Does inappropriate initial antibiotic therapy affect in-hospital mortality of patients in the emergency department with Escherichia coli and Klebsiella pneumoniae bloodstream infections?

doi:10.1177/2058738420942375

中山醫學大學機構典藏 CSMUIR > 中山醫學大學研究成果 > 期刊論文 > Item 310902500/24346

Please use this identifier to cite or link to this item: https://ir.csmu.edu.tw:8080/ir/handle/310902500/24346

Title:	Does inappropriate initial antibiotic therapy affect in-hospital mortality of patients in the emergency department with Escherichia coli and Klebsiella pneumoniae bloodstream infections?
Authors:	Chen, FC;Ho, YN;Cheng, HH;Wu, CH;Change, MW;Su, CM
Keywords:	bloodstream infection;E;coli;ESBL;inappropriate initial antibiotic therapy;in-hospital mortality;K;pneumoniae
Date:	2020
Issue Date:	2022-08-09T08:00:48Z (UTC)
Publisher:	SAGE PUBLICATIONS INC
ISSN:	0394-6320
Abstract:	Extended-spectrum beta -lactamase (ESBL)-positive bloodstream infection (BSI) is on the rise worldwide. The purpose of this study is to evaluate the impact of inappropriate initial antibiotic therapy (IIAT) on in-hospital mortality of patients in the emergency department (ED) with Escherichia coli and Klebsiella pneumoniae BSIs. This retrospective single-center cohort study included all adult patients with E. coli and K. pneumoniae BSIs between January 2007 and December 2013, who had undergone a blood culture test and initiation of antibiotics within 6 h of ED registration time. Multiple logistic regression was used to adjust for bacterial species, IIAT, time to antibiotics, age, sex, quick Sepsis Related Organ Failure Assessment (qSOFA) score2, and comorbidities. A total of 3533 patients were enrolled (2967 alive and 566 deceased, in-hospital mortality rate 16%). The patients with K. pneumoniae ESBL-positive BSI had the highest mortality rate. Non-survivors had qSOFA scores2 (33.6% vs 9.5%, P<0.001), more IIAT (15.0% vs 10.7%, P=0.004), but shorter mean time to antibiotics (1.70 vs 1.84h, P<0.001). A qSOFA score2 is the most significant predictor for in-hospital mortality; however, IIAT and time to antibiotics were not significant predictors in multiple logistic regression analysis. In subgroup analysis divided by qSOFA scores, IIAT was still not a significant predictor. Severity of the disease (qSOFA score2) is the key factor influencing in-hospital mortality of patients with E. coli and K. pneumoniae BSIs. The time to antibiotics and IIAT were not significant predictors because they in turn were affected by disease severity.
URI:	http://dx.doi.org/10.1177/2058738420942375 https://www.webofscience.com/wos/woscc/full-record/WOS:000615279800001 https://ir.csmu.edu.tw:8080/handle/310902500/24346
Relation:	INTERNATIONAL JOURNAL OF IMMUNOPATHOLOGY AND PHARMACOLOGY ,2020 ,v34
Appears in Collections:	[中山醫學大學研究成果] 期刊論文

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