Dataset Information

Clinical utility of prior positive cultures to optimize empiric antibiotic therapy selection: A cross-sectional analysis.

ABSTRACT:

Background

Despite reduced infectious disease mortality and improved survival, infectious diseases continue to pose health threats due to their contagiousness, societal harm, and morbidity. Empiric antibiotic therapy, often prescribed without knowledge of the causative pathogen, faces challenges from rising antibiotic resistance. This study explores the potential of prior positive culture results to guide empiric antibiotic therapy.

Methods

Data from King Abdullah University Hospital (Jan 2014-Dec 2019) included adult patients with recurrent bacterial infections (pneumonia, sepsis, UTIs, wounds). Excluded cases included: mixed infections, transfers, <14 days or >12 months between episodes. The study compared bacterial growth and sensitivity patterns between previous and recent cultures.

Results

The study included 970 episodes from 650 patients, mainly UTIs (60.3%) and gram-negative bacteria (77.9%). The study found that (65.1%) of culture pairs matched. Empirical therapy was accurate in (71.8%) of cases. Further, accuracy of selected empiric antibiotic therapy was significantly predicted (p < 0.001) by: type of infection, type of antibiotics, and concordance with prior microbiologic data. Multivariate logistic analysis showed blood culture as less predictive of pending identity (OR: 0.234, P < 0.001) compared to urine culture; and prior affirmed gram negative bacterial culture was less predictive (OR: 0.606, P = 0.021) compared to gram positive bacterial culture.

Conclusion

This study underscores the potential of prior positive culture results in guiding empiric antibiotic therapy, enhancing accuracy and identity agreement. Future research should explore this approach in different infection contexts and across multiple centers. Reducing the indiscriminate use of broad-spectrum antibiotics is essential to combat antibiotic resistance.

SUBMITTER: Khasawneh RA

PROVIDER: S-EPMC10542003 | biostudies-literature | 2023 Oct

REPOSITORIES: biostudies-literature

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Publications

Clinical utility of prior positive cultures to optimize empiric antibiotic therapy selection: A cross-sectional analysis.

Khasawneh Rawand A RA Almomani Basima A BA Al-Shatnawi Samah F SF Al-Natour Lara L

New microbes and new infections 20230921

<h4>Background</h4>Despite reduced infectious disease mortality and improved survival, infectious diseases continue to pose health threats due to their contagiousness, societal harm, and morbidity. Empiric antibiotic therapy, often prescribed without knowledge of the causative pathogen, faces challenges from rising antibiotic resistance. This study explores the potential of prior positive culture results to guide empiric antibiotic therapy.<h4>Methods</h4>Data from King Abdullah University Hospi ...[more]

PMID: 37786609

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Project description:In light of rising antibiotic resistance, better methods for selection of empiric antibiotic treatment based on clinical and microbiological data are needed. Most guidelines target specific clinical infections, and variably adjust empiric antibiotic selection by certain patient characteristics. Coverage estimates reflect the probability that an antibiotic regimen will be active against the causative pathogen once confirmed and can provide an objective basis for empiric regimen selection. Coverage can be estimated for specific infections using a weighted incidence syndromic combination antibiograms (WISCAs) framework. However, no comprehensive data combining clinical and microbiological data for specific clinical syndromes are available in Switzerland. We therefore describe estimating coverage from semi-deterministically linked routine microbiological and cohort data of hospitalised children with sepsis. Coverage estimates were generated for each hospital and separately pooling data across ten contributing hospitals for five pre-defined patient risk groups. Data from 1,082 patients collected during the Swiss Paediatric Sepsis Study (SPSS) 2011-2015 were included. Preterm neonates were the most commonly represented group, and half of infants and children had a comorbidity. 67% of neonatal sepsis cases were hospital-acquired late-onset whereas in children 76% of infections were community-acquired. Escherichia coli, Coagulase-negative staphylococci (CoNS) and Staphylococcus aureus were the most common pathogens. At all hospitals, ceftazidime plus amikacin regimen had the lowest coverage, and coverage of amoxicillin plus gentamicin and meropenem were generally comparable. Coverage was improved when vancomycin was included in the regimen, reflecting uncertainty about the empirically targeted pathogen spectrum. Children with community-acquired infections had high coverage overall. It is feasible to estimate coverage of common empiric antibiotic regimens from linked data. Pooling data by patient risk groups with similar expected pathogen and susceptibility profiles may improve coverage estimate precision, supporting better differentiation of coverage between regimens. Identification of data sources, selection of regimens and consideration of pathogens to target for improved empiric coverage is important.

