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Antimicrobial Agents and Chemotherapy, March 2007, p. 839-844, Vol. 51, No. 3
0066-4804/07/$08.00+0     doi:10.1128/AAC.00901-06
Copyright © 2007, American Society for Microbiology. All Rights Reserved.

Impact of Empiric Antibiotic Therapy on Outcomes in Patients with Pseudomonas aeruginosa Bacteremia{triangledown}

Regina B. Osih,1 Jessina C. McGregor,2 Shayna E. Rich,2 Anita C. Moore,2 Jon P. Furuno,2 Eli N. Perencevich,2,3 and Anthony D. Harris2,3*

Department of Medicine, University of Maryland, Baltimore, Maryland,1 Department of Epidemiology and Preventive Medicine, University of Maryland, Baltimore, Maryland,2 VA Maryland Healthcare System, Baltimore, Maryland3

Received 21 July 2006/ Returned for modification 21 November 2006/ Accepted 17 December 2006

The impact of appropriate empirical antimicrobial therapy for Pseudomonas aeruginosa bacteremia on patient outcomes has not been clearly established. We assessed the effect of appropriate empirical therapy on in-hospital mortality and length of stay (LOS) among patients with P. aeruginosa bacteremia. This was a retrospective cohort study of inpatients with a positive blood culture for P. aeruginosa between January 2001 and June 2005. Empirical therapy was defined as appropriate if the patient received an antibiotic the organism was susceptible to between 8 h before culture collection and the time the susceptibility results were available. The severity of the illness was measured 24 h before culture collection. The data were analyzed using logistic regression (in-hospital mortality) and linear regression (LOS). Overall, there were 167 episodes of P. aeruginosa bacteremia, 123 (86%) of which received appropriate empirical antibiotics. Sixty-one patients died (36.5%). The median time from culture collection to susceptibility results was 3.4 days. After we adjusted for age, severity of illness, and time at risk, we found that the appropriate empirical therapy was not significantly associated with mortality (odds ratio = 0.96; 95% confidence interval = 0.31 to 2.93). There was a 7% reduction in the mean LOS for patients who had received appropriate therapy at the time susceptibility results were available compared to those who did not (P = 0.74). These data suggest that the use of appropriate empirical therapy, i.e., before susceptibility results are known may not be as critical to patient outcomes as other studies have suggested.

* Corresponding author. Mailing address: University of Maryland, Department of Epidemiology and Preventive Medicine, 100 N. Greene St. (lower level), Baltimore, MD 21201. Phone: (410) 706-0064. Fax: (410) 706-0098. E-mail: aharris{at}epi.umaryland.edu.

{triangledown} Published ahead of print on 28 December 2006.

Antimicrobial Agents and Chemotherapy, March 2007, p. 839-844, Vol. 51, No. 3
0066-4804/07/$08.00+0     doi:10.1128/AAC.00901-06
Copyright © 2007, American Society for Microbiology. All Rights Reserved.



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