Universität zu Köln

Kaasch, A. J., Rieg, S., Kuetscher, J., Brodt, H. -R., Widmann, T., Herrmann, M., Meyer, C., Welte, T., Kern, P., Haars, U., Reuter, S., Huebner, I., Strauss, R., Sinha, B., Brunkhorst, F. M., Hellmich, M., Faetkenheuer, G., Kern, W. V. and Seifert, H. (2013). Delay in the administration of appropriate antimicrobial therapy in Staphylococcus aureus bloodstream infection: a prospective multicenter hospital-based cohort study. Infection, 41 (5). S. 979 - 986. HEIDELBERG: SPRINGER HEIDELBERG. ISSN 1439-0973

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Abstract

Early broad-spectrum antimicrobial treatment reduces mortality in patients with septic shock. In a multicenter, prospective observational study, we explored whether delayed appropriate antimicrobial therapy (AAT) influences outcome in Staphylococcus aureus bloodstream infection (SAB). Two hundred and fifty-six patients with SAB from ten German study centers were enrolled and followed for 3 months. Predisposing factors, clinical features, diagnostic procedures, antimicrobial therapy, and outcome were recorded. The appropriateness of antimicrobial therapy was judged by a trained physician based on in vitro activity, dosage, and duration of therapy. Therapy was considered to be delayed when more than 24 h elapsed between the first positive blood culture and the start of appropriate therapy. The association of delayed therapy with overall mortality and SAB-related events (i.e., attributable mortality or late SAB-related complications) was assessed by crosstabulation and propensity score-based logistic regression. One hundred and sixty-eight patients received AAT during their hospital stay, of whom 42 (25 %) received delayed AAT. The overall mortality and the occurrence of severe sepsis or septic shock were lower in patients with delayed AAT, pointing towards confounding by indication. Adjusted 90-day mortality (adjusted odds ratio [OR] 0.91, 95 % confidence interval [CI] [0.39-2.13], p 0.82) and SAB-related events (adjusted OR 1.46, 95 % CI [0.47-4.51], p 0.52) also failed to show a significant impact of delayed AAT on outcome. In patients with SAB, early AAT may not improve survival. However, confounding by indication is a major challenge when analyzing and interpreting observational studies on the impact of delayed AAT.

Item Type:	Journal Article
Creators:	Creators Email ORCID ORCID Put Code Kaasch, A. J. UNSPECIFIED UNSPECIFIED UNSPECIFIED Rieg, S. UNSPECIFIED UNSPECIFIED UNSPECIFIED Kuetscher, J. UNSPECIFIED UNSPECIFIED UNSPECIFIED Brodt, H. -R. UNSPECIFIED UNSPECIFIED UNSPECIFIED Widmann, T. UNSPECIFIED UNSPECIFIED UNSPECIFIED Herrmann, M. UNSPECIFIED UNSPECIFIED UNSPECIFIED Meyer, C. UNSPECIFIED UNSPECIFIED UNSPECIFIED Welte, T. UNSPECIFIED UNSPECIFIED UNSPECIFIED Kern, P. UNSPECIFIED UNSPECIFIED UNSPECIFIED Haars, U. UNSPECIFIED UNSPECIFIED UNSPECIFIED Reuter, S. UNSPECIFIED UNSPECIFIED UNSPECIFIED Huebner, I. UNSPECIFIED UNSPECIFIED UNSPECIFIED Strauss, R. UNSPECIFIED UNSPECIFIED UNSPECIFIED Sinha, B. UNSPECIFIED UNSPECIFIED UNSPECIFIED Brunkhorst, F. M. UNSPECIFIED UNSPECIFIED UNSPECIFIED Hellmich, M. UNSPECIFIED UNSPECIFIED UNSPECIFIED Faetkenheuer, G. UNSPECIFIED UNSPECIFIED UNSPECIFIED Kern, W. V. UNSPECIFIED UNSPECIFIED UNSPECIFIED Seifert, H. UNSPECIFIED UNSPECIFIED UNSPECIFIED
URN:	urn:nbn:de:hbz:38-475001
DOI:	10.1007/s15010-013-0428-9
Journal or Publication Title:	Infection
Volume:	41
Number:	5
Page Range:	S. 979 - 986
Date:	2013
Publisher:	SPRINGER HEIDELBERG
Place of Publication:	HEIDELBERG
ISSN:	1439-0973
Language:	English
Faculty:	Unspecified
Divisions:	Unspecified
Subjects:	no entry
Uncontrolled Keywords:	Keywords Language EMPIRICAL ANTIBIOTIC-THERAPY; 30-DAY MORTALITY; IMPACT; BACTEREMIA; PREDICTORS; ADEQUACY; SEPSIS; SHOCK Multiple languages Infectious Diseases Multiple languages
URI:	http://kups.ub.uni-koeln.de/id/eprint/47500