Antibiotic use and outcome in patients with negative blood cultures, a new target population for antimicrobial stewardship interventions: a prospective multicentre cohort (NO-BACT)
Girón Ortega, J.A. ; Fernández Guerrero, R. ; Montes de Oca Arjona, M. ; Sánchez Galán, F. ; Pellejero Sagastizábal, G. (Universidad de Zaragoza) ; Morte Romea, E. (Universidad de Zaragoza) ; De Cueto, M. ; Beltrán García, M. ; Palacios Baena, Z. ; Jiménez Jorge, S. ; Rodríguez Baño, J. ; Retamar Gentil, P.
Resumen: Objectives: 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.
Idioma: Inglés
DOI: 10.1016/j.jinf.2023.11.013
Año: 2023
Publicado en: JOURNAL OF INFECTION 88, 2 (2023), 95-102
ISSN: 0163-4453
Factor impacto JCR: 14.3 (2023)
Categ. JCR: INFECTIOUS DISEASES rank: 3 / 132 = 0.023 (2023) - Q1 - T1
Factor impacto CITESCORE: 45.9 - Microbiology (medical) (Q1) - Infectious Diseases (Q1)
Factor impacto SCIMAGO: 2.669 - Microbiology (medical) (Q1) - Infectious Diseases (Q1)
Financiación: info:eu-repo/grantAgreement/ES/ISCIII/CB21-13-00012
Financiación: info:eu-repo/grantAgreement/ES/ISCIII/CB21-13-00087
Financiación: info:eu-repo/grantAgreement/ES/ISCIII/PI17-01809
Financiación: info:eu-repo/grantAgreement/ES/ISCIII/PT17-0017-0012
Financiación: info:eu-repo/grantAgreement/ES/ISCIII/RD16CIII-0004-0002
Financiación: info:eu-repo/grantAgreement/ES/ISCIII-REIPI/RD16-0016-0001
Tipo y forma: Article (Published version)
Área (Departamento): Area Medicina (Dpto. Medicina, Psiqu. y Derm.)
You must give appropriate credit, provide a link to the license, and indicate if changes were made. You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use. You may not use the material for commercial purposes. If you remix, transform, or build upon the material, you may not distribute the modified material.
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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.
Idioma: Inglés
DOI: 10.1016/j.jinf.2023.11.013
Año: 2023
Publicado en: JOURNAL OF INFECTION 88, 2 (2023), 95-102
ISSN: 0163-4453
Factor impacto JCR: 14.3 (2023)
Categ. JCR: INFECTIOUS DISEASES rank: 3 / 132 = 0.023 (2023) - Q1 - T1
Factor impacto CITESCORE: 45.9 - Microbiology (medical) (Q1) - Infectious Diseases (Q1)
Factor impacto SCIMAGO: 2.669 - Microbiology (medical) (Q1) - Infectious Diseases (Q1)
Financiación: info:eu-repo/grantAgreement/ES/ISCIII/CB21-13-00012
Financiación: info:eu-repo/grantAgreement/ES/ISCIII/CB21-13-00087
Financiación: info:eu-repo/grantAgreement/ES/ISCIII/PI17-01809
Financiación: info:eu-repo/grantAgreement/ES/ISCIII/PT17-0017-0012
Financiación: info:eu-repo/grantAgreement/ES/ISCIII/RD16CIII-0004-0002
Financiación: info:eu-repo/grantAgreement/ES/ISCIII-REIPI/RD16-0016-0001
Tipo y forma: Article (Published version)
Área (Departamento): Area Medicina (Dpto. Medicina, Psiqu. y Derm.)
You must give appropriate credit, provide a link to the license, and indicate if changes were made. You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use. You may not use the material for commercial purposes. If you remix, transform, or build upon the material, you may not distribute the modified material. Exportado de SIDERAL (2025-10-17-14:33:21)
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Record created 2025-07-10, last modified 2025-10-17