TY - JOUR
T1 - Prognostic Effects of Delayed Administration of Antimicrobial Therapy in Older Persons Experiencing Bacteremia With or Without Initial Sepsis Presentations
AU - Lee, Ching Chi
AU - Chen, Po Lin
AU - Huang, Yi Tzu
AU - Ho, Ching Yu
AU - Hong, Ming Yuan
AU - Hsieh, Chih Chia
AU - Lin, Chih Hao
AU - Ko, Wen Chien
N1 - Funding Information:
This study is supported by research grants from the Ministry of Science and Technology ( MOST 109-2314-B-006-097 , MOST 109-2634-F-006-023 , and MOST 110-2314-B-006-068 ), the Ministry of Health and Welfare, Taiwan (MOHW109-TDU-B-211-114003), Sin-Lau Hospital, Taiwan (SLH-M106-01, SLH-M107-02, SLH-M108-01, and SLH-109-04), and National Cheng Kung University Hospital ( NCKUH-10909031 and NCKUH-11004029 ), Taiwan.
Publisher Copyright:
© 2021 AMDA – The Society for Post-Acute and Long-Term Care Medicine
PY - 2022/1
Y1 - 2022/1
N2 - Objectives: To investigate the prognostic effects of delayed administration of appropriate antimicrobial therapy (AAT) in older persons experiencing bacteremia with and without initial sepsis syndrome, respectively. Design: A 4-year multicenter cohort study. Setting and Participants: Older people (≥65 years of age) with community-onset bacteremia in the emergency department (ED) of 3 participating hospitals. Methods: Clinical data were retrospectively collected and causative microorganisms were prospectively collected for susceptibilities to determine the period of delayed AAT for each bacteremia episode. Sepsis was defined based on the Sepsis-3 criteria. A multivariable regression model was used to investigate the prognostic effects of delayed AAT, after adjusting independent determinants of 30-day mortality. Results: Of the total 2357 patients, their median (interquartile range) age was 78 (72–84) years and septic patients accounted for 48.4% (1140 patients) of the overall patients. Compared with nonseptic patients, septic individuals exhibited the shorter period of delayed AAT (median, 2.0 vs 2.5 hours; P < .001), longer hospitalization (median, 11 vs 9 days; P < .001), and higher crude mortality rates at 15 (28.9% vs 2.1%; P < .001) and 30 days (34.6% vs 4.0%; P < .001). In multivariable regression analyses, each hour of delayed AAT resulted in average increases in the 30-day crude mortality rates of 0.38% [adjusted odds ratio (AOR) 1.0038; P < .001), 0.42% (AOR 1.0042; P < .001), and 0.31% (AOR 1.0031; P = .04) among overall, septic, and nonseptic patients, respectively. Conclusions and Implications: For older persons with community-onset bacteremia, irrespective of whether or not patients experiencing initial sepsis presentations, the prognostic impacts of delayed AAT have been evidenced. Notably, because of the longer period of delayed AAT in patients without fulfilling the Sepsis-3, adopting a stricter sepsis definition and/or early bacteremia predictor to avoid delayed AAT and unfavorable prognoses in patients with bacteremia is necessary.
AB - Objectives: To investigate the prognostic effects of delayed administration of appropriate antimicrobial therapy (AAT) in older persons experiencing bacteremia with and without initial sepsis syndrome, respectively. Design: A 4-year multicenter cohort study. Setting and Participants: Older people (≥65 years of age) with community-onset bacteremia in the emergency department (ED) of 3 participating hospitals. Methods: Clinical data were retrospectively collected and causative microorganisms were prospectively collected for susceptibilities to determine the period of delayed AAT for each bacteremia episode. Sepsis was defined based on the Sepsis-3 criteria. A multivariable regression model was used to investigate the prognostic effects of delayed AAT, after adjusting independent determinants of 30-day mortality. Results: Of the total 2357 patients, their median (interquartile range) age was 78 (72–84) years and septic patients accounted for 48.4% (1140 patients) of the overall patients. Compared with nonseptic patients, septic individuals exhibited the shorter period of delayed AAT (median, 2.0 vs 2.5 hours; P < .001), longer hospitalization (median, 11 vs 9 days; P < .001), and higher crude mortality rates at 15 (28.9% vs 2.1%; P < .001) and 30 days (34.6% vs 4.0%; P < .001). In multivariable regression analyses, each hour of delayed AAT resulted in average increases in the 30-day crude mortality rates of 0.38% [adjusted odds ratio (AOR) 1.0038; P < .001), 0.42% (AOR 1.0042; P < .001), and 0.31% (AOR 1.0031; P = .04) among overall, septic, and nonseptic patients, respectively. Conclusions and Implications: For older persons with community-onset bacteremia, irrespective of whether or not patients experiencing initial sepsis presentations, the prognostic impacts of delayed AAT have been evidenced. Notably, because of the longer period of delayed AAT in patients without fulfilling the Sepsis-3, adopting a stricter sepsis definition and/or early bacteremia predictor to avoid delayed AAT and unfavorable prognoses in patients with bacteremia is necessary.
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U2 - 10.1016/j.jamda.2021.09.021
DO - 10.1016/j.jamda.2021.09.021
M3 - Article
C2 - 34666065
AN - SCOPUS:85118274888
SN - 1525-8610
VL - 23
SP - 73
EP - 80
JO - Journal of the American Medical Directors Association
JF - Journal of the American Medical Directors Association
IS - 1
ER -