TY - JOUR
T1 - Systematic review of the impact of appropriate versus inappropriate initial antibiotic therapy on outcomes of patients with severe bacterial infections
AU - Bassetti, Matteo
AU - Rello, Jordi
AU - Blasi, Francesco
AU - Goossens, Herman
AU - Sotgiu, Giovanni
AU - Tavoschi, Lara
AU - Zasowski, Evan J.
AU - Arber, Mick R.
AU - McCool, Rachael
AU - Patterson, Jacoby V.
AU - Longshaw, Christopher M.
AU - Lopes, Sara
AU - Manissero, Davide
AU - Nguyen, Sean T.
AU - Tone, Keiko
AU - Aliberti, Stefano
N1 - Funding Information:
Funding: The study was funded by Shionogi BV. The authors would like to acknowledge Grace Wilson (Ashfield Healthcare Communications, part of UDG Healthcare plc) for medical writing support, which was funded by Shionogi BV, and Sarah King and Katy Wilson (York Health Economics Consortium, University of York) for support with study selection and data extraction that was funded by Shionogi BV.
Publisher Copyright:
© 2020
Copyright:
Copyright 2020 Elsevier B.V., All rights reserved.
PY - 2020/12
Y1 - 2020/12
N2 - We investigated the impact of appropriate versus inappropriate initial antimicrobial therapy on the clinical outcomes of patients with severe bacterial infections as part of a systematic review and meta-analyses assessing the impact of delay in appropriate antimicrobial therapy. Literature searches of MEDLINE and Embase, conducted on 24 July 2018, identified studies published after 2007 reporting the impact of delay in appropriate antibiotic therapy for hospitalised adult patients with bacterial infections. Results were statistically pooled for outcomes including mortality, hospital length of stay (LOS) and treatment failure. Subgroup analyses were explored by site of infection where data permitted. Inclusion criteria were met by 145 studies, of which 114 reported data on the impact of appropriate versus inappropriate initial therapy. In the pooled analysis, rates of mortality were significantly in favour of appropriate therapy [odds ratio (OR) = 0.44, 95% CI 0.38–0.50]. Across eight studies, LOS was shorter with appropriate therapy compared with inappropriate therapy [mean difference (MD) −2.54 days (95% CI −5.30 to 0.23)], but not significantly so. The incidence of treatment failure was significantly lower in patients who received appropriate therapy compared with patients who received inappropriate therapy (six studies: OR = 0.33, 95% CI 0.16–0.66) as was mean hospital costs (four studies: MD −7.38 thousand US$ or Euros, 95% CI −14.14 to −0.62). Initiation of appropriate versus inappropriate antibiotics can reduce mortality, reduce treatment failure and decrease LOS, highlighting the importance of broad‑spectrum empirical therapy and rapid diagnostics for early identification of the causative pathogen. [Study registration: PROSPERO: CRD42018104669]
AB - We investigated the impact of appropriate versus inappropriate initial antimicrobial therapy on the clinical outcomes of patients with severe bacterial infections as part of a systematic review and meta-analyses assessing the impact of delay in appropriate antimicrobial therapy. Literature searches of MEDLINE and Embase, conducted on 24 July 2018, identified studies published after 2007 reporting the impact of delay in appropriate antibiotic therapy for hospitalised adult patients with bacterial infections. Results were statistically pooled for outcomes including mortality, hospital length of stay (LOS) and treatment failure. Subgroup analyses were explored by site of infection where data permitted. Inclusion criteria were met by 145 studies, of which 114 reported data on the impact of appropriate versus inappropriate initial therapy. In the pooled analysis, rates of mortality were significantly in favour of appropriate therapy [odds ratio (OR) = 0.44, 95% CI 0.38–0.50]. Across eight studies, LOS was shorter with appropriate therapy compared with inappropriate therapy [mean difference (MD) −2.54 days (95% CI −5.30 to 0.23)], but not significantly so. The incidence of treatment failure was significantly lower in patients who received appropriate therapy compared with patients who received inappropriate therapy (six studies: OR = 0.33, 95% CI 0.16–0.66) as was mean hospital costs (four studies: MD −7.38 thousand US$ or Euros, 95% CI −14.14 to −0.62). Initiation of appropriate versus inappropriate antibiotics can reduce mortality, reduce treatment failure and decrease LOS, highlighting the importance of broad‑spectrum empirical therapy and rapid diagnostics for early identification of the causative pathogen. [Study registration: PROSPERO: CRD42018104669]
KW - Appropriate antibiotic therapy
KW - Empirical therapy
KW - Length of stay
KW - Mortality rate
KW - Treatment failure
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U2 - 10.1016/j.ijantimicag.2020.106184
DO - 10.1016/j.ijantimicag.2020.106184
M3 - Review article
C2 - 33045353
AN - SCOPUS:85096008964
VL - 56
JO - International Journal of Antimicrobial Agents
JF - International Journal of Antimicrobial Agents
SN - 0924-8579
IS - 6
M1 - 106184
ER -