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Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
medicine
Gram-negative bacteraemia; A multi-centre prospective evaluation of empiric antibiotic therapy and outcome in English acute hospitals
Clinical Microbiology and Infection, Volume 22, No. 3, Year 2016
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Description
Increasing antibiotic resistance makes choosing antibiotics for suspected Gram-negative infection challenging. This study set out to identify key determinants of mortality among patients with Gram-negative bacteraemia, focusing particularly on the importance of appropriate empiric antibiotic treatment. We conducted a prospective observational study of 679 unselected adults with Gram-negative bacteraemia at ten acute english hospitals between October 2013 and March 2014. Appropriate empiric antibiotic treatment was defined as intravenous treatment on the day of blood culture collection with an antibiotic to which the cultured organism was sensitive in vitro. Mortality analyses were adjusted for patient demographics, co-morbidities and illness severity. The majority of bacteraemias were community-onset (70%); most were caused by Escherichia coli (65%), Klebsiella spp. (15%) or Pseudomonas spp. (7%). Main foci of infection were urinary tract (51%), abdomen/biliary tract (20%) and lower respiratory tract (14%). The main antibiotics used were co-amoxiclav (32%) and piperacillin-tazobactam (30%) with 34% receiving combination therapy (predominantly aminoglycosides). Empiric treatment was inappropriate in 34%. All-cause mortality was 8% at 7 days and 15% at 30 days. Independent predictors of mortality (<0.05) included older age, greater burden of co-morbid disease, severity of illness at presentation and inflammatory response. Inappropriate empiric antibiotic therapy was not associated with mortality at either time-point (adjusted OR 0.82; 95% CI 0.35-1.94 and adjusted OR 0.92; 95% CI 0.50-1.66, respectively). Although our study does not exclude an impact of empiric antibiotic choice on survival in Gram-negative bacteraemia, outcome is determined primarily by patient and disease factors. © 2015 European Society of Clinical Microbiology and Infectious Diseases.
Authors & Co-Authors
Edgeworth, Jonathan D.
United Kingdom, London
King's College London
Jenkins, Neil
United Kingdom, Birmingham
University Hospitals Birmingham Nhs Foundation Trust
Morris-Jones, Stephen D.
United Kingdom, London
University College London Hospitals Nhs Foundation Trust
Nsutebu, Emmanuel Fru
United Kingdom, Liverpool
Royal Liverpool University Hospital
Morris, Lynn G.
United Kingdom, Birmingham
University Hospitals Birmingham Nhs Foundation Trust
Price, James Richard
United Kingdom, Worthing
University Hospitals Sussex Nhs Foundation Trust
Scarborough, Matthew
United Kingdom, Oxford
Nihr Oxford Biomedical Research Centre
Thwaites, G. E.
United Kingdom, Oxford
University of Oxford
Tilley, Robert A.F.
United Kingdom, Plymouth
University Hospitals Plymouth Nhs Trust
Walker, A. Sarah
United Kingdom, Oxford
Nihr Oxford Biomedical Research Centre
United Kingdom, Oxford
University of Oxford
Llewelyn, Martin J.
United Kingdom, Brighton
Royal Sussex County Hospital
United Kingdom, Brighton
Brighton and Sussex Medical School
Statistics
Citations: 49
Authors: 11
Affiliations: 12
Identifiers
Doi:
10.1016/j.cmi.2015.10.034
ISSN:
1198743X
Research Areas
Health System And Policy
Study Design
Cohort Study