Effects of Inappropriate Administration of Empirical Antibiotics on Mortality in Adults With Bacteraemia: Systematic Review and Meta-Analysis
IntroductionBloodstream infections are associated with high mortality rates and contribute substantially to healthcare costs, but a consensus on the prognostic benefits of appropriate empirical antimicrobial therapy (EAT) for bacteraemia is lacking.MethodsWe performed a systematic search of the PubM...
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Frontiers Media S.A.
2022-05-01
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author | Yuan-Pin Hung Yuan-Pin Hung Yuan-Pin Hung Ching-Chi Lee Ching-Chi Lee Wen-Chien Ko Wen-Chien Ko |
author_facet | Yuan-Pin Hung Yuan-Pin Hung Yuan-Pin Hung Ching-Chi Lee Ching-Chi Lee Wen-Chien Ko Wen-Chien Ko |
author_sort | Yuan-Pin Hung |
collection | DOAJ |
description | IntroductionBloodstream infections are associated with high mortality rates and contribute substantially to healthcare costs, but a consensus on the prognostic benefits of appropriate empirical antimicrobial therapy (EAT) for bacteraemia is lacking.MethodsWe performed a systematic search of the PubMed, Cochrane Library, and Embase databases through July 2021. Studies comparing the mortality rates of patients receiving appropriate and inappropriate EAT were considered eligible. The quality of the included studies was assessed using Joanna Briggs Institute checklists.ResultsWe ultimately assessed 198 studies of 89,962 total patients. The pooled odds ratio (OR) for the prognostic impacts of inappropriate EAT was 2.06 (P < 0.001), and the funnel plot was symmetrically distributed. Among subgroups without between-study heterogeneity (I2 = 0%), those of patients with severe sepsis and septic shock (OR, 2.14), Pitt bacteraemia scores of ≥4 (OR, 1.88), cirrhosis (OR, 2.56), older age (OR, 1.78), and community-onset/acquired Enterobacteriaceae bacteraemia infection (OR, 2.53) indicated a significant effect of inappropriate EAT on mortality. The pooled adjusted OR of 125 studies using multivariable analyses for the effects of inappropriate EAT on mortality was 2.02 (P < 0.001), and the subgroups with low heterogeneity (I2 < 25%) exhibiting significant effects of inappropriate EAT were those of patients with vascular catheter infections (adjusted OR, 2.40), pneumonia (adjusted OR, 2.72), or Enterobacteriaceae bacteraemia (adjusted OR, 4.35). Notably, the pooled univariable and multivariable analyses were consistent in revealing the negligible impacts of inappropriate EAT on the subgroups of patients with urinary tract infections and Enterobacter bacteraemia.ConclusionAlthough the current evidence is insufficient to demonstrate the benefits of prompt EAT in specific bacteraemic populations, we indicated that inappropriate EAT is associated with unfavorable mortality outcomes overall and in numerous subgroups. Prospective studies designed to test these specific populations are needed to ensure reliable conclusions.Systematic Review Registrationhttps://www.crd.york.ac.uk/prospero/, identifier: CRD42021270274. |
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spelling | doaj.art-82be26649ba74038b85eec05bfc262c32022-12-22T03:35:22ZengFrontiers Media S.A.Frontiers in Medicine2296-858X2022-05-01910.3389/fmed.2022.869822869822Effects of Inappropriate Administration of Empirical Antibiotics on Mortality in Adults With Bacteraemia: Systematic Review and Meta-AnalysisYuan-Pin Hung0Yuan-Pin Hung1Yuan-Pin Hung2Ching-Chi Lee3Ching-Chi Lee4Wen-Chien Ko5Wen-Chien Ko6Department of Internal Medicine, Tainan Hospital, Ministry of Health and Welfare, Tainan City, TaiwanDepartment of Internal Medicine, College of Medicine, National Cheng Kung University Hospital, National Cheng Kung University, Tainan City, TaiwanDepartment of Medicine, College of Medicine, National Cheng Kung University, Tainan City, TaiwanDepartment of Internal Medicine, College of Medicine, National Cheng Kung University Hospital, National Cheng Kung University, Tainan City, TaiwanClinical Medicine Research Centre, College of Medicine, National Cheng Kung University Hospital, National Cheng Kung