Does appropriate empiric antibiotic therapy modify intensive care unit-acquired Enterobacteriaceae bacteraemia mortality and discharge?
| Autor: | Timo Smieszek, Stijn Vansteelandt, Koen B. Pouwels, E. van Kleef, Rahul Batra, Julie V. Robotham, Jonathan D. Edgeworth |
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| Přispěvatelé: | PharmacoTherapy, -Epidemiology and -Economics |
| Jazyk: | angličtina |
| Rok vydání: | 2017 |
| Předmět: |
0301 basic medicine
Microbiology (medical) Adult Male medicine.medical_specialty 030106 microbiology Marginal structural model Bacteremia law.invention Cohort Studies 03 medical and health sciences 0302 clinical medicine Enterobacteriaceae law medicine Journal Article Humans 030212 general & internal medicine Hospital Mortality Intensive care medicine Aged Cross Infection business.industry Inverse probability weighting Confounding Hazard ratio General Medicine Middle Aged medicine.disease Intensive care unit Confidence interval Patient Discharge Anti-Bacterial Agents Intensive Care Units Infectious Diseases England Emergency medicine Female business Cohort study |
| Zdroj: | Journal of Hospital Infection, 96(1), 23-28. W B SAUNDERS CO LTD |
| ISSN: | 0195-6701 |
| Popis: | BACKGROUND: Conflicting results have been found regarding outcomes of intensive care unit (ICU)-acquired Enterobacteriaceae bacteraemia and the potentially modifying effect of appropriate empiric antibiotic therapy.AIM: To evaluate these associations while adjusting for potential time-varying confounding using methods from the causal inference literature.METHODS: Patients who stayed more than two days in two general ICUs in England between 2002 and 2006 were included in this cohort study. Marginal structural models with inverse probability weighting were used to estimate the mortality and discharge associated with Enterobacteriaceae bacteraemia and the impact of appropriate empiric antibiotic therapy on these outcomes.FINDINGS: Among 3411 ICU admissions, 195 (5.7%) ICU-acquired Enterobacteriaceae bacteraemia cases occurred. Enterobacteriaceae bacteraemia was associated with an increased daily risk of ICU death [cause-specific hazard ratio (HR): 1.48; 95% confidence interval (CI): 1.10-1.99] and a reduced daily risk of ICU discharge (HR: 0.66; 95% CI: 0.54-0.80). Appropriate empiric antibiotic therapy did not significantly modify ICU mortality (HR: 1.08; 95% CI: 0.59-1.97) or discharge (HR: 0.91; 95% CI: 0.63-1.32).CONCLUSION: ICU-acquired Enterobacteriaceae bacteraemia was associated with an increased daily risk of ICU mortality. Furthermore, the daily discharge rate was also lower after acquiring infection, even when adjusting for time-varying confounding using appropriate methodology. No evidence was found for a beneficial modifying effect of appropriate empiric antibiotic therapy on ICU mortality and discharge. |
| Databáze: | OpenAIRE |
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