Impact of inactive empiric antimicrobial therapy on inpatient mortality and length of stay

Kimberly K. Scarsi, Joe M. Feinglass, Marc H. Scheetz, Michael J. Postelnick, Maureen K. Bolon, Gary A. Noskin

Research output: Contribution to journalArticle

30 Citations (Scopus)

Abstract

The consequences of inactive empiric antimicrobial therapy are not well-described and may cause prolonged hospitalization or infection-related mortality. In vitro susceptibility results for 884 patients hospitalized at an academic medical center with gram-negative bloodstream infections (GNBI) from 2001 to 2003 were matched to antimicrobial orders within 24 h of culture. Clinical characteristics, organism, inpatient mortality, and length of stay after culture for patients with GNBI were compared between patients receiving active versus inactive empiric antimicrobial therapy. A total of 14.1% of patients with GNBI received inactive empiric therapy, defined as no antimicrobial therapy within 24 h of the culture active against the identified organism based on in vitro microbiology reports. Patients who received inactive therapy were more likely to be younger, to be infected with Pseudomonas aeruginosa, to have a nosocomial infection, and to receive antimicrobial monotherapy but less likely to be bacteremic with Escherichia coli or to have sepsis (P < 0.05). There were no significant differences in mortality between patients receiving active versus inactive empiric therapy (16.1% versus 13.6%, respectively) or in length of stay after positive culture (11.5 days versus 12.6 days, respectively). Only 45 patients had greater than 2 days of exposure to inactive therapy; however, 8/30 patients (26.7%) who never received active antimicrobial therapy died while in the hospital. Inactive empiric therapy was more common in healthier patients. Inactive antimicrobial therapy in the first 24 h did not significantly impact average outcomes for GNBI among hospitalized patients but may have caused harm to specific individuals.

Original languageEnglish (US)
Pages (from-to)3355-3360
Number of pages6
JournalAntimicrobial Agents and Chemotherapy
Volume50
Issue number10
DOIs
StatePublished - Oct 1 2006

Fingerprint

Inpatients
Length of Stay
Mortality
Therapeutics
Infection
Cross Infection
Microbiology
Pseudomonas aeruginosa
Sepsis
Hospitalization
Escherichia coli

ASJC Scopus subject areas

  • Pharmacology
  • Pharmacology (medical)
  • Infectious Diseases

Cite this

Impact of inactive empiric antimicrobial therapy on inpatient mortality and length of stay. / Scarsi, Kimberly K.; Feinglass, Joe M.; Scheetz, Marc H.; Postelnick, Michael J.; Bolon, Maureen K.; Noskin, Gary A.

In: Antimicrobial Agents and Chemotherapy, Vol. 50, No. 10, 01.10.2006, p. 3355-3360.

Research output: Contribution to journalArticle

Scarsi, Kimberly K. ; Feinglass, Joe M. ; Scheetz, Marc H. ; Postelnick, Michael J. ; Bolon, Maureen K. ; Noskin, Gary A. / Impact of inactive empiric antimicrobial therapy on inpatient mortality and length of stay. In: Antimicrobial Agents and Chemotherapy. 2006 ; Vol. 50, No. 10. pp. 3355-3360.
@article{4751ed8f0983459abf4f2802444b3e48,
title = "Impact of inactive empiric antimicrobial therapy on inpatient mortality and length of stay",
abstract = "The consequences of inactive empiric antimicrobial therapy are not well-described and may cause prolonged hospitalization or infection-related mortality. In vitro susceptibility results for 884 patients hospitalized at an academic medical center with gram-negative bloodstream infections (GNBI) from 2001 to 2003 were matched to antimicrobial orders within 24 h of culture. Clinical characteristics, organism, inpatient mortality, and length of stay after culture for patients with GNBI were compared between patients receiving active versus inactive empiric antimicrobial therapy. A total of 14.1{\%} of patients with GNBI received inactive empiric therapy, defined as no antimicrobial therapy within 24 h of the culture active against the identified organism based on in vitro microbiology reports. Patients who received inactive therapy were more likely to be younger, to be infected with Pseudomonas aeruginosa, to have a nosocomial infection, and to receive antimicrobial monotherapy but less likely to be bacteremic with Escherichia coli or to have sepsis (P < 0.05). There were no significant differences in mortality between patients receiving active versus inactive empiric therapy (16.1{\%} versus 13.6{\%}, respectively) or in length of stay after positive culture (11.5 days versus 12.6 days, respectively). Only 45 patients had greater than 2 days of exposure to inactive therapy; however, 8/30 patients (26.7{\%}) who never received active antimicrobial therapy died while in the hospital. Inactive empiric therapy was more common in healthier patients. Inactive antimicrobial therapy in the first 24 h did not significantly impact average outcomes for GNBI among hospitalized patients but may have caused harm to specific individuals.",
author = "Scarsi, {Kimberly K.} and Feinglass, {Joe M.} and Scheetz, {Marc H.} and Postelnick, {Michael J.} and Bolon, {Maureen K.} and Noskin, {Gary A.}",
year = "2006",
month = "10",
day = "1",
doi = "10.1128/AAC.00466-06",
language = "English (US)",
volume = "50",
pages = "3355--3360",
journal = "Antimicrobial Agents and Chemotherapy",
issn = "0066-4804",
publisher = "American Society for Microbiology",
number = "10",

