期刊
INFECTION
卷 41, 期 5, 页码 979-985出版社
SPRINGER HEIDELBERG
DOI: 10.1007/s15010-013-0428-9
关键词
Staphylococcus aureus; Bloodstream infection; Antimicrobial; Antibiotic; Adequate; Empiric; Appropriate
资金
- Deutsche Forschungsgemeinschaft (DFG) [KA 3104/1-1]
- German Federal Ministry of Education and Research [BMBF 01KI1017, 01EO0803, 01KI0772, 01EO1002]
- Thuringian Ministry of Education, Science and Culture [PE 108-2]
- Thuringian Foundation for Technology, Innovation and Research (STIFT)
- German Sepsis Society (GSS)
- DFG [IRTG1522, SFB-TR34]
Early broad-spectrum antimicrobial treatment reduces mortality in patients with septic shock. In a multicenter, prospective observational study, we explored whether delayed appropriate antimicrobial therapy (AAT) influences outcome in Staphylococcus aureus bloodstream infection (SAB). Two hundred and fifty-six patients with SAB from ten German study centers were enrolled and followed for 3 months. Predisposing factors, clinical features, diagnostic procedures, antimicrobial therapy, and outcome were recorded. The appropriateness of antimicrobial therapy was judged by a trained physician based on in vitro activity, dosage, and duration of therapy. Therapy was considered to be delayed when more than 24 h elapsed between the first positive blood culture and the start of appropriate therapy. The association of delayed therapy with overall mortality and SAB-related events (i.e., attributable mortality or late SAB-related complications) was assessed by crosstabulation and propensity score-based logistic regression. One hundred and sixty-eight patients received AAT during their hospital stay, of whom 42 (25 %) received delayed AAT. The overall mortality and the occurrence of severe sepsis or septic shock were lower in patients with delayed AAT, pointing towards confounding by indication. Adjusted 90-day mortality (adjusted odds ratio [OR] 0.91, 95 % confidence interval [CI] [0.39-2.13], p 0.82) and SAB-related events (adjusted OR 1.46, 95 % CI [0.47-4.51], p 0.52) also failed to show a significant impact of delayed AAT on outcome. In patients with SAB, early AAT may not improve survival. However, confounding by indication is a major challenge when analyzing and interpreting observational studies on the impact of delayed AAT.
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