This Article
Right arrow Full Text
Right arrow Full Text (PDF)
Right arrow Alert me when this article is cited
Right arrow Alert me if a correction is posted
Services
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Download to citation manager
Right arrowReprints and Permissions
Right arrow Copyright Information
Right arrow Books from ASM Press
Right arrow MicrobeWorld
Citing Articles
Right arrow Citing Articles via HighWire
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Scarsi, K. K.
Right arrow Articles by Noskin, G. A.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Scarsi, K. K.
Right arrow Articles by Noskin, G. A.

 Previous Article  |  Next Article 

Antimicrobial Agents and Chemotherapy, October 2006, p. 3355-3360, Vol. 50, No. 10
0066-4804/06/$08.00+0     doi:10.1128/AAC.00466-06
Copyright © 2006, American Society for Microbiology. All Rights Reserved.

Impact of Inactive Empiric Antimicrobial Therapy on Inpatient Mortality and Length of Stay

Kimberly K. Scarsi,1* Joe M. Feinglass,2 Marc H. Scheetz,1 Michael J. Postelnick,1 Maureen K. Bolon,3 and Gary A. Noskin3

Department of Pharmacy, Northwestern Memorial Hospital, Chicago, Illinois,1 Division of General Internal Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois,2 Division of Infectious Diseases, Northwestern University Feinberg School of Medicine, Chicago, Illinois3

Received 14 April 2006/ Returned for modification 12 May 2006/ Accepted 1 August 2006

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.

* Corresponding author. Mailing address: Northwestern Memorial Hospital, 251 E. Huron St., LC-700, Chicago, IL 60611. Phone: (312) 926-8358. Fax: (312) 926-9630. E-mail: kscarsi{at}nmh.org.

Antimicrobial Agents and Chemotherapy, October 2006, p. 3355-3360, Vol. 50, No. 10
0066-4804/06/$08.00+0     doi:10.1128/AAC.00466-06
Copyright © 2006, American Society for Microbiology. All Rights Reserved.



This article has been cited by other articles:

  • Scheetz, M. H., Bolon, M. K., Postelnick, M., Noskin, G. A., Lee, T. A. (2009). Cost-effectiveness analysis of an antimicrobial stewardship team on bloodstream infections: a probabilistic analysis. J Antimicrob Chemother 63: 816-825 [Abstract] [Full Text]  
  • DeFife, R., Scheetz, M. H., Feinglass, J. M., Postelnick, M. J., Scarsi, K. K. (2009). Effect of Differences in MIC Values on Clinical Outcomes in Patients with Bloodstream Infections Caused by Gram-Negative Organisms Treated with Levofloxacin. Antimicrob. Agents Chemother. 53: 1074-1079 [Abstract] [Full Text]  
  • Lin, M. Y., Weinstein, R. A., Hota, B. (2008). Delay of Active Antimicrobial Therapy and Mortality among Patients with Bacteremia: Impact of Severe Neutropenia. Antimicrob. Agents Chemother. 52: 3188-3194 [Abstract] [Full Text]  
  • Marschall, J., Agniel, D., Fraser, V. J., Doherty, J., Warren, D. K. (2008). Gram-negative bacteraemia in non-ICU patients: factors associated with inadequate antibiotic therapy and impact on outcomes. J Antimicrob Chemother 61: 1376-1383 [Abstract] [Full Text]  
  • Garnacho-Montero, J., Ortiz-Leyba, C., Herrera-Melero, I., Aldabo-Pallas, T., Cayuela-Dominguez, A., Marquez-Vacaro, J. A., Carbajal-Guerrero, J., Garcia-Garmendia, J. L. (2008). Mortality and morbidity attributable to inadequate empirical antimicrobial therapy in patients admitted to the ICU with sepsis: a matched cohort study. J Antimicrob Chemother 61: 436-441 [Abstract] [Full Text]  


Copyright © 2009 by the American Society for Microbiology.   For an alternate route to Journals.ASM.org, visit: http://intl-journals.asm.org | More Info»