Empirical antibiotic therapy modalities for Enterobacteriaceae bloodstream infections in older patients and their impact on mortality: a multicentre retrospective study.
Bloodstream infection
Elderly
Empirical antimicrobial therapy
Enterobacteriaceae
Functional trajectories
Journal
Infection
ISSN: 1439-0973
Titre abrégé: Infection
Pays: Germany
ID NLM: 0365307
Informations de publication
Date de publication:
22 Aug 2023
22 Aug 2023
Historique:
received:
10
04
2023
accepted:
01
07
2023
medline:
23
8
2023
pubmed:
23
8
2023
entrez:
22
8
2023
Statut:
aheadofprint
Résumé
Enterobacteriaceae (EB) bloodstream infections (BSI) are frequent and serious in older patients. Physicians are faced with the dilemma of prescribing early appropriate empirical antibiotics to limit the risk of death, and sparing broad-spectrum antibiotic prescription. The aim of the study was to assess the rate of appropriate empirical antibiotics prescription to treat EB BSI in older patients and its impact on survival. This study conducted in 49 centres enrolled retrospectively up to the 10 last consecutive patients aged 75 years and over and treated for EB BSI. Factors related to in-hospital death were investigated using logistic regression. Among the 487 enrolled patients (mean age 86 ± 5.9 years), 70% had at least one risk factor of being infected by third-generation cephalosporins (3GC)-resistant strain; however, only 13.8% of EB strains were resistant to 3GC. An empirical antimicrobial treatment was initiated for 418 patients (85.8%), and for 86% (n = 360/418) of them, it was considered appropriate. In-hospital mortality was 12.7% (n = 62) and was related to the severity of infection (OR 3.17, CI 95% 1.75-5.75), while a urinary portal of entry was protective (OR 0.34, CI 95% 0.19-0.60). Neither the absence of nor inappropriate empirical antibiotics prescription was associated with increased mortality. While patients enrolled in this study were at risk of being infected by multidrug-resistant bacteria, yet mainly treated with 3GC, empirical antibiotics prescription was appropriate in most cases and did not influence mortality.
Identifiants
pubmed: 37608043
doi: 10.1007/s15010-023-02073-0
pii: 10.1007/s15010-023-02073-0
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Investigateurs
Guillaume Chapelet
(G)
Audrey Rouet
(A)
Anani Akpabie
(A)
Sylvain Gaujard
(S)
Davide Angioni
(D)
Sebastien Jardry
(S)
Jerôme Hervé
(J)
Caroline Bussy
(C)
Flora Ketz
(F)
Rishma Amarsy
(R)
Audrey Barrelet
(A)
Véronique Moulin
(V)
Alain Putot
(A)
Nicolas Baclet
(N)
Céline Jarry
(C)
Cyprien Arlaud
(C)
Rocco Collarino
(R)
Bernard Durand-Gasselin
(B)
Cedric Devillelongue
(C)
Loubna Elmansouf
(L)
Benoit de Wazieres
(B)
Géraldine Martin-Gaujard
(G)
Nadir Kadri
(N)
Emmanuelle Magny
(E)
Amale Safir
(A)
Valérie Garrait
(V)
Aurélia Eden
(A)
Lise El Hajj
(L)
Anne Chahwakilian
(A)
Emmanuelle Gras
(E)
Karin Maley
(K)
Christina Picu
(C)
Dorothée Gueret
(D)
Marie-Agnes Lepine
(MA)
Diamondra Andrianasolo
(D)
Véronique Bérard
(V)
Charlotte Naline
(C)
Thibaud Fraisse
(T)
Diana Negoita
(D)
Louis Bernard
(L)
Catherine Vignes
(C)
Aurélie Baldolli
(A)
Julia Brochard
(J)
Chloé Porche
(C)
Véronique Moulin
(V)
Sylvain Diamantis
(S)
Renaud Verdon
(R)
Rachid Sehouane
(R)
Marie de la Roche
(M)
Yves Welker
(Y)
Camille Gomart
(C)
Georgette Muhorakeye
(G)
Daniel Letonturier
(D)
Olivier Gallon
(O)
Informations de copyright
© 2023. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany.
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