}

TY - JOUR

T1 - Impact of inactive empiric antimicrobial therapy on inpatient mortality and length of stay

AU - Scarsi, Kimberly K.

AU - Feinglass, Joe M.

AU - Scheetz, Marc H.

AU - Postelnick, Michael J.

AU - Bolon, Maureen K.

AU - Noskin, Gary A.

PY - 2006/10/1

Y1 - 2006/10/1

N2 - The consequences of inactive empiric antimicrobial therapy are not well-described and may cause prolonged hospitalization or infection-related mortality. In vitro susceptibility results for 884 patients hospitalized at an academic medical center with gram-negative bloodstream infections (GNBI) from 2001 to 2003 were matched to antimicrobial orders within 24 h of culture. Clinical characteristics, organism, inpatient mortality, and length of stay after culture for patients with GNBI were compared between patients receiving active versus inactive empiric antimicrobial therapy. A total of 14.1% of patients with GNBI received inactive empiric therapy, defined as no antimicrobial therapy within 24 h of the culture active against the identified organism based on in vitro microbiology reports. Patients who received inactive therapy were more likely to be younger, to be infected with Pseudomonas aeruginosa, to have a nosocomial infection, and to receive antimicrobial monotherapy but less likely to be bacteremic with Escherichia coli or to have sepsis (P < 0.05). There were no significant differences in mortality between patients receiving active versus inactive empiric therapy (16.1% versus 13.6%, respectively) or in length of stay after positive culture (11.5 days versus 12.6 days, respectively). Only 45 patients had greater than 2 days of exposure to inactive therapy; however, 8/30 patients (26.7%) who never received active antimicrobial therapy died while in the hospital. Inactive empiric therapy was more common in healthier patients. Inactive antimicrobial therapy in the first 24 h did not significantly impact average outcomes for GNBI among hospitalized patients but may have caused harm to specific individuals.

AB - The consequences of inactive empiric antimicrobial therapy are not well-described and may cause prolonged hospitalization or infection-related mortality. In vitro susceptibility results for 884 patients hospitalized at an academic medical center with gram-negative bloodstream infections (GNBI) from 2001 to 2003 were matched to antimicrobial orders within 24 h of culture. Clinical characteristics, organism, inpatient mortality, and length of stay after culture for patients with GNBI were compared between patients receiving active versus inactive empiric antimicrobial therapy. A total of 14.1% of patients with GNBI received inactive empiric therapy, defined as no antimicrobial therapy within 24 h of the culture active against the identified organism based on in vitro microbiology reports. Patients who received inactive therapy were more likely to be younger, to be infected with Pseudomonas aeruginosa, to have a nosocomial infection, and to receive antimicrobial monotherapy but less likely to be bacteremic with Escherichia coli or to have sepsis (P < 0.05). There were no significant differences in mortality between patients receiving active versus inactive empiric therapy (16.1% versus 13.6%, respectively) or in length of stay after positive culture (11.5 days versus 12.6 days, respectively). Only 45 patients had greater than 2 days of exposure to inactive therapy; however, 8/30 patients (26.7%) who never received active antimicrobial therapy died while in the hospital. Inactive empiric therapy was more common in healthier patients. Inactive antimicrobial therapy in the first 24 h did not significantly impact average outcomes for GNBI among hospitalized patients but may have caused harm to specific individuals.

UR - http://www.scopus.com/inward/record.url?scp=33749517364&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=33749517364&partnerID=8YFLogxK

U2 - 10.1128/AAC.00466-06

DO - 10.1128/AAC.00466-06

M3 - Article

C2 - 17005817

AN - SCOPUS:33749517364

VL - 50

SP - 3355

EP - 3360

JO - Antimicrobial Agents and Chemotherapy

JF - Antimicrobial Agents and Chemotherapy

SN - 0066-4804

IS - 10

ER -