Reviewed by Cindy Noyes, MD, University of Vermont Medical Center
Receipt of appropriate empiric antibiotics can reduce mortality in patients with bacteremia. Ohnuma and colleagues performed a cross-sectional study including data from 32,100 patients with bloodstream infections (BSI) from 183 hospitals.1 Crude proportions of appropriate antimicrobial therapy use were noted to be 94% for patients with gram-negative rod BSI, 97% for patients with gram-positive bacteremia and 65% for those with candidemia. Proportions of appropriate empiric antibiotics in patients with resistant organisms were lower; 55% in those with carbapenem-resistant Enterobacterales (CRE), 60% in patients with vancomycin-resistant Enterococci (VRE).1 Patients who received appropriate empiric antibiotic therapy had a lower risk of in-hospital death demonstrated in all three pathogen groups.1 Rapid molecular diagnostics, such as polymerase chain reaction (PCR) testing of positive blood cultures, could guide early initiation of appropriate empiric antibiotic therapy among resistant organisms.1,2 Satlin and colleagues describe their observational study of 137 patients from 8 different medical centers with CRE bacteremia conducted from 2016-2018.2 When PCR testing was available in the patient’s clinical laboratory and identified the Klebsiella pneumoniae carbapenemase (KPC) producing gene (the most common mechanism for resistance at the time in the region), the median time to receipt of effective antibiotic treatment was reduced from a median of 50 hours to 24 hours. This earlier initiation of appropriate antimicrobials was associated with a decrease in both 14 and 30-day mortality. These studies suggest that use of rapid diagnostic tests can help optimize antibiotic regimens and reduce mortality.1,2
References:
Ohnuma T, Chihara C, Costin B, et al. Association of appropriate empirical antimicrobial therapy with in-hospital mortality in patients with bloodstream infections in the US. JAMA Network Open. 2023; 6(1): e2249353. doi:10.1001/jamanetworkopen.2022.49353.
Satlin M, Chen L, Gomez-Simmonds A, et al. Impact of a rapid molecular test for Klebsiella pneumoniae carbapenemase and ceftazidime-avibactam use on outcomes after bacteremia caused by carbapenem-resistant Enterobacterales. CID. 2022; 75 (12): 2066-75.