most signifi cant comorbidities, N (%) Cardiac arrhythmia 3 (30.0) 2 (8.33) Hypertens...

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Section: Discussionmentioning

confidence: 45%

Empirical use of antibiotics in adult intensive care unit: a real-life approach

Protić¹,

Stojković²,

Marković-Denić³

et al. 2019

Hosp Pharm Int Multi J

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“…In many cases, clinicians' decision seemed to depend upon surveillance sampling for bacterial colonisation of the lower airways rather than direct microbiological investigation of the clinically diagnosed infections, often with an excess of antibiotics. Such overtreatment seems widespread in Italy [37,38] and elsewhere [39,40].…”

Section: Discussionmentioning

confidence: 98%

Antimicrobial use and microbiological testing in district general hospital ICUs of the Veneto region of north-east Italy

Benedetti

Sefton

Menegozzo

et al. 2016

Eur J Clin Microbiol Infect Dis

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“…However, in clinical practice, patients with suspected moderate to severe bacterial infections are not given empirical antibiotic treatment that would result in a maximum coverage rate [2]. Nor do guidelines aim at 100% coverage with empirical treatment.…”

Section: The Ethical Dilemmasmentioning

confidence: 98%

Ethical dilemmas in antibiotic treatment: focus on the elderly

Leibovici

2015

Clinical Microbiology and Infection

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Maximal antibiotic treatment for all patients suspected of harbouring a bacterial infection is non-viable, because it will rapidly induce resistance and exhaust this finite resource. This raises two ethical dilemmas: the question of whether we are justified in increasing the danger to a present, named, patient so as to benefit future, unknown, patients; and whether we are allowed to do so without asking the present patient for consent. Although the considerations for healthy elderly patients are similar to younger adults, the answers are complex when addressing patients with dementia, severely reduced quality of life and at end of life. We argue that a public debate on the balance between benefit to a present patient versus harm to future patients should be conducted. Such a debate should include examinations of scenarios in which antibiotic treatment does not gain any benefit in a patient with infection: at the end of life; in situations in which resistance is such that empirical antibiotic treatment seldom matches the susceptibilities of the pathogen; and in patients with no quality of life. An explicit cost-benefit model, incorporating quality of life and risk of resistance, in computerized decision support might obviate a clinician's need to deal with these difficult issues at bedside.

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Benchmarking inappropriate empirical antibiotic treatment

Cited by 27 publications

References 14 publications

Empirical use of antibiotics in adult intensive care unit: a real-life approach

Empirical use of antibiotics in adult intensive care unit: a real-life approach

Antimicrobial use and microbiological testing in district general hospital ICUs of the Veneto region of north-east Italy

Ethical dilemmas in antibiotic treatment: focus on the elderly

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