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An evaluation of antipseudomonal dosing on the incidence of treatment failure
INTRODUCTION: Significant mortality is associated with delays in appropriate antibiotic therapy in Pseudomonas aeruginosa infections. The impact of empiric dosing on clinical outcomes has been largely unreported. METHODS: This retrospective cohort compared treatment failure in patients receiving gui...
Autores principales: | , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
SAGE Publications
2021
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7968010/ https://www.ncbi.nlm.nih.gov/pubmed/33796294 http://dx.doi.org/10.1177/20503121211000927 |
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author | Hawkins, Brandon K Wingler, Mary Joyce B Cretella, David A Barber, Katie E Stover, Kayla R Wagner, Jamie L |
author_facet | Hawkins, Brandon K Wingler, Mary Joyce B Cretella, David A Barber, Katie E Stover, Kayla R Wagner, Jamie L |
author_sort | Hawkins, Brandon K |
collection | PubMed |
description | INTRODUCTION: Significant mortality is associated with delays in appropriate antibiotic therapy in Pseudomonas aeruginosa infections. The impact of empiric dosing on clinical outcomes has been largely unreported. METHODS: This retrospective cohort compared treatment failure in patients receiving guideline-concordant or guideline-discordant empiric therapy with cefepime, meropenem, or piperacillin/tazobactam. Patients with culture-positive P. aeruginosa between 1 July 2013 and 31 July 2019 were eligible for inclusion. Patients with cystic fibrosis, polymicrobial infection, and urinary or pulmonary colonization were excluded. The composite primary outcome was treatment failure, defined as (1) therapy modification due to resistance/perceived treatment failure, (2) increased/unchanged qSOFA, or (3) persistent fever 48 h after initiating appropriate therapy. Secondary outcomes included rate of infectious diseases consultation, all-cause inpatient mortality, mechanical ventilation requirement, and infection-related intensive care unit and hospital lengths of stay. RESULTS: In total, 198 patients were included: 90 guideline-concordant and 108 guideline-discordant. Baseline characteristics were balanced. Treatment failure was more common in the guideline-discordant than the guideline-concordant group (62% versus 48%; p = 0.04). This remained significant when adjusting for supratherapeutic dosing (p = 0.02). Infectious diseases consultation was higher in the guideline-discordant group (46% versus 29%, p = 0.01), while intensive care unit length of stay was longer in the guideline-concordant group (4.5 versus 3 days, p = 0.03). Additional secondary outcomes were similar. CONCLUSION: Treatment failure was significantly higher in patients receiving guideline-discordant empiric antipseudomonal dosing. Guideline-directed dosing, disease states, and patient-specific factors should be assessed when considering empiric antipseudomonal dosing. |
format | Online Article Text |
id | pubmed-7968010 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2021 |
publisher | SAGE Publications |
record_format | MEDLINE/PubMed |
spelling | pubmed-79680102021-03-31 An evaluation of antipseudomonal dosing on the incidence of treatment failure Hawkins, Brandon K Wingler, Mary Joyce B Cretella, David A Barber, Katie E Stover, Kayla R Wagner, Jamie L SAGE Open Med Original Research Article INTRODUCTION: Significant mortality is associated with delays in appropriate antibiotic therapy in Pseudomonas aeruginosa infections. The impact of empiric dosing on clinical outcomes has been largely unreported. METHODS: This retrospective cohort compared treatment failure in patients receiving guideline-concordant or guideline-discordant empiric therapy with cefepime, meropenem, or piperacillin/tazobactam. Patients with culture-positive P. aeruginosa between 1 July 2013 and 31 July 2019 were eligible for inclusion. Patients with cystic fibrosis, polymicrobial infection, and urinary or pulmonary colonization were excluded. The composite primary outcome was treatment failure, defined as (1) therapy modification due to resistance/perceived treatment failure, (2) increased/unchanged qSOFA, or (3) persistent fever 48 h after initiating appropriate therapy. Secondary outcomes included rate of infectious diseases consultation, all-cause inpatient mortality, mechanical ventilation requirement, and infection-related intensive care unit and hospital lengths of stay. RESULTS: In total, 198 patients were included: 90 guideline-concordant and 108 guideline-discordant. Baseline characteristics were balanced. Treatment failure was more common in the guideline-discordant than the guideline-concordant group (62% versus 48%; p = 0.04). This remained significant when adjusting for supratherapeutic dosing (p = 0.02). Infectious diseases consultation was higher in the guideline-discordant group (46% versus 29%, p = 0.01), while intensive care unit length of stay was longer in the guideline-concordant group (4.5 versus 3 days, p = 0.03). Additional secondary outcomes were similar. CONCLUSION: Treatment failure was significantly higher in patients receiving guideline-discordant empiric antipseudomonal dosing. Guideline-directed dosing, disease states, and patient-specific factors should be assessed when considering empiric antipseudomonal dosing. SAGE Publications 2021-03-15 /pmc/articles/PMC7968010/ /pubmed/33796294 http://dx.doi.org/10.1177/20503121211000927 Text en © The Author(s) 2021 https://creativecommons.org/licenses/by-nc/4.0/ This article is distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 License (https://creativecommons.org/licenses/by-nc/4.0/) which permits non-commercial use, reproduction and distribution of the work without further permission provided the original work is attributed as specified on the SAGE and Open Access page (https://us.sagepub.com/en-us/nam/open-access-at-sage). |
spellingShingle | Original Research Article Hawkins, Brandon K Wingler, Mary Joyce B Cretella, David A Barber, Katie E Stover, Kayla R Wagner, Jamie L An evaluation of antipseudomonal dosing on the incidence of treatment failure |
title | An evaluation of antipseudomonal dosing on the incidence of treatment failure |
title_full | An evaluation of antipseudomonal dosing on the incidence of treatment failure |
title_fullStr | An evaluation of antipseudomonal dosing on the incidence of treatment failure |
title_full_unstemmed | An evaluation of antipseudomonal dosing on the incidence of treatment failure |
title_short | An evaluation of antipseudomonal dosing on the incidence of treatment failure |
title_sort | evaluation of antipseudomonal dosing on the incidence of treatment failure |
topic | Original Research Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7968010/ https://www.ncbi.nlm.nih.gov/pubmed/33796294 http://dx.doi.org/10.1177/20503121211000927 |
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