The benefit of appropriate empirical antibiotic treatment in patients with bloodstream infection

作者：Leibovici, Shraga, Drucker, Konigsberger, Samra, Pitlik, Pitlik · 发表于：Journal of Internal Medicine · 年份：1998 · DOI：10.1046/j.1365-2796.1998.00379.x · 被引用次数：688 · 研究领域：Sepsis Diagnosis and Treatment、Streptococcal Infections and Treatments、Bacterial Identification and Susceptibility Testing

OBJECTIVES: To test whether empirical antibiotic treatment that matches the in vitro susceptibility of the pathogen (appropriate treatment) improves survival in patients with bloodstream infections; and to measure the improvement. DESIGN: Observational, prospective cohort study. SETTING: University hospital in Israel. SUBJECTS: All patients with bloodstream infections detected during 1988-94. INTERVENTIONS: None. MAIN OUTCOME MEASURES: In-hospital fatality rate and length of hospitalization. RESULTS: Out of 2158 patients given appropriate empirical antibiotic treatment, 436 (20%) died, compared with 432 of 1255 patients (34%) given inappropriate treatment (P = 0.0001). The median durations of hospital stay for patients who survived were 9 days for patients given appropriate treatment and 11 days for patients given inappropriate treatment. For patients who died, the median durations were 5 and 4 days, respectively (P < 0.05), for both comparisons. In a stratified analysis, fatality was higher in patients given inappropriate treatment than in those given appropriate treatment in all strata but two: patients with infections caused by streptococci other than Streptococcus gr. A and Streptoccocus pneumoniae (odds ratio (OR) of 1.0, 95% confidence interval (95% CI) 0.4-2.5); and hypothermic patients (OR = 0.9, 95% CI = 0.3-2.4). Even in patients with septic shock, inappropriate empirical treatment was associated with higher fatality rate (OR = 1.6, 95% CI = 1.0-2.7). The highest be...