Impact of inappropriate antibiotic therapy on mortality in patients with ventilator-associated pneumonia and blood stream infection: A meta-analysis

Objectives: Studies have found that initial treatment of ventilator-associated pneumonia (VAP) and blood stream infections (BSI) with inappropriate antimicrobial therapy is associated with higher rates of mortality, but additional studies have failed to confirm this. Methods: Databases were searched to identify studies that met the following criteria: observational trials, patients with VAP or BSI receiving appropriate and inappropriate antimicrobial therapy, and mortality data. We conducted random-effects model meta-analyses, both with and without adjustment. Results: Meta-analyses of VAP studies using unadjusted and adjusted data indicated that inappropriate therapy significantly increased patients' odds of mortality (odds ratio [OR], 2.34; 95% confidence interval [CI], 1.51-3.63; P =.0001, 12 = 28.5% and OR, 3.03; 95% CI, 1.12-8.19; P =.0292, I-2 = 89.2%, respectively). Meta-analyses of BSI studies using unadjusted and adjusted data showed that inappropriate therapy significantly increased patients' odds of mortality (OR, 2.33- 95% CI, 1.96-2.76; P <.0001, I-2 = 48.7% and OR, 2.28; 95% CI, 1.43-3.65; P =.0006, = 88.2%, respectively). Conclusions: There appears to be an association between initial inappropriate antimicrobial therapy and increased mortality in patients with VAP and BSI. (c) 2008 Elsevier Inc. All rights reserved.