Clinical features and impact of empirical therapy in cirrhotic adults with community-onset bacteremia

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Abstract

Abstract Objectives The objectives were to investigate the clinical characteristics of community-onset bacteremia in cirrhotic adults visiting the emergency department (ED), as well as the clinical impact of empirical antibiotics on their outcome. Methods Cirrhotic adults with community-onset bacteremia who visited the ED from January 2005 to December 2009 were included retrospectively. Clinical data and outcome were collected from the medical chart. The in vitro susceptibility was measured by the broth microdilution method. Results Of the 246 bacteremic episodes in cirrhotic patients, the major sources of bacteremia included intraabdominal infections (111, 45.1%), primary bacteremia (43, 17.5%), urinary tract infection (39, 15.9%), and soft tissue infection (22, 8.9%). Of the 258 bacteremic pathogens identified, Escherichia coli (83 isolates, 33.7%) and Klebsiella pneumoniae (61, 23.6%) were the most common microorganisms. In the multivariate analysis, delayed appropriate antibiotic therapy (> 72 hours; odds ratio [OR], 4.29; P =.003), serum creatinine greater than 1.5 mg/dL at the ED (OR, 3.12; P =.005), severe sepsis (OR, 3.61; P =.01), Pittsburgh bacteremia score of at least 4 (OR, 2.66; P =.04), bacteremia due to pneumonia (OR, 5.44; P =.02), and a comorbidity of diabetes mellitus (OR, 3.54; P =.004) were independently associated with the 28-day mortality. Conclusions Focusing on cirrhotic adults with community-onset bacteremia, we emphasized that the cirrhosis severity is one of the critical factors when choosing empirical antimicrobial therapy and that the strategy of empirical therapy is warranted for cirrhotic adults with severe decompensation (Child's C group). For critically ill patients, especially in those with Child's C group, only piperacillin/tazobactam, ertapenem, or imipenem treatment was warranted because of susceptibility rate of greater than 90%.

Original languageEnglish
Article number54626
Pages (from-to)222-228
Number of pages7
JournalAmerican Journal of Emergency Medicine
Volume33
Issue number2
DOIs
Publication statusPublished - 2015 Feb 1

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Bacteremia
Odds Ratio
Hospital Emergency Service
Therapeutics
Anti-Bacterial Agents
Intraabdominal Infections
Soft Tissue Infections
Imipenem
Klebsiella pneumoniae
Critical Illness
Urinary Tract Infections
Comorbidity
Creatinine
Sepsis
Pneumonia
Diabetes Mellitus
Fibrosis
Multivariate Analysis
Escherichia coli
Mortality

All Science Journal Classification (ASJC) codes

  • Emergency Medicine
  • Medicine(all)

Cite this

@article{5e0a873408df438e918a6e081b659b54,
title = "Clinical features and impact of empirical therapy in cirrhotic adults with community-onset bacteremia",
abstract = "Abstract Objectives The objectives were to investigate the clinical characteristics of community-onset bacteremia in cirrhotic adults visiting the emergency department (ED), as well as the clinical impact of empirical antibiotics on their outcome. Methods Cirrhotic adults with community-onset bacteremia who visited the ED from January 2005 to December 2009 were included retrospectively. Clinical data and outcome were collected from the medical chart. The in vitro susceptibility was measured by the broth microdilution method. Results Of the 246 bacteremic episodes in cirrhotic patients, the major sources of bacteremia included intraabdominal infections (111, 45.1{\%}), primary bacteremia (43, 17.5{\%}), urinary tract infection (39, 15.9{\%}), and soft tissue infection (22, 8.9{\%}). Of the 258 bacteremic pathogens identified, Escherichia coli (83 isolates, 33.7{\%}) and Klebsiella pneumoniae (61, 23.6{\%}) were the most common microorganisms. In the multivariate analysis, delayed appropriate antibiotic therapy (> 72 hours; odds ratio [OR], 4.29; P =.003), serum creatinine greater than 1.5 mg/dL at the ED (OR, 3.12; P =.005), severe sepsis (OR, 3.61; P =.01), Pittsburgh bacteremia score of at least 4 (OR, 2.66; P =.04), bacteremia due to pneumonia (OR, 5.44; P =.02), and a comorbidity of diabetes mellitus (OR, 3.54; P =.004) were independently associated with the 28-day mortality. Conclusions Focusing on cirrhotic adults with community-onset bacteremia, we emphasized that the cirrhosis severity is one of the critical factors when choosing empirical antimicrobial therapy and that the strategy of empirical therapy is warranted for cirrhotic adults with severe decompensation (Child's C group). For critically ill patients, especially in those with Child's C group, only piperacillin/tazobactam, ertapenem, or imipenem treatment was warranted because of susceptibility rate of greater than 90{\%}.",
author = "Chih-Chia Hsieh and Lee, {Ching Chi} and Tsung-Yu Chan and Ming-Yuan Hong and Chih-Hsien Chi and Wen-Chien Ko",
year = "2015",
month = "2",
day = "1",
doi = "10.1016/j.ajem.2014.11.024",
language = "English",
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pages = "222--228",
journal = "American Journal of Emergency Medicine",
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T1 - Clinical features and impact of empirical therapy in cirrhotic adults with community-onset bacteremia

