Delays in appropriate antibiotic therapy for gram-negative bloodstream infections: a multicenter, community hospital study.
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BACKGROUND: Gram-negative bacterial bloodstream infection (BSI) is a serious condition with estimated 30% mortality. Clinical outcomes for patients with severe infections improve when antibiotics are appropriately chosen and given early. The objective of this study was to estimate the association of prior healthcare exposure on time to appropriate antibiotic therapy in patients with gram-negative BSI. METHOD: We performed a multicenter cohort study of adult, hospitalized patients with gram-negative BSI using time to event analysis in nine community hospitals from 2003-2006. Event time was defined as the first administration of an antibiotic with in vitro activity against the infecting organism. Healthcare exposure status was categorized as community-acquired, healthcare-associated, or hospital-acquired. Time to appropriate therapy among groups of patients with differing healthcare exposure status was assessed using Kaplan-Meier analyses and multivariate Cox proportional hazards models. RESULTS: The cohort included 578 patients with gram-negative BSI, including 320 (55%) healthcare-associated, 217 (38%) community-acquired, and 41 (7%) hospital-acquired infections. 529 (92%) patients received an appropriate antibiotic during their hospitalization. Time to appropriate therapy was significantly different among the groups of healthcare exposure status (log-rank p=0.02). Time to first antibiotic administration regardless of drug appropriateness was not different between groups (p=0.3). The unadjusted hazard ratios (HR) (95% confidence interval) were 0.80 (0.65-0.98) for healthcare-associated and 0.72 (0.63-0.82) for hospital-acquired, relative to patients with community-acquired BSI. In multivariable analysis, interaction was found between the main effect and baseline Charlson comorbidity index. When Charlson index was 3, adjusted HRs were 0.66 (0.48-0.92) for healthcare-associated and 0.57 (0.44-0.75) for hospital-acquired, relative to patients with community-acquired infections. CONCLUSIONS: Patients with healthcare-associated or hospital-acquired BSI experienced delays in receipt of appropriate antibiotics for gram-negative BSI compared to patients with community-acquired BSI. This difference was not due to delayed initiation of antibiotic therapy, but due to the inappropriate choice of antibiotic.
Aged, 80 and over
Gram-Negative Bacterial Infections
Proportional Hazards Models
Published Version (Please cite this version)10.1371/journal.pone.0076225
Publication InfoMoehring, Rebekah W; Sloane, Richard; Chen, Luke F; Smathers, Emily C; Schmader, Kenneth E; Fowler, Vance G; ... Anderson, Deverick J (2013). Delays in appropriate antibiotic therapy for gram-negative bloodstream infections: a multicenter, community hospital study. PLoS One, 8(10). pp. e76225. 10.1371/journal.pone.0076225. Retrieved from https://hdl.handle.net/10161/13317.
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Professor of Medicine
Hospital epidemiology, infection control, antibiotic stewardship, multidrug-resistant organisms, device-related infections, surgical site infections, catheter-associated bloodstream infections, cost of infections, infections in community hospitals
Associate Professor of Medicine
Epidemiology, Infection Prevention, Infection Control, Outbreak Investigations, Multi-drug resistant organisms, multidrug-resistant gram-negative pathogens MDR GNR (e.g. ESBL, CRE, KPC, NDM-1), C. difficile, MRSA infections health care epidemiology, HIV medicine, respiratory viral infections, infection control and prevention, health care-associated infections including bloodstream and surgical-site infections
This author no longer has a Scholars@Duke profile, so the information shown here reflects their Duke status at the time this item was deposited.
Florence McAlister Distinguished Professor of Medicine
Determinants of Outcome in Patients with Staphylococcus aureus Bacteremia Antibacterial ResistancePathogenesis of Bacterial Infections Tropical medicine/International Health
Associate Professor of Medicine
Professor of Medicine
Dr. Schmader’s areas of research include herpes zoster, infections, and vaccines in older adults. He conducts translational, clinical trials and observational studies of zoster, influenza, and other infections funded by grants from the National Institute on Aging (NIA), National Institute of Allergy and Infectious Diseases (NIAID), Centers for Disease Control (CDC), VA Office of Research and Development, and Industry sources. He has played a pivotal role in the development o
Professor Emeritus of Medicine
During the past 8 years my research interests have changed from a focus on tick-borne disease and endocarditis to a primary focus on healthcare-associated infections (HAIs). Specifically, I have been interested in HAIs in community hospitals. Using prospective data collected as part of our surveillance activities in the Duke Infection Control Outreach Network (DICON), I and my colleagues have focused on these specific areas of research: • The accuracy and reliability of s
Alphabetical list of authors with Scholars@Duke profiles.