Article Figures & Data
Figures
- FIG. 1.
Survival curve using the Kaplan-Meier method for patients with antibiotic-resistant gram-negative bacteremia who received appropriate initial antimicrobial therapy compared to those who received inappropriate therapy. The inappropriate therapy group has the lower probability of survival than the appropriate therapy group. The 30-day mortality rate of the appropriate initial antimicrobial therapy group was 27.4%, whereas that of the inappropriate therapy group was 38.4% (P = 0.049).
Tables
- TABLE 1.
Demographic characteristics of study populationa
Characteristic Value for groupb P value Appropriate initial antibiotics (n = 135) Inappropriate initial antibiotics (n = 151) No. of males 83 (61.5) 100 (66.2) NS Age (yr) (mean ± SD, range) 53 ± 16, 16-86 56 ± 16, 16-95 NS APACHE II score (mean ± SD, range) 11.39 ± 4.85, 0-25 11.02 ± 5.15, 0-24 NS Underlying disease Leukemia 20 (14.8) 21 (13.9) NS Malignant lymphoma 3 (2.2) 4 (2.6) NS Solid organ transplantation 7 (5.2) 7 (4.6) NS Liver cirrhosis 13 (9.6) 14 (9.3) NS End-stage renal disease 6 (4.4) 6 (4.0) NS Pancreaticobiliary tract disease 13 (9.6) 20 (13.2) NS Solid tumor 51 (37.8) 59 (39.1) NS Others 22 (16.3) 20 (13.2) NS Comorbid condition Neutropenia 27 (20) 29 (19.2) NS Presentation with septic shock 33 (24.4) 42 (27.8) NS Long hospital stay (> 14 days) 79 (58.5) 76 (50.3) NS ICU care 27 (20) 26 (17.2) NS Postoperative state 19 (14.1) 21 (13.9) NS Polymicrobial 18 (13.3) 25 (16.6) NS Primary site of infection Catheter related 3 (2.2) 5 (3.3) NS Pancreaticobiliary tract 50 (37) 59 (39.1) NS Urinary tract 14 (10.4) 18 (11.9) NS Lung 4 (3) 12 (7.9) NS Peritoneum 18 (13.3) 21 (13.9) NS Unknown 45 (33.3) 32 (21.1) NS Microorganism E. coli 30 (22.2) 31 (20.5) NS K. pneumoniae 42 (31.1) 23 (15.2) 0.001 Enterobacter species 49 (36.3) 37 (24.5) 0.030 P. aeruginosa 14 (10.4) 60 (39.7) <0.001 - TABLE 2.
Reasons for inappropriate initial antimicrobial therapy
Reasons for inappropriate therapy No. of patients E. coli (n = 31) K. pneumoniae (n = 23) Enterobacter (n = 37) P. aeruginosa (n = 60) Cephalosporin use and resistance to druga 11 12 21 Combination therapy and resistance to multiple drugs 17 10 11 5 Monotherapy and resistance to drugb 3 1 1 17 Monotherapy with aminoglycoside in Pseudomonasc 33 No therapy 0 0 4 5 ↵ a Applied to bloodstream infections caused by E. coli, K. pneumoniae, and Enterobacter spp.
↵ b Patients who received cephalosporin monotherapy for bloodstream infections caused by E. coli, K. pneumoniae, or Enterobacter spp. were not included. Those were classified under cephalosporin use and resistance to drug.
↵ c Applied to P. aeruginosa bacteremia.
- TABLE 3.
Risk factors associated with 30-day mortality in bloodstream infections caused by antimicrobial-resistant gram-negative bacilli based on univariate analysis
Risk factor No. of survivors (n = 191) (%) No. of nonsurvivors (n = 95) (%) OR (95% CI) P value Inappropriate initial empirical antimicrobial therapy 93 (48.7) 58 (61.1) 1.65 (1.001-2.73) 0.049 Old age (>65 yrs) 49 (25.7) 28 (24.2) 0.93 (0.52-1.64) 0.791 Long hospital stay (>14 days)a 87 (45.5) 68 (71.6) 3.01 (1.77-5.11) <0.001 Immunosuppressive therapy 14 (7.3) 16 (16.8) 2.56 (1.19-5.50) 0.013 Corticosteroid use 30 (15.7) 32 (33.7) 2.73 (1.53-4.85) 0.001 Care in ICU 20 (10.5) 33 (34.7) 4.55 (2.43-8.52) <0.001 High-risk source of bacteremia 62 (32.5) 70 (73.7) 5.83 (3.37-10.08) <0.001 Neutropenic state 30 (15.7) 26 (27.4) 2.02 (1.11-3.67) 0.019 Postoperative state 24 (12.6) 16 (16.8) 1.41 (0.71-2.00) 0.326 Polymicrobial 23 (12) 20 (21.1) 1.95 (1.01-3.76) 0.045 Presentation with septic shock 10 (5.2) 65 (68.4) 39.22 (18.16-84.68) <0.001 APACHE II score ≤7 66 (34.6) 6 (6.3) 8-15 109 (57.1) 44 (46.3) <0.001 ≥16 16 (8.4) 45 (47.4) Microorganism E. coli 48 (25.1) 13 (13.7) 0.47 (0.24-0.92) 0.026 K. pneumoniae 44 (23) 21 (22.1) 0.95 (0.53-1.71) 0.859 Enterobacter species 57 (29.8) 29 (30.5) 1.03 (0.61-1.77) 0.906 P. aeruginosa 42 (22) 32 (33.7) 1.80 (1.04-3.11) 0.033 ↵ a Hospital stay prior to onset of bacteremia.
- TABLE 4.
Independent risk factors for mortality in bloodstream infections caused by antimicrobial-resistant gram-negative bacilli based on multivariate analysisa
Risk factor Adjusted OR (95% CI) P value All patients of study population (n = 286) High-risk source of bacteremia 3.95 (1.66-9.41) 0.002 Presentation with septic shock 40.99 (15.30-109.82) <0.001 APACHE II score (per 1-point increment) 1.29 (1.16-1.44) <0.001 P. aeruginosa bacteremia 3.07 (1.21-7.79) 0.018 Patients with low-risk source of bacteremia (n = 154)b Presentation with septic shock 23.01 (6.42-82.49) <0.001 APACHE II score (per 1-point increment) 1.25 (1.09-1.43) 0.001 P. aeruginosa bacteremia 4.27 (1.33-13.67) 0.015 Patients with high-risk source of bacteremia (n = 132)c Presentation with septic shock 100.87 (17.98-565.89) <0.001 APACHE II score (per 1-point increment) 1.348 (1.13-1.61) 0.001 Inappropriate initial antimicrobial therapy 3.64 (1.13-11.72) 0.030 ↵ a Variables with a P value of <0.05 in the univariate analysis were candidates for multivariate analysis as well as the main variable of interest (i.e., inappropriate initial antimicrobial therapy).
↵ b Multivariate analysis using a logistic regression model included the following variables: a long hospital stay, ICU care, neutropenia, polymicrobial, septic shock, APACHE II score, Pseudomonas infection, and inappropriate initial antimicrobial therapy.
↵ c Multivariate analysis included ICU care, septic shock, APACHE II score, Pseudomonas infection, old age, and inappropriate initial antimicrobial therapy.
