Impact of Inappropriate Empiric Antimicrobial Therapy on Mortality of Septic Patients with Bacteremia: A Retrospective Study

Lueangarun, Saoraya; Leelarasamee, Amorn

doi:10.1155/2012/765205

Cited by 41 publications

(23 citation statements)

References 63 publications

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“…A base-case survival of 80% for individuals who test true positive was calculated based on published data. [11][12][13][14][15] We used the same sources to determine the survival for individuals who test false negative and estimated a base-case survival of 50% based on the range of values reported in the literature. We assumed that true positive test cases were treated with appropriate antimicrobials and that treatment was inappropriately withheld among those with false-negative tests.…”

Section: Methodsmentioning

confidence: 99%

Cost-Effectiveness of Surveillance for Bloodstream Infections for Sepsis Management in Low-Resource Settings

Penno¹,

Baird²,

Crump³

2015

The American Journal of Tropical Medicine and Hygiene

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Abstract. Bacterial sepsis is a leading cause of mortality among febrile patients in low-and middle-income countries, but blood culture services are not widely available. Consequently, empiric antimicrobial management of suspected bloodstream infection is based on generic guidelines that are rarely informed by local data on etiology and patterns of antimicrobial resistance. To evaluate the cost-effectiveness of surveillance for bloodstream infections to inform empiric management of suspected sepsis in low-resource areas, we compared costs and outcomes of generic antimicrobial management with management informed by local data on etiology and patterns of antimicrobial resistance. We applied a decision tree model to a hypothetical population of febrile patients presenting at the district hospital level in Africa. We found that the evidence-based regimen saved 534 more lives per 100,000 patients at an additional cost of $25.35 per patient, resulting in an incremental cost-effectiveness ratio of $4,739. This ratio compares favorably to standard cost-effectiveness thresholds, but should ultimately be compared with other policyrelevant alternatives to determine whether routine surveillance for bloodstream infections is a cost-effective strategy in the African context.

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Section: Methodsmentioning

confidence: 99%

Cost-Effectiveness of Surveillance for Bloodstream Infections for Sepsis Management in Low-Resource Settings

Penno¹,

Baird²,

Crump³

2015

The American Journal of Tropical Medicine and Hygiene

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“…A base-case survival for sepsis of 80% for individuals who tested true positive was calculated based on published data. [16][17][18][19][20] We used the same sources to determine the survival for individuals who tested false negative and calculated a base-case survival of 50%. These numbers assume that true positive test cases were treated with appropriate antimicrobials and treatment was inappropriately withheld among those with false-negative tests.…”

Section: Methodsmentioning

confidence: 99%

“…15 Patient survival. Fourth, we allowed for variation in survival when testing true positive or false negative from 32% and 25% in the worst case 19 to 90% and 65% in the best case, 16,17 respectively. In addition, to investigate the potential effect of false-positive results masking non-sepsis febrile disease states such as malaria, we allowed for a probability of survival for patients with a false positive of either 99% or 92% based on the estimates of the probability that untreated malaria in high transmission area becomes severe and then progresses to death.…”

Section: Methodsmentioning

confidence: 99%

Performance Requirements to Achieve Cost-Effectiveness of Point-of-Care Tests for Sepsis Among Patients with Febrile Illness in Low-Resource Settings

Penno

Crump

Baird

2015

The American Journal of Tropical Medicine and Hygiene

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Abstract. Bacterial sepsis is an important cause of mortality in low-and middle-income countries, yet distinguishing patients with sepsis from those with other illnesses remains a challenge. Currently, management decisions are based on clinical assessment using algorithms such as Integrated Management of Adolescent and Adult Illness. Efforts to develop and evaluate point-of-care tests (POCTs) for sepsis to guide decisions on the use of antimicrobials are underway. To establish the minimum performance characteristics of such a test, we varied the characteristics of a hypothetical POCT for sepsis required for it to be cost-effective and applied a decision tree model to a population of febrile patients presenting at the district hospital level in a low-resource setting. We used a case fatality probability of 20% for appropriately treated sepsis and of 50% for inappropriately treated sepsis. On the basis of clinical assessment for sepsis with established sensitivity of 0.83 and specificity of 0.62, we found that a POCT for sepsis with a sensitivity of 0.83 and a specificity of 0.94 was cost-effective, resulting in parity in survival but costing $1.14 less per live saved. A POCT with accuracy equivalent to the best malaria rapid diagnostic test was cheaper and more effective than clinical assessment.