University, Tainan City, TaiwanDepartment of Internal Medicine, College of Medicine, National Cheng Kung University Hospital, National Cheng Kung University, Tainan City, TaiwanDepartment of Medicine, College of Medicine, National Cheng Kung University, Tainan City, TaiwanIntroductionBloodstream infections are associated with high mortality rates and contribute substantially to healthcare costs, but a consensus on the prognostic benefits of appropriate empirical antimicrobial therapy (EAT) for bacteraemia is lacking.MethodsWe performed a systematic search of the PubMed, Cochrane Library, and Embase databases through July 2021. Studies comparing the mortality rates of patients receiving appropriate and inappropriate EAT were considered eligible. The quality of the included studies was assessed using Joanna Briggs Institute checklists.ResultsWe ultimately assessed 198 studies of 89,962 total patients. The pooled odds ratio (OR) for the prognostic impacts of inappropriate EAT was 2.06 (P < 0.001), and the funnel plot was symmetrically distributed. Among subgroups without between-study heterogeneity (I2 = 0%), those of patients with severe sepsis and septic shock (OR, 2.14), Pitt bacteraemia scores of ≥4 (OR, 1.88), cirrhosis (OR, 2.56), older age (OR, 1.78), and community-onset/acquired Enterobacteriaceae bacteraemia infection (OR, 2.53) indicated a significant effect of inappropriate EAT on mortality. The pooled adjusted OR of 125 studies using multivariable analyses for the effects of inappropriate EAT on mortality was 2.02 (P < 0.001), and the subgroups with low heterogeneity (I2 < 25%) exhibiting significant effects of inappropriate EAT were those of patients with vascular catheter infections (adjusted OR, 2.40), pneumonia (adjusted OR, 2.72), or Enterobacteriaceae bacteraemia (adjusted OR, 4.35). Notably, the pooled univariable and multivariable analyses were consistent in revealing the negligible impacts of inappropriate EAT on the subgroups of patients with urinary tract infections and Enterobacter bacteraemia.ConclusionAlthough the current evidence is insufficient to demonstrate the benefits of prompt EAT in specific bacteraemic populations, we indicated that inappropriate EAT is associated with unfavorable mortality outcomes overall and in numerous subgroups. Prospective studies designed to test these specific populations are needed to ensure reliable conclusions.Systematic Review Registrationhttps://www.crd.york.ac.uk/prospero/, identifier: CRD42021270274.https://www.frontiersin.org/articles/10.3389/fmed.2022.869822/fullempirical antibioticbacteraemiamortalitysystematic reviewmeta-analysis |
spellingShingle | Yuan-Pin Hung Yuan-Pin Hung Yuan-Pin Hung Ching-Chi Lee Ching-Chi Lee Wen-Chien Ko Wen-Chien Ko Effects of Inappropriate Administration of Empirical Antibiotics on Mortality in Adults With Bacteraemia: Systematic Review and Meta-Analysis Frontiers in Medicine empirical antibiotic bacteraemia mortality systematic review meta-analysis |
title | Effects of Inappropriate Administration of Empirical Antibiotics on Mortality in Adults With Bacteraemia: Systematic Review and Meta-Analysis |
title_full | Effects of Inappropriate Administration of Empirical Antibiotics on Mortality in Adults With Bacteraemia: Systematic Review and Meta-Analysis |
title_fullStr | Effects of Inappropriate Administration of Empirical Antibiotics on Mortality in Adults With Bacteraemia: Systematic Review and Meta-Analysis |
title_full_unstemmed | Effects of Inappropriate Administration of Empirical Antibiotics on Mortality in Adults With Bacteraemia: Systematic Review and Meta-Analysis |
title_short | Effects of Inappropriate Administration of Empirical Antibiotics on Mortality in Adults With Bacteraemia: Systematic Review and Meta-Analysis |
title_sort | effects of inappropriate administration of empirical antibiotics on mortality in adults with bacteraemia systematic review and meta analysis |
topic | empirical antibiotic bacteraemia mortality systematic review meta-analysis |
url | https://www.frontiersin.org/articles/10.3389/fmed.2022.869822/full |
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