Appropriateness of Empirical Antibiotic Therapy in Hospitalized Patients with Bacterial Infection: A Retrospective Cohort Study

Yuting Luo; Zhaowang Guo; Ying Li; Hui Ouyang; Shanfeng Huang; Yuanli Chen; Kenan Li; Yuxin Ji; Hongqiong Zhu; Wentao Luo; Xu Liu; Xinghua Li; Jinyu Xia; Xi Liu

doi:10.2147/IDR.S402172

Appropriateness of Empirical Antibiotic Therapy in Hospitalized Patients with Bacterial Infection: A Retrospective Cohort Study

Infect Drug Resist. 2023 Jul 12:16:4555-4568. doi: 10.2147/IDR.S402172. eCollection 2023.

Authors

Yuting Luo^#¹, Zhaowang Guo^#², Ying Li^#¹, Hui Ouyang¹, Shanfeng Huang¹, Yuanli Chen³, Kenan Li¹, Yuxin Ji¹, Hongqiong Zhu¹, Wentao Luo¹, Xu Liu^{1

4}, Xinghua Li¹, Jinyu Xia¹, Xi Liu¹

Affiliations

¹ Department of Infectious Diseases, The Fifth Affiliated Hospital, Sun Yat-sen University, Zhuhai, People's Republic of China.
² Clinical Laboratory, The Fifth Affiliated Hospital, Sun Yat-sen University, Zhuhai, People's Republic of China.
³ Department of Hospital Infection Control, The Fifth Affiliated Hospital, Sun Yat-sen University, Zhuhai, People's Republic of China.
⁴ Guangdong Provincial Key Laboratory of Biomedical Imaging and Guangdong Provincial Engineering Research Center of Molecular Imaging, Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, People's Republic of China.

^# Contributed equally.

Abstract

Objective: The incidence of inappropriate and excessive empirical antibiotic therapy is unclear. The aim of this study was to determine the prevalence of different empirical antibiotic therapy prescriptions, related factors, and outcomes in hospitalized patients with bacterial infection.

Methods: A retrospective cohort study was performed and patients with bacterial infection who were admitted between October 1, 2019, and September 30, 2020, were included. Multivariable analysis was performed by the logistic regression model.

Results: A total of 536 (42.6%) of the 1257 included patients received inappropriate empirical antibiotic therapy (IEAT), and 368 (29.3%) patients received appropriate but unnecessarily broad-spectrum empirical antibiotic therapy (AUEAT). MDRO (adjusted OR 2.932 [95% CI 2.201~3.905]; p < 0.001) and fever on admission (adjusted OR 0.592 [95% CI 0.415~0.844]; p = 0.004) were correlates of IEAT; sepsis (adjusted OR 2.342 [95% CI 1.371~3.999]; p = 0.002), age (adjusted OR 1.019 [95% CI 1.008~1.030]; p < 0.001), MDRO (adjusted OR 0.664 [95% CI 0.469~0.941]; p = 0.021), and urinary tract infection (adjusted OR 0.352 [95% CI 0.203~0.611]; p < 0.001) were correlates of AUEAT. Patients who received AUEAT were more likely to have a poor prognosis (63 [17.8%] vs 101 [27.4%]; p = 0.002). Both IEAT (median [IQR], 24,971 [13,135-70,155] vs 31,489 [14,894-101,082] CNY; p = 0.007) and AUEAT (median [IQR], 24,971 [13,135-70,155] vs 30,960 [16,475-90,881] CNY; p = 0.002) increased hospital costs. 45.3% (570/1257) of patients were infected with MDRO and 62.9% of them received IEAT.

Conclusion: Inappropriate and excessive empirical antibiotic use was widely prevalent among hospitalized patients. Either inappropriate or excessive use of antibiotics may increase the burden of healthcare costs, the latter of which may be associated with poor prognosis. Clinicians need to be more judicious in choosing antibiotic(s). The MDRO epidemic was severe, especially in patients who received IEAT. It is imperative to take effective measures to improve the current situation of antibiotic abuse and antimicrobial resistance.

Keywords: antimicrobial resistance; bacterial culture-positive; empirical antibiotic therapy; multidrug-resistant organism; patient outcome.

Grants and funding

This work was supported in part by: the National Natural Science Foundation of China (Grant No. 82101843), Guangdong Basic and Applied Basic Research Foundation (2020A1515010254).