AU - Hsieh, Chih-Chia

AU - Lee, Ching Chi

AU - Chan, Tsung-Yu

AU - Hong, Ming-Yuan

AU - Chi, Chih-Hsien

AU - Ko, Wen-Chien

PY - 2015/2/1

Y1 - 2015/2/1

N2 - Abstract Objectives The objectives were to investigate the clinical characteristics of community-onset bacteremia in cirrhotic adults visiting the emergency department (ED), as well as the clinical impact of empirical antibiotics on their outcome. Methods Cirrhotic adults with community-onset bacteremia who visited the ED from January 2005 to December 2009 were included retrospectively. Clinical data and outcome were collected from the medical chart. The in vitro susceptibility was measured by the broth microdilution method. Results Of the 246 bacteremic episodes in cirrhotic patients, the major sources of bacteremia included intraabdominal infections (111, 45.1%), primary bacteremia (43, 17.5%), urinary tract infection (39, 15.9%), and soft tissue infection (22, 8.9%). Of the 258 bacteremic pathogens identified, Escherichia coli (83 isolates, 33.7%) and Klebsiella pneumoniae (61, 23.6%) were the most common microorganisms. In the multivariate analysis, delayed appropriate antibiotic therapy (> 72 hours; odds ratio [OR], 4.29; P =.003), serum creatinine greater than 1.5 mg/dL at the ED (OR, 3.12; P =.005), severe sepsis (OR, 3.61; P =.01), Pittsburgh bacteremia score of at least 4 (OR, 2.66; P =.04), bacteremia due to pneumonia (OR, 5.44; P =.02), and a comorbidity of diabetes mellitus (OR, 3.54; P =.004) were independently associated with the 28-day mortality. Conclusions Focusing on cirrhotic adults with community-onset bacteremia, we emphasized that the cirrhosis severity is one of the critical factors when choosing empirical antimicrobial therapy and that the strategy of empirical therapy is warranted for cirrhotic adults with severe decompensation (Child's C group). For critically ill patients, especially in those with Child's C group, only piperacillin/tazobactam, ertapenem, or imipenem treatment was warranted because of susceptibility rate of greater than 90%.

AB - Abstract Objectives The objectives were to investigate the clinical characteristics of community-onset bacteremia in cirrhotic adults visiting the emergency department (ED), as well as the clinical impact of empirical antibiotics on their outcome. Methods Cirrhotic adults with community-onset bacteremia who visited the ED from January 2005 to December 2009 were included retrospectively. Clinical data and outcome were collected from the medical chart. The in vitro susceptibility was measured by the broth microdilution method. Results Of the 246 bacteremic episodes in cirrhotic patients, the major sources of bacteremia included intraabdominal infections (111, 45.1%), primary bacteremia (43, 17.5%), urinary tract infection (39, 15.9%), and soft tissue infection (22, 8.9%). Of the 258 bacteremic pathogens identified, Escherichia coli (83 isolates, 33.7%) and Klebsiella pneumoniae (61, 23.6%) were the most common microorganisms. In the multivariate analysis, delayed appropriate antibiotic therapy (> 72 hours; odds ratio [OR], 4.29; P =.003), serum creatinine greater than 1.5 mg/dL at the ED (OR, 3.12; P =.005), severe sepsis (OR, 3.61; P =.01), Pittsburgh bacteremia score of at least 4 (OR, 2.66; P =.04), bacteremia due to pneumonia (OR, 5.44; P =.02), and a comorbidity of diabetes mellitus (OR, 3.54; P =.004) were independently associated with the 28-day mortality. Conclusions Focusing on cirrhotic adults with community-onset bacteremia, we emphasized that the cirrhosis severity is one of the critical factors when choosing empirical antimicrobial therapy and that the strategy of empirical therapy is warranted for cirrhotic adults with severe decompensation (Child's C group). For critically ill patients, especially in those with Child's C group, only piperacillin/tazobactam, ertapenem, or imipenem treatment was warranted because of susceptibility rate of greater than 90%.

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