Project description:BackgroundAntibiotic resistance in uropathogens has rapidly escalated over time, complicating treatment and increasing morbidity and mortality. Few studies have explored how the social determinants of health may be associated with patients' risks for acquiring antibiotic-resistant (AR) uropathogens.MethodsWe identified urine cultures collected from outpatients presenting to Tufts Medical Center Primary Care Practices between 2015 and 2020. Specimens were included if patients' age, sex, and residential address were recorded in the electronic medical record (EMR) and if their urine culture yielded Enterococcus spp. or one or more gram-negative bacterial organism(s) or for which antibiotic susceptibility profiling and species identification was conducted. We abstracted patients' sociodemographic characteristics from the EMR and used US Census Bureau data to identify characteristics about patients' census tracts of residence. We evaluated associations between individual- and neighborhood-level characteristics and patients' risk of having a urine culture resistant to (1) three or more antibiotic classes (i.e., multidrug resistant [MDR]), (2) first-line treatments, (3) fluoroquinolones, (4) aminoglycosides, or (5) ceftriaxone using logistic regression models and a Bonferroni correction to account for multiple hypothesis testing.ResultsWe included urine cultures from 1,306 unique outpatients, most of whom were female (89%). Patients largely self-identified as Non-Hispanic White (36%), Asian (15%), or Non-Hispanic Black (11%). Over 60% lived in an environmental justice-designated census tract. Most included isolates were Escherichia coli (76%) or Klebsiella pneumoniae (7%). Using public insurance increased patients' odds of having a uropathogen resistant to first-line antibiotics, but living in a limited-income neighborhood reduced patients' odds of having a MDR uropathogen by 47%. We noted a strong but non-significant positive trend between speaking a language other than English and having an aminoglycoside-resistant uropathogen (p-value = 0.02). Most notably, after controlling for other factors, we observed no statistically significant associations between race or ethnicity and AR uropathogens.ConclusionThe social determinants of health may play important and intersecting roles in determining a patient's risk of having a resistant uropathogens that is more challenging or expensive to treat. It is crucial to acknowledge how race is likely to be a proxy for other factors affecting health, and to consider that some groups may be disproportionately impacted by antibiotic resistance.

Project description:There has been a significant rise in global antibiotic use in recent years. Development of resistance has been linked to easy accessibility, lack of regulation of sale, increased tendency to self-medicate and the lack of public knowledge. The increase in antibiotic misuse, including self-medication, has not been well documented in developing countries. Antibiotic use prior to visiting health facilities has been found to be prevalent in developing countries. It has been identified by some studies to increase the likelihood of missed diagnoses and influence the outcome of bacteriological tests. This study is aimed at determining the prevalence of prior antibiotic use through a cross-sectional survey of patients undergoing laboratory tests at two health facilities in Ghana. Face-to-face questionnaires were used to interview 261 individuals chosen by random sampling of patients visiting the bacteriology laboratory of the hospitals within a two-month period. The questionnaire investigated participant demographic characteristics, knowledge about antibiotics and the nature of antibiotic use. Antibiotic property detection bioassay was performed on patient's urine sample using a disk diffusion method to accurately determine antibiotic use within 72 hours. Culture results were used as an index to evaluate the effect of prior antibiotic use on bacteriological tests. Out of a 261 participants enrolled, 19.9% (95% CI, 14.9-24.9) acknowledged using antibiotics prior to their visit to the laboratory during the study period. On the contrary, 31.4% (95% CI, 25.7-37.5) of participants' urine samples were positive for antimicrobial activity. Participants within the age ranges of 20-30, 31-40 and 41-50 years had significantly lower odds of urine antimicrobial activity. Participants who had urine antimicrobial activity were more likely to have no growth on their culture plates than participants who had no urine antimicrobial activity [OR 2.39(1.37-4.18), p = 0.002]. The most commonly used antibiotics were the penicillins, fluoroquinolones and metronidazole. Although, majority of the participant (54.8%) had knowledge of antibiotics, most of them had inadequate information on their proper use. The commonest indications for antibiotic use were aches and pains (30.3%), diarrhoea (43.3%) and urinary tract infections (28.0%). Prior antibiotic use was found to increase the likelihood of obtaining a culture negative result and can affect the outcome of bacteriological tests.

Dataset Information

Clinical utility of prior positive cultures to optimize empiric antibiotic therapy selection: A cross-sectional analysis.

Background

Methods

Results

Conclusion

Publications

Clinical utility of prior positive cultures to optimize empiric antibiotic therapy selection: A cross-sectional analysis.

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