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 InfoAnderson, DJ; Chen, LF; Fowler, Vance Garrison Jr; Moehring, Rebekah; Schmader, KE; Sexton, DJ; ... Weber, DJ (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 http://hdl.handle.net/10161/13317.
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Professor of Medicine
Determinants of Outcome in Patients with Staphylococcus aureus Bacteremia Pathogenesis of Bacterial Infections Infections due to Resistant Gram Positive Organisms Tropical medicine/International Health
Associate Professor of Medicine
Professor of Medicine
Dr. Schmader's primary area of research is herpes zoster and postherpetic neuralgia (PHN) and vaccines in older adults. He conducts pre-clinical, epidemiological and intervention studies of zoster and PHN, particularly with the zoster and influenza vaccines. He is involved with other adult vaccine development in older adults. With colleagues in the Division of Infectious Diseases, Dr. Schmader investigates other infections in older adults. Another major research focus is ad
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