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Incidence and outcome of inappropriate in-hospital empiric antibiotics for severe infection: a systematic review and meta-analysis.

Marquet K, Liesenborgs A, Bergs J, Vleugels A, Claes N - Crit Care (2015)

Bottom Line: A meta-analysis, using a random-effects model, was conducted to quantify the effect on mortality by using risk ratios.Studies with outcome parameter 28-day and 60-day mortality reported significantly (P ≤0.02) higher mortality rates in patients receiving inappropriate antibiotics.Two studies assessed the total costs, which were significantly higher in both studies (P ≤0.01).

View Article: PubMed Central - PubMed

Affiliation: Hasselt University, Faculty of Medicine and Life Sciences, Agoralaan, Building D, Room C53, Diepenbeek, BE3590, Belgium. kristel.marquet@uhasselt.be.

ABSTRACT

Introduction: The aims of this study were to explore the incidence of in-hospital inappropriate empiric antibiotic use in patients with severe infection and to identify its relationship with patient outcomes.

Methods: Medline (from 2004 to 2014) was systematically searched by using predefined inclusion criteria. Reference lists of retrieved articles were screened for additional relevant studies. The systematic 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. A meta-analysis, using a random-effects model, was conducted to quantify the effect on mortality by using risk ratios.

Results: In total, 27 individual articles fulfilled the inclusion criteria. The percentage of inappropriate empiric antibiotic use ranged from 14.1% to 78.9% (Q1-Q3: 28.1% to 57.8%); 13 of 27 studies (48.1%) described an incidence of 50% or more. A meta-analysis for 30-day mortality and in-hospital mortality showed risk ratios of 0.71 (95% confidence interval 0.62 to 0.82) and 0.67 (95% confidence interval 0.56 to 0.80), respectively. Studies with outcome parameter 28-day and 60-day mortality reported significantly (P ≤0.02) higher mortality rates in patients receiving inappropriate antibiotics. Two studies assessed the total costs, which were significantly higher in both studies (P ≤0.01).

Conclusions: This systematic review with meta-analysis provides evidence that inappropriate use of empiric antibiotics increases 30-day and in-hospital mortality in patients with a severe infection.

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Related in: MedlinePlus

PRISMA (Preferred Reporting Items of Systematic reviews and Meta-Analyses) diagram for study selection. LOS, length of stay.
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Fig1: PRISMA (Preferred Reporting Items of Systematic reviews and Meta-Analyses) diagram for study selection. LOS, length of stay.

Mentions: The initial database search identified 1,097 unique citations. Review of the reference lists of included studies identified 11 additional studies. After critical assessment of these 1,108 publications, 32 individual trials [8,12,19,21,22,32-58] fulfilled the inclusion criteria and were considered for further analysis (Figure 1). After quality assessment of the individual studies, 27 studies [8,12,19,21,22,33,34,36-48,50-52,54-57] were included in the systematic review.Figure 1


Incidence and outcome of inappropriate in-hospital empiric antibiotics for severe infection: a systematic review and meta-analysis.

Marquet K, Liesenborgs A, Bergs J, Vleugels A, Claes N - Crit Care (2015)

PRISMA (Preferred Reporting Items of Systematic reviews and Meta-Analyses) diagram for study selection. LOS, length of stay.
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4358713&req=5

Fig1: PRISMA (Preferred Reporting Items of Systematic reviews and Meta-Analyses) diagram for study selection. LOS, length of stay.
Mentions: The initial database search identified 1,097 unique citations. Review of the reference lists of included studies identified 11 additional studies. After critical assessment of these 1,108 publications, 32 individual trials [8,12,19,21,22,32-58] fulfilled the inclusion criteria and were considered for further analysis (Figure 1). After quality assessment of the individual studies, 27 studies [8,12,19,21,22,33,34,36-48,50-52,54-57] were included in the systematic review.Figure 1

Bottom Line: A meta-analysis, using a random-effects model, was conducted to quantify the effect on mortality by using risk ratios.Studies with outcome parameter 28-day and 60-day mortality reported significantly (P ≤0.02) higher mortality rates in patients receiving inappropriate antibiotics.Two studies assessed the total costs, which were significantly higher in both studies (P ≤0.01).

View Article: PubMed Central - PubMed

Affiliation: Hasselt University, Faculty of Medicine and Life Sciences, Agoralaan, Building D, Room C53, Diepenbeek, BE3590, Belgium. kristel.marquet@uhasselt.be.

ABSTRACT

Introduction: The aims of this study were to explore the incidence of in-hospital inappropriate empiric antibiotic use in patients with severe infection and to identify its relationship with patient outcomes.

Methods: Medline (from 2004 to 2014) was systematically searched by using predefined inclusion criteria. Reference lists of retrieved articles were screened for additional relevant studies. The systematic 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. A meta-analysis, using a random-effects model, was conducted to quantify the effect on mortality by using risk ratios.

Results: In total, 27 individual articles fulfilled the inclusion criteria. The percentage of inappropriate empiric antibiotic use ranged from 14.1% to 78.9% (Q1-Q3: 28.1% to 57.8%); 13 of 27 studies (48.1%) described an incidence of 50% or more. A meta-analysis for 30-day mortality and in-hospital mortality showed risk ratios of 0.71 (95% confidence interval 0.62 to 0.82) and 0.67 (95% confidence interval 0.56 to 0.80), respectively. Studies with outcome parameter 28-day and 60-day mortality reported significantly (P ≤0.02) higher mortality rates in patients receiving inappropriate antibiotics. Two studies assessed the total costs, which were significantly higher in both studies (P ≤0.01).

Conclusions: This systematic review with meta-analysis provides evidence that inappropriate use of empiric antibiotics increases 30-day and in-hospital mortality in patients with a severe infection.

Show MeSH
Related in: MedlinePlus