000162047 001__ 162047 000162047 005__ 20251017144644.0 000162047 0247_ $$2doi$$a10.1016/j.jinf.2023.11.013 000162047 0248_ $$2sideral$$a144587 000162047 037__ $$aART-2023-144587 000162047 041__ $$aeng 000162047 100__ $$aGirón Ortega, J.A. 000162047 245__ $$aAntibiotic use and outcome in patients with negative blood cultures, a new target population for antimicrobial stewardship interventions: a prospective multicentre cohort (NO-BACT) 000162047 260__ $$c2023 000162047 5060_ $$aAccess copy available to the general public$$fUnrestricted 000162047 5203_ $$aObjectives: To evaluate the appropriateness of antimicrobial treatment and the risk factors for mortality in patients with negative blood cultures (BC), in order to evaluate whether this population would be a suitable target for antimicrobial stewardship (AMS) interventions. Methods: A multicentre prospective cohort study of patients with negative BC in three Spanish hospitals between October 2018 and July 2019 was performed. The main endpoints were the appropriateness of antimicrobial treatment (evaluated by two investigators according to local guidelines) and 30-day mortality. Cox-regression was performed to estimate the association between variables and 30-day mortality. Results: Of 1011 patients in whom BC was obtained, these were negative in 803 (79%) and were included; 30-day mortality was 9% (70 patients); antibiotic treatment was considered inappropriate in 299 (40%) of 747 patients evaluated at day 2, and in 266 (46%) of 573 at day 5–7. The variables independently associated with increased risk of 30-day mortality were higher age (HR 1.05; 95% CI 1.03–1.07), neoplasia (HR 2.73; 95% CI 1.64–4.56), antibiotic treatment in the 48 h prior to BC extraction (HR 2.06; 95% CI 1.23–3.43) and insufficient antibiotic coverage at day 2 after BC obtainment (HR 2.35; 95% CI 1.39–4.00). Urinary, catheter and biliary sources of infection were associated with lower risk (HR 0.40; 95% CI 0.20–0.81). Conclusions: Antimicrobial treatment is frequently inappropriate among patients with negative BC; insufficient antibiotic coverage at day 2 was associated with mortality. These results suggest that patients with negative BC are a suitable population for AS interventions. Summary: Antimicrobial treatment in patients with negative blood culture was frequently inappropriate, and inappropriate coverage at day 2 was associated with increased risk of death. These data support the consideration of this population as a potential target for antimicrobial stewardship interventions. 000162047 536__ $$9info:eu-repo/grantAgreement/ES/ISCIII/CB21-13-00012$$9info:eu-repo/grantAgreement/ES/ISCIII/CB21-13-00087$$9info:eu-repo/grantAgreement/ES/ISCIII/PI17-01809$$9info:eu-repo/grantAgreement/ES/ISCIII/PT17-0017-0012$$9info:eu-repo/grantAgreement/ES/ISCIII/RD16CIII-0004-0002$$9info:eu-repo/grantAgreement/ES/ISCIII-REIPI/RD16-0016-0001 000162047 540__ $$9info:eu-repo/semantics/openAccess$$aby-nc-nd$$uhttps://creativecommons.org/licenses/by-nc-nd/4.0/deed.es 000162047 590__ $$a14.3$$b2023 000162047 591__ $$aINFECTIOUS DISEASES$$b3 / 132 = 0.023$$c2023$$dQ1$$eT1 000162047 592__ $$a2.669$$b2023 000162047 593__ $$aMicrobiology (medical)$$c2023$$dQ1 000162047 593__ $$aInfectious Diseases$$c2023$$dQ1 000162047 594__ $$a45.9$$b2023 000162047 655_4 $$ainfo:eu-repo/semantics/article$$vinfo:eu-repo/semantics/publishedVersion 000162047 700__ $$aFernández Guerrero, R. 000162047 700__ $$aMontes de Oca Arjona, M. 000162047 700__ $$aSánchez Galán, F. 000162047 700__ $$aPellejero Sagastizábal, G.$$uUniversidad de Zaragoza 000162047 700__ $$0(orcid)0000-0001-9262-2461$$aMorte Romea, E.$$uUniversidad de Zaragoza 000162047 700__ $$aDe Cueto, M. 000162047 700__ $$aBeltrán García, M. 000162047 700__ $$aPalacios Baena, Z. 000162047 700__ $$aJiménez Jorge, S. 000162047 700__ $$aRodríguez Baño, J. 000162047 700__ $$aRetamar Gentil, P. 000162047 7102_ $$11007$$2610$$aUniversidad de Zaragoza$$bDpto. Medicina, Psiqu. y Derm.$$cArea Medicina 000162047 773__ $$g88, 2 (2023), 95-102$$pJ. infect.$$tJOURNAL OF INFECTION$$x0163-4453 000162047 8564_ $$s912033$$uhttps://zaguan.unizar.es/record/162047/files/texto_completo.pdf$$yVersión publicada 000162047 8564_ $$s2372767$$uhttps://zaguan.unizar.es/record/162047/files/texto_completo.jpg?subformat=icon$$xicon$$yVersión publicada 000162047 909CO $$ooai:zaguan.unizar.es:162047$$particulos$$pdriver 000162047 951__ $$a2025-10-17-14:33:21 000162047 980__ $$aARTICLE