Optimization of Empirical Antimicrobial Therapy in Enterobacterales Bloodstream Infection Using the Extended-Spectrum Beta-Lactamase Prediction Score
Abstract
:1. Introduction
2. Results
2.1. Clinical Characteristics and Microbiology
2.2. Time to Appropriate Antimicrobial Therapy
3. Discussion
3.1. Clinical Interpretation of Study Findings
3.2. Potential Applications of the ESBL Prediction Score
3.3. Clinical Prediction Tools versus Advanced Rapid Diagnostics
3.4. Strengths and Limitations
4. Methods
4.1. Setting
4.2. Case Ascertainment
4.3. Microbiology Techniques
4.4. Antimicrobial Stewardship Intervention
4.5. Outcomes and Statistical Analysis
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
Abbreviations
References
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Variable | Total (n = 146) | Pre-Intervention (n = 45) | Post-Intervention (n = 101) | p-Value |
---|---|---|---|---|
Median age (IQR) in years | 66 (51–75) | 68 (50–76) | 63 (51–75) | 0.27 |
Male sex | 85 (58) | 24 (53) | 61 (60) | 0.42 |
Hospital-onset BSI | 37 (25) | 8 (18) | 29 (29) | 0.16 |
Residence at SNF | 33 (23) | 12 (27) | 21 (21) | 0.43 |
Urinary source of BSI | 86 (59) | 26 (58) | 60 (59) | 0.85 |
Diabetes mellitus | 63 (43) | 17 (38) | 46 (46) | 0.38 |
End-stage renal disease | 13 (9) | 5 (11) | 8 (8) | 0.53 |
Liver cirrhosis | 4 (3) | 3 (7) | 1 (1) | 0.09 |
Cancer | 24 (16) | 9 (20) | 15 (15) | 0.44 |
Immune compromised | 18 (12) | 4 (9) | 14 (14) | 0.40 |
ICU admission | 43 (29) | 14 (31) | 29 (29) | 0.77 |
Antibiotic | Pre-Intervention Period (n = 45) | Post-Intervention Period (n = 101) | ||
---|---|---|---|---|
Before Gram Stain | After Gram Stain | Before Gram Stain | After Gram Stain | |
Ampicillin/sulbactam | 0 (0) | 0 (0) | 3 (3) | 0 (0) |
Ceftriaxone | 9 (20) | 8 (18) | 28 (28) | 5 (5) |
Cefepime | 4 (9) | 3 (7) | 29 (29) | 14 (14) |
Piperacillin/tazobactam | 14 (31) | 12 (27) | 26 (26) | 12 (12) |
Ertapenem | 3 (7) | 7 (16) | 7 (7) | 52 (52) |
Meropenem | 8 (18) | 9 (20) | 6 (6) | 14 (14) |
Fluoroquinolones * | 6 (13) | 3 (7) | 1 (1) | 4 (4) |
Gentamicin | 1 (2) | 3 (7) | 1 (1) | 0 (0) |
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Haimerl, B.J.; Encinas, R.; Justo, J.A.; Kohn, J.; Bookstaver, P.B.; Winders, H.R.; Al-Hasan, M.N. Optimization of Empirical Antimicrobial Therapy in Enterobacterales Bloodstream Infection Using the Extended-Spectrum Beta-Lactamase Prediction Score. Antibiotics 2023, 12, 1003. https://doi.org/10.3390/antibiotics12061003
Haimerl BJ, Encinas R, Justo JA, Kohn J, Bookstaver PB, Winders HR, Al-Hasan MN. Optimization of Empirical Antimicrobial Therapy in Enterobacterales Bloodstream Infection Using the Extended-Spectrum Beta-Lactamase Prediction Score. Antibiotics. 2023; 12(6):1003. https://doi.org/10.3390/antibiotics12061003
Chicago/Turabian StyleHaimerl, Brian J., Rodrigo Encinas, Julie Ann Justo, Joseph Kohn, P. Brandon Bookstaver, Hana Rac Winders, and Majdi N. Al-Hasan. 2023. "Optimization of Empirical Antimicrobial Therapy in Enterobacterales Bloodstream Infection Using the Extended-Spectrum Beta-Lactamase Prediction Score" Antibiotics 12, no. 6: 1003. https://doi.org/10.3390/antibiotics12061003