Cargando…

Fear of Missing Organisms (FOMO): the discordance among broad-spectrum empiric antibiotic therapy, microbiologic results, and definitive antibiotic therapy for diabetic foot infections and lower extremity osteomyelitis

OBJECTIVE: Empiric broad-spectrum antibiotic therapy is commonly prescribed for patients hospitalized with diabetic foot infections (DFI) and lower extremity osteomyelitis (OM). The primary objective was to evaluate the concordance between empiric antibiotic therapy, microbiologic results, and defin...

Descripción completa

Detalles Bibliográficos
Autores principales: Morelli, Morgan K., Son, Andrea H., Bitar, Yanis, Hecker, Michelle T.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Cambridge University Press 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10654958/
https://www.ncbi.nlm.nih.gov/pubmed/38028912
http://dx.doi.org/10.1017/ash.2023.467
_version_ 1785136722462375936
author Morelli, Morgan K.
Son, Andrea H.
Bitar, Yanis
Hecker, Michelle T.
author_facet Morelli, Morgan K.
Son, Andrea H.
Bitar, Yanis
Hecker, Michelle T.
author_sort Morelli, Morgan K.
collection PubMed
description OBJECTIVE: Empiric broad-spectrum antibiotic therapy is commonly prescribed for patients hospitalized with diabetic foot infections (DFI) and lower extremity osteomyelitis (OM). The primary objective was to evaluate the concordance between empiric antibiotic therapy, microbiologic results, and definitive antibiotic therapy with a focus on methicillin-resistant Staphylococcus aureus (MRSA) and resistant gram-negative organisms. The secondary objective was to evaluate the negative predictive values (NPV) of select risk factors for MRSA and resistant gram-negative organisms for microbiologic results with these organisms. DESIGN: Retrospective cohort study. SETTING: Safety-net health system in Ohio. PATIENTS: Adults hospitalized and receiving antibiotic therapy for DFI or lower extremity OM in 2021. RESULTS: For 259 unique patients, empiric therapies with activity against MRSA and resistant gram-negative organisms were administered to 224 (86.5%) and 217 (83.8%) patients, respectively. Definitive therapies with activity against MRSA and resistant gram-negative organisms were administered to 91 (35%) and 74 (28.6%) patients, respectively. Of 234 patients with microbiologic testing, 29 (12.4%) had positive cultures with MRSA and 41 (17.5%) with resistant gram-negative organisms. The NPVs of risk factors for MRSA and resistant gram-negative organisms for the absence of these organisms in culture were 91% and 85%, respectively. CONCLUSIONS: For patients hospitalized with DFI and lower extremity OM, our data suggest opportunities for substantial reductions in empiric therapies with activity against MRSA and resistant gram-negative organisms. The absence of risk factors for these organisms was reasonably good at predicting negative cultures with these organisms.
format Online
Article
Text
id pubmed-10654958
institution National Center for Biotechnology Information
language English
publishDate 2023
publisher Cambridge University Press
record_format MEDLINE/PubMed
spelling pubmed-106549582023-10-25 Fear of Missing Organisms (FOMO): the discordance among broad-spectrum empiric antibiotic therapy, microbiologic results, and definitive antibiotic therapy for diabetic foot infections and lower extremity osteomyelitis Morelli, Morgan K. Son, Andrea H. Bitar, Yanis Hecker, Michelle T. Antimicrob Steward Healthc Epidemiol Original Article OBJECTIVE: Empiric broad-spectrum antibiotic therapy is commonly prescribed for patients hospitalized with diabetic foot infections (DFI) and lower extremity osteomyelitis (OM). The primary objective was to evaluate the concordance between empiric antibiotic therapy, microbiologic results, and definitive antibiotic therapy with a focus on methicillin-resistant Staphylococcus aureus (MRSA) and resistant gram-negative organisms. The secondary objective was to evaluate the negative predictive values (NPV) of select risk factors for MRSA and resistant gram-negative organisms for microbiologic results with these organisms. DESIGN: Retrospective cohort study. SETTING: Safety-net health system in Ohio. PATIENTS: Adults hospitalized and receiving antibiotic therapy for DFI or lower extremity OM in 2021. RESULTS: For 259 unique patients, empiric therapies with activity against MRSA and resistant gram-negative organisms were administered to 224 (86.5%) and 217 (83.8%) patients, respectively. Definitive therapies with activity against MRSA and resistant gram-negative organisms were administered to 91 (35%) and 74 (28.6%) patients, respectively. Of 234 patients with microbiologic testing, 29 (12.4%) had positive cultures with MRSA and 41 (17.5%) with resistant gram-negative organisms. The NPVs of risk factors for MRSA and resistant gram-negative organisms for the absence of these organisms in culture were 91% and 85%, respectively. CONCLUSIONS: For patients hospitalized with DFI and lower extremity OM, our data suggest opportunities for substantial reductions in empiric therapies with activity against MRSA and resistant gram-negative organisms. The absence of risk factors for these organisms was reasonably good at predicting negative cultures with these organisms. Cambridge University Press 2023-10-25 /pmc/articles/PMC10654958/ /pubmed/38028912 http://dx.doi.org/10.1017/ash.2023.467 Text en © The Author(s) 2023 https://creativecommons.org/licenses/by/4.0/This is an Open Access article, distributed under the terms of the Creative Commons Attribution licence (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted re-use, distribution and reproduction, provided the original article is properly cited.
spellingShingle Original Article
Morelli, Morgan K.
Son, Andrea H.
Bitar, Yanis
Hecker, Michelle T.
Fear of Missing Organisms (FOMO): the discordance among broad-spectrum empiric antibiotic therapy, microbiologic results, and definitive antibiotic therapy for diabetic foot infections and lower extremity osteomyelitis
title Fear of Missing Organisms (FOMO): the discordance among broad-spectrum empiric antibiotic therapy, microbiologic results, and definitive antibiotic therapy for diabetic foot infections and lower extremity osteomyelitis
title_full Fear of Missing Organisms (FOMO): the discordance among broad-spectrum empiric antibiotic therapy, microbiologic results, and definitive antibiotic therapy for diabetic foot infections and lower extremity osteomyelitis
title_fullStr Fear of Missing Organisms (FOMO): the discordance among broad-spectrum empiric antibiotic therapy, microbiologic results, and definitive antibiotic therapy for diabetic foot infections and lower extremity osteomyelitis
title_full_unstemmed Fear of Missing Organisms (FOMO): the discordance among broad-spectrum empiric antibiotic therapy, microbiologic results, and definitive antibiotic therapy for diabetic foot infections and lower extremity osteomyelitis
title_short Fear of Missing Organisms (FOMO): the discordance among broad-spectrum empiric antibiotic therapy, microbiologic results, and definitive antibiotic therapy for diabetic foot infections and lower extremity osteomyelitis
title_sort fear of missing organisms (fomo): the discordance among broad-spectrum empiric antibiotic therapy, microbiologic results, and definitive antibiotic therapy for diabetic foot infections and lower extremity osteomyelitis
topic Original Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10654958/
https://www.ncbi.nlm.nih.gov/pubmed/38028912
http://dx.doi.org/10.1017/ash.2023.467
work_keys_str_mv AT morellimorgank fearofmissingorganismsfomothediscordanceamongbroadspectrumempiricantibiotictherapymicrobiologicresultsanddefinitiveantibiotictherapyfordiabeticfootinfectionsandlowerextremityosteomyelitis
AT sonandreah fearofmissingorganismsfomothediscordanceamongbroadspectrumempiricantibiotictherapymicrobiologicresultsanddefinitiveantibiotictherapyfordiabeticfootinfectionsandlowerextremityosteomyelitis
AT bitaryanis fearofmissingorganismsfomothediscordanceamongbroadspectrumempiricantibiotictherapymicrobiologicresultsanddefinitiveantibiotictherapyfordiabeticfootinfectionsandlowerextremityosteomyelitis
AT heckermichellet fearofmissingorganismsfomothediscordanceamongbroadspectrumempiricantibiotictherapymicrobiologicresultsanddefinitiveantibiotictherapyfordiabeticfootinfectionsandlowerextremityosteomyelitis