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Impact of Incremental Delays in Appropriate Therapy on the Outcomes of Hospitalized Adult Patients with Gram‐negative Bloodstream Infections: “Every day matters”
Author(s) -
Lodise Thomas P.,
Kanakamedala Hemanth,
Hsu WeiChun,
Cai Bin
Publication year - 2020
Publication title -
pharmacotherapy: the journal of human pharmacology and drug therapy
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.227
H-Index - 109
eISSN - 1875-9114
pISSN - 0277-0008
DOI - 10.1002/phar.2446
Subject(s) - medicine , retrospective cohort study , cohort , acinetobacter baumannii , pseudomonas aeruginosa , bloodstream infection , pediatrics , gram , bacteria , biology , genetics
Background Serious bloodstream infections (BSIs) are often caused by Gram‐negative (GN) bacteria in hospitalized patients. Treatment of these infections has been further complicated by the continued rise and spread of drug‐resistant pathogens, including carbapenem resistant (CR) strains of Enterobacteriaceae, Acinetobacter baumannii , and Pseudomonas aeruginosa . Methods This retrospective cohort analysis used real‐world data from a large United States hospital‐based database to examine the association between key clinical outcomes and different lengths of time to appropriate treatment between October 2010 and September 2015. Results Of 40,549 patients with GN‐BSIs who were identified, 1117 (2.8%) had a CR GN‐BSI. Overall, outcomes of hospitalized adult patients with GN‐BSIs incrementally worsened the longer appropriate therapy was delayed. Patients with CR GN‐BSIs had a median infection‐associated length of stay (LOS) of 8, 9, 10, and 13 days, whereas patients with CS GN‐BSIs had a median infection‐associated LOS of 6, 7, 8, and 11 days for patients with days to appropriate therapy of 0, 1–2, 3–4, and ≥ 5 days, respectively. Among patients with CR GN‐BSIs, the percentage of patients discharged home was 38%, 33%, 35%, and 31%, whereas in patients with CS GN‐BSIs, the percentage of patients discharged home was 58%, 53%, 48%, and 43% for patients with days to appropriate therapy of 0, 1–2, 3–4, and ≥ 5 days, respectively. Conclusion The findings from this study highlight the clear need to deliver appropriate therapy more expeditiously in patients with CS and CR GN‐BSIs.