Comparing the Prognostic Impacts of Delayed Administration of Appropriate Antimicrobials in Older Patients with Afebrile and Febrile Community-Onset Bacteremia (2024)

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Antibiotics

Volume 13

Issue 5

10.3390/antibiotics13050465

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Article

by

Shu-Chun Hsueh

Comparing the Prognostic Impacts of Delayed Administration of Appropriate Antimicrobials in Older Patients with Afebrile and Febrile Community-Onset Bacteremia (6)Shu-Chun Hsueh

1,

Po-Lin Chen

Comparing the Prognostic Impacts of Delayed Administration of Appropriate Antimicrobials in Older Patients with Afebrile and Febrile Community-Onset Bacteremia (7)Po-Lin Chen

2,3Comparing the Prognostic Impacts of Delayed Administration of Appropriate Antimicrobials in Older Patients with Afebrile and Febrile Community-Onset Bacteremia (8),

Ching-Yu Ho

Comparing the Prognostic Impacts of Delayed Administration of Appropriate Antimicrobials in Older Patients with Afebrile and Febrile Community-Onset Bacteremia (9)Ching-Yu Ho

4,5,

Ming-Yuan Hong

Comparing the Prognostic Impacts of Delayed Administration of Appropriate Antimicrobials in Older Patients with Afebrile and Febrile Community-Onset Bacteremia (10)Ming-Yuan Hong

2,6Comparing the Prognostic Impacts of Delayed Administration of Appropriate Antimicrobials in Older Patients with Afebrile and Febrile Community-Onset Bacteremia (11),

Ching-Chi Lee

Comparing the Prognostic Impacts of Delayed Administration of Appropriate Antimicrobials in Older Patients with Afebrile and Febrile Community-Onset Bacteremia (12)Ching-Chi Lee

2,7,*Comparing the Prognostic Impacts of Delayed Administration of Appropriate Antimicrobials in Older Patients with