Prognostic Factors and Adequacy of Empirical Antibiotic Therapy for Patients with Bloodstream Infection in the Emergency Department

Bae, Young Shin; Park, Hyeon Soo; Jung, Yoon Seok; Min, Young Gi

Abstract

PURPOSE
To characterize the prognostic factors and evaluate the inadequate empirical antibiotic therapy for patients with bloodstream infection.
METHODS
We reviewed retrospectively the medical records of all adult patients with bloodstream infections detected from November 1, 2002, to June 30, 2003. Clinical and microbiological characteristics were recorded, and the adequacy of empirical antimicrobial therapy was determined in each case. A multiple logistic regression analysis with SPSS 11.5 was used to determine the prognostic factors for mortality related to bloodstream infections.
RESULTS
Escherichia coliand Klebsiella spp. were the most commonly isolated organisms, and the main sources were the intra-abdominal (40.4%), the urinary tract (28.7%), and pneumonia (36.8%). Approximately 19.1% of the patients died. Statistical analysis of independent risk factors showed that mortality was significantly related to inadequate empirical antibiotic therapy (OR 34.72, p=0.019), renal insufficiency (OR 10.54, p=0.011), the rapidity of fatal diseases (OR 4.77, p=0.018), and the severity of sepsis (OR 3.58, p=0.031). Patients with inadequate empirical antibiotic therapy had a 50% survival rate. The main reason for the administration of an inadequate antibiotic therapy was the presence of antibiotic-resistant bacteria and/or fungal infections.
CONCLUSION
Better understanding of the correlation between mortality and prognostic factors may improve the outcome for patients with bloodstream infections. Inadequate antibiotic therapy is the most important influence on the outcome for such patients. Our data suggest that clinical efforts aimed at reducing the occurrence of inadequate antibiotic therapy could improve the outcomes for bacteremic patients.