OBJECTIVE: To determine the occurrence of inadequate antimicrobial therapy among @entity3124 @entity1 with @entity2259 and the factors associated with it, to identify the microorganisms that received inadequate antimicrobial treatment, and to determine the relationship between inadequate treatment and @entity1 outcome. METHODS: From June 1995 to January 1999 we collected data on all clinically significant @entity2259 in our teaching hospital. Clinical and microbiological characteristics were recorded and the adequacy of empirical antimicrobial treatment in each case was determined. We defined inappropriate empirical antimicrobial treatment as applying to infection that was not being effectively treated at the time the causative microorganism and its antibiotic susceptibility were known. Multivariate analysis was used to determine the variables associated with inappropriate empirical antimicrobial treatment and to evaluate the influence of this on the related mortality to @entity2259 , using the SPSS package (9.0). RESULTS: Among 166 intensive care unit @entity1 with @entity2259 , 39 (23.5%) received inadequate antimicrobial treatment. In this last group the mean age of @entity1 was 64.1 +/- 13.2 years, and 64% were @entity1 . @entity2259 was hospital-acquired in 92% of these cases. Eleven percent developed @entity326 and 37.7% severe @entity295 , and ultimately fatal underlying disease was present in 28.2% of @entity1 given inadequate empirical antimicrobial treatment. The main sources of @entity2259 in this group were: a vascular catheter (15.3%), respiratory (7.6%) or unknown (53.8%). The microorganisms most frequently isolated in the group with inadequate empirical antimicrobial treatment were: coagulase-negative staphylococci (29.5%), @entity3064 (27.3%), @entity797 , @entity796 , @entity7100 , @entity5609 , @entity526 , and Candida species (4.5% each). The frequency of coagulase-negative staphylococci in the cases with inappropriate treatment was higher than in the group with appropriate treatment (OR 2.62; 95% CI: 1.10-6.21; P = 0.015). The global mortality rate was 56% and the related mortality was 30% in the group with inadequate empirical antimicrobial treatment. The only factor associated with inappropriate empirical antibiotic treatment was the absence of abdominal or respiratory focus (P = 0.04; OR = 0.35; 95% CI: 0.12-0.97). @entity326 was related to attributable mortality (P = 0.03; OR = 3.19; 95% CI: 1.08-9.40), but not inappropriate empirical antibiotic treatment (P = 0.24; OR = 1.71; 95% CI: 0.66-4.78). CONCLUSION: Almost a quarter of @entity3124 @entity1 with bloodstream infections were given inadequate empirical antibiotic treatment, but mortality was not higher in the group with inadequate treatment than in the group with adequate treatment. This fact was probably due to microbiological factors and clinical features, such as the type of microorganism most frequently isolated and the source of the @entity2259 .

The influence of inadequate empirical antimicrobial treatment on XXXX with bloodstream infections in an intensive care unit.

@entity1 :: ('9606', 'Species') :: ['patients', 'men'] @entity295 :: ('MESH:D018805', 'Disease') :: ['sepsis'] @entity796 :: ('287', 'Species') :: ['Pseudomonas aeruginosa'] @entity326 :: ('MESH:D012772', 'Disease') :: ['septic shock', 'Septic shock'] @entity3124 :: ('MESH:D016638', 'Disease') :: ['critically ill'] @entity5609 :: ('584', 'Species') :: ['Proteus mirabilis'] @entity797 :: ('1351', 'Species') :: ['Enterococcus faecalis'] @entity3064 :: ('470', 'Species') :: ['Acinetobacter baumannii'] @entity2259 :: ('MESH:D016470', 'Disease') :: ['bacteremia', 'ICU-bacteremias', 'Bacteremia', 'bacteremias'] @entity7100 :: ('550', 'Species') :: ['Enterobacter cloacae'] @entity526 :: ('562', 'Species') :: ['Escherichia coli']
@entity1 :: (9606,Species) :: ['patients']