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“…Studies have shown that the optimal management of patients with Staphylococcus aureus bacteremia relies on commencing appropriate antibiotics as quickly as possible, with the risk of mortality or treatment failure increasing with each passing hour (32)(33)(34)(35)(36)(37)(38)(39)(40). The BD Max StaphSR assay allows blood cultures to be rapidly screened for MRSA/MSSA as they flag positive on a 24/7 basis, thereby providing clinicians with more timely results so that more appropriate and effective treatment can be commenced earlier.…”

mentioning

confidence: 99%

Rapid Detection of Methicillin-Resistant Staphylococcus aureus and Methicillin-Susceptible S. aureus Directly from Positive Blood Cultures by Use of the BD Max StaphSR Assay

2015

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bThe BD Max StaphSR assay is an automated qualitative in vitro diagnostic test for the direct detection and differentiation of methicillin-susceptible Staphylococcus aureus (MSSA) and methicillin-resistant S. aureus (MRSA). A total of 460 specimens were tested, and the results were compared with standard culture-based identification. MRSA was detected in 48 samples (sensitivity of 100%; positive predictive value [PPV] of 100%). MSSA was detected in 112 samples (sensitivity of 99.1%; PPV of 100%), and 299 samples containing coagulase-negative staphylococcus and nonstaphylococcal species were negative by the BD Max StaphSR assay (specificity of 100%; negative predictive value [NPV] of 99.7 to 100%). Staphylococcus aureus is one of the most common pathogens isolated in blood cultures. S. aureus bacteremia is often a severe, life-threatening infection, for which early treatment can circumvent serious morbidity. The initial antimicrobial treatment is often based on the results of the Gram stain from a positive blood culture, with confirmatory culture results and susceptibilities taking an additional 24 to 48 h. In the case of suspected S. aureus bacteremia, empirical treatment with glycopeptides is common (1) to provide cover for methicillin-resistant S. aureus (MRSA), resulting in undesirable selection pressure for the development and spread of vancomycin resistance, particularly vancomycinresistant Enterococcus spp. (2-5). Although vancomycin is indicated for MRSA bacteremia, it is less effective for methicillin-sensitive S. aureus (MSSA) than ␤-lactam antibiotics, but the latter are often only commenced once methicillin-susceptible status is known (6-8). Therefore, the rapid identification and differentiation of MSSA or MRSA bacteremia allow clinicians to switch to the most effective treatment earlier, while also potentially reducing in-hospital transmission of MRSA by expediting the initiation of appropriate infection control measures (6, 9).The challenge is to provide this information in real time as blood cultures signal positive rather than as a batch process. Many molecular methods developed for this purpose are cumbersome to use, expensive, and time-consuming, making them unsuitable for out-of-hours use or routine use in busy multitasked laboratories. The BD Max StaphSR is a multiplex PCR assay targeting the nuc and mecA/C genes and the SCCmec/orfX junction. While the BD Max StaphSR assay was designed for the rapid screening of nasal swabs for MRSA and MSSA, it is a simplified molecular platform with minimal hands-on time that may allow processing of blood cultures on demand, as they signal positive. This would be especially effective in a 24 h a day/7 days/week microbiology laboratory, enabling a more meaningful and timely service to clinicians, with a real impact on patient management and outcomes. We assessed the application of the BD Max StaphSR assay to positive blood cultures with Gram stains typical of staphylococci.(This work was presented in part as a poster at the 2015 Australian Society of Antimic...

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Impact of Inappropriate Empiric Antimicrobial Therapy on Mortality of Septic Patients with Bacteremia: A Retrospective Study

Cited by 41 publications

References 63 publications

Cost-Effectiveness of Surveillance for Bloodstream Infections for Sepsis Management in Low-Resource Settings

Cost-Effectiveness of Surveillance for Bloodstream Infections for Sepsis Management in Low-Resource Settings

Performance Requirements to Achieve Cost-Effectiveness of Point-of-Care Tests for Sepsis Among Patients with Febrile Illness in Low-Resource Settings

Rapid Detection of Methicillin-Resistant Staphylococcus aureus and Methicillin-Susceptible S. aureus Directly from Positive Blood Cultures by Use of the BD Max StaphSR Assay

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