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Incorrect antibiotic usage in hospitals increases mortality rates

Incorrect antibiotic usage in hospitals increases
Photo: Incorrect antibiotic usage in hospitals increases
A recent study published in Critical Care has shown that inappropriate use of empiric antibiotics increases both the 30-day and in-hospital mortality rates.

Headed by lead author Kirstel Marquet with Hasselt University’s faculty of medicine in Belgium, the study explored the inappropriate empiric antibiotic use in hospital patients with severe infection and to identify patient outcomes.

“Sepsis is one of the leading causes of death in the critically ill, with a mortality rate of 28 percent to 55 percent. Antibiotics are the mainstay of treatment for these serious infections,” the authors wrote. “Antibiotic treatment for moderate to severe infections has to start early and, in the absence of evidence on the causative pathogen or its sensitivity to antibiotics, is often guided by empirical evidence.”
The researchers used the Medline database for records between 2004 and 2014 using predefined inclusion criteria. The review included original articles reporting a quantitative measure of the association between the use of (in) appropriate empiric antibiotics in patients with severe in-hospital infections and their outcomes.

In all, 27 articles fulfilled the criteria for inclusion and inappropriate empiric antibiotic use ranged from 14.1 percent to 78.9 percent.

Analysis for 30-day mortality and in-hospital mortality showed risk ratios of 0.71 and 0.67, respectively. Studies with outcome parameter 28-day and 60-day mortality reported significantly (P ≤0.02) higher mortality rates in patients receiving inappropriate antibiotics.

“For patients with Staphylococcus aureus bacteremia, the breakpoint between delayed and early treatment was 44.75 hours, and delayed treatment was found to be an independent predictor of infection-related mortality,” the authors wrote.

The authors concluded that the systemic review shows a high incidence of IAAT in patients with severe infections. Clinicians, they wrote, should be aware of this problem, and further improvement actions should be taken. Further computerized decision support needs to be developed.

“Inappropriate antibiotic treatment stems from several causes, mainly due to resistance; therefore, it is not easy to find the most appropriate treatment option,” the authors noted. “As long as general recommendations about antibiotic stewardship are missing, problems will remain. Computerized decision support, including complex and locally calibrated decision algorithms or early molecular identification or both, might be helpful.”

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