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Antimicrobial Use and the Influence of Inadequate Empiric Antimicrobial Therapy on the Outcomes of Nosocomial Bloodstream Infections in a Neonatal Intensive Care Unit

Published online by Cambridge University Press:  02 January 2015

Anucha Apisarnthanarak ,
Galit Holzmann-Pazgal ,
Aaron Hamvas ,
Margaret A. Olsen  and
Victoria J. Fraser
Anucha Apisarnthanarak
Affiliation:
Division of Infectious Diseases, Faculty of Medicine, Thammasart University Hospital, Pratumthani, Thailand
Galit Holzmann-Pazgal
Affiliation:
Division of Infectious Diseases, Departments of Pediatric and Internal Medicine, St. Louis Children's Hospital, BJC Health Care andWashington University School of Medicine, St. Louis, Missouri
Aaron Hamvas
Affiliation:
Division of Newborn Medicine, St. Louis Children's Hospital, BJC Health Care andWashington University School of Medicine, St. Louis, Missouri
Margaret A. Olsen
Affiliation:
Division of Infectious Diseases, Departments of Pediatric and Internal Medicine, St. Louis Children's Hospital, BJC Health Care andWashington University School of Medicine, St. Louis, Missouri
Victoria J. Fraser*
Affiliation:
Division of Infectious Diseases, Departments of Pediatric and Internal Medicine, St. Louis Children's Hospital, BJC Health Care andWashington University School of Medicine, St. Louis, Missouri
*
Washington University School of Medicine, Campus Box 8051, 660 South Euclid Ave., St. Louis, MO 63110
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Abstract

Objective:

To evaluate antimicrobial use and the influence of inadequate empiric antimicrobial therapy on the outcomes of nosocomial bloodstream infections (BSIs).

Design:

Prospective cohort study with nested case-control analysis.

Setting:

Neonatal intensive care unit (NICU).

Methods:

All patients weighing 2,000 g or less were enrolled. Data collection included risk factors for nosocomial BSI, admission severity of illness, microbiology, antimicrobial therapy, and outcomes. Inadequate empiric antimicrobial therapy was defined as the use of antibiotics for more than 48 hours after the day that blood cultures were performed that did not cover the microorganisms causing the bacteremia or administration of antibiotics that failed to cover resistant microorganisms.

Results:

Two hundred twenty-nine patients were enrolled. Forty-five developed nosocomial BSIs. The BSI rates were 11.2, 2.8, and 0 per 1,000 catheter-days for patients weighing 1,000 g or less, between 1,001 and 1,500 g, and between 1,501 and 2,000 g, respectively. After adjustment for severity of illness, the mortality in patients with nosocomial BSI receiving inadequate empiric antimicrobial therapy was higher than in those receiving adequate therapy (adjusted odds ratio [AOR], 5.3; 95% confidence interval [CI95], 1.2-23.2). By multivariate analysis, nosocomial BSI attributed to Candida species (AOR, 6.3; CI95, 1.4-28.0) and invasive procedure prior to onset of BSI (AOR, 6.4; CI95, 1.0-39.0) were associated with administration of inadequate empiric antimicrobial therapy.

Conclusions:

Administration of inadequate empiric antimicrobial therapy among NICU patients with nosocomial BSI was associated with higher mortality. Additional studies on the role of inadequate empiric antimicrobial therapy and the outcomes of BSIs among NICU patients are needed.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 25 , Issue 9 , September 2004 , pp. 735 - 741
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2004

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