Appropriateness of Empirical Antibiotic Therapy in Hospitalized Patients with Bacterial Infection: A Retrospective Cohort Study

Abstract

Yuting Luo,1,* Zhaowang Guo,2,* Ying Li,1,* Hui Ouyang,1 Shanfeng Huang,1 Yuanli Chen,3 Kenan Li,1 Yuxin Ji,1 Hongqiong Zhu,1 Wentao Luo,1 Xu Liu,1,4 Xinghua Li,1 Jinyu Xia,1 Xi Liu1 1Department of Infectious Diseases, The Fifth Affiliated Hospital, Sun Yat-sen University, Zhuhai, People’s Republic of China; 2Clinical Laboratory, The Fifth Affiliated Hospital, Sun Yat-sen University, Zhuhai, People’s Republic of China; 3Department of Hospital Infection Control, The Fifth Affiliated Hospital, Sun Yat-sen University, Zhuhai, People’s Republic of China; 4Guangdong Provincial Key Laboratory of Biomedical Imaging and Guangdong Provincial Engineering Research Center of Molecular Imaging, Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, People’s Republic of China*These authors contributed equally to this workCorrespondence: Xi Liu; Xinghua Li, Department of Infectious Diseases, The Fifth Affiliated Hospital, Sun Yat-sen University, 52 Meihua East Road, Xiangzhou District, Zhuhai, 519000, People’s Republic of China, Tel/Fax [phone], Email [email protected]; [email protected]: The incidence of inappropriate and excessive empirical antibiotic therapy is unclear. The aim of this study was to determine the prevalence of different empirical antibiotic therapy prescriptions, related factors, and outcomes in hospitalized patients with bacterial infection.Methods: A retrospective cohort study was performed and patients with bacterial infection who were admitted between October 1, 2019, and September 30, 2020, were included. Multivariable analysis was performed by the logistic regression model.Results: A total of 536 (42.6%) of the 1257 included patients received inappropriate empirical antibiotic therapy (IEAT), and 368 (29.3%) patients received appropriate but unnecessarily broad-spectrum empirical antibiotic therapy (AUEAT). MDRO (adjusted OR 2.932 [95% CI 2.201~3.905]; p < 0.001) and fever on admission (adjusted OR 0.592 [95% CI 0.415~0.844]; p = 0.004) were correlates of IEAT; sepsis (adjusted OR 2.342 [95% CI 1.371~3.999]; p = 0.002), age (adjusted OR 1.019 [95% CI 1.008~1.030]; p < 0.001), MDRO (adjusted OR 0.664 [95% CI 0.469~0.941]; p = 0.021), and urinary tract infection (adjusted OR 0.352 [95% CI 0.203~0.611]; p < 0.001) were correlates of AUEAT. Patients who received AUEAT were more likely to have a poor prognosis (63 [17.8%] vs 101 [27.4%]; p = 0.002). Both IEAT (median [IQR], 24,971 [13,135– 70,155] vs 31,489 [14,894– 101,082] CNY; p = 0.007) and AUEAT (median [IQR], 24,971 [13,135– 70,155] vs 30,960 [16,475– 90,881] CNY; p = 0.002) increased hospital costs. 45.3% (570/1257) of patients were infected with MDRO and 62.9% of them received IEAT.Conclusion: Inappropriate and excessive empirical antibiotic use was widely prevalent among hospitalized patients. Either inappropriate or excessive use of antibiotics may increase the burden of healthcare costs, the latter of which may be associated with poor prognosis. Clinicians need to be more judicious in choosing antibiotic(s). The MDRO epidemic was severe, especially in patients who received IEAT. It is imperative to take effective measures to improve the current situation of antibiotic abuse and antimicrobial resistance.Keywords: antimicrobial resistance, bacterial culture-positive, empirical antibiotic therapy, patient outcome, multidrug-resistant organism

Keywords

• antimicrobial resistance
• bacterial culture-positive
• empirical antibiotic therapy
• patient outcome
• multidrug-resistant organism