Author:
Marquet Kristel,Liesenborgs An,Bergs Jochen,Vleugels Arthur,Claes Neree
Abstract
Abstract
Introduction
The aims of this study were to explore the incidence of in-hospital inappropriate empiric antibiotic use in patients with severe infection and to identify its relationship with patient outcomes.
Methods
Medline (from 2004 to 2014) was systematically searched by using predefined inclusion criteria. Reference lists of retrieved articles were screened for additional relevant studies. The systematic review included original articles reporting a quantitative measure of the association between the use of (in)appropriate empiric antibiotics in patients with severe in-hospital infections and their outcomes. A meta-analysis, using a random-effects model, was conducted to quantify the effect on mortality by using risk ratios.
Results
In total, 27 individual articles fulfilled the inclusion criteria. The percentage of inappropriate empiric antibiotic use ranged from 14.1% to 78.9% (Q1-Q3: 28.1% to 57.8%); 13 of 27 studies (48.1%) described an incidence of 50% or more. A meta-analysis for 30-day mortality and in-hospital mortality showed risk ratios of 0.71 (95% confidence interval 0.62 to 0.82) and 0.67 (95% confidence interval 0.56 to 0.80), respectively. Studies with outcome parameter 28-day and 60-day mortality reported significantly (P ≤0.02) higher mortality rates in patients receiving inappropriate antibiotics. Two studies assessed the total costs, which were significantly higher in both studies (P ≤0.01).
Conclusions
This systematic review with meta-analysis provides evidence that inappropriate use of empiric antibiotics increases 30-day and in-hospital mortality in patients with a severe infection.
Publisher
Springer Science and Business Media LLC
Subject
Critical Care and Intensive Care Medicine
Reference70 articles.
1. World Health Organization. World health statistics 2012. http://www.who.int/gho/publications/world_health_statistics/EN_WHS2012_Full.pdf. Accessed March 9, 2015.
2. Heron M, Hoyert S, Murphy J, Kochanek K, Tejada-Vera B. Deaths: final data for 2006. Division of Vital Statistics, Centers for Disease Control and Prevention. Natl Vital Stat Rep. 2009;57:1–136.
3. Wenzel RP, Edmond MB. The impact of hospital-acquired bloodstream infections. Emerg Infect Dis. 2001;7:174–7.
4. Dellinger RP. Cardiovascular management of septic shock. Crit Care Med. 2003;31:946–55.
5. Eagye KJ, Kim A, Laohavaleeson S, Kuti JL, Nicolau DP. Surgical site infections: does inadequate antibiotic therapy affect patient outcomes? Surg Infect (Larchmt). 2009;10:323–31.
Cited by
143 articles.
订阅此论文施引文献
订阅此论文施引文献,注册后可以免费订阅5篇论文的施引文献,订阅后可以查看论文全部施引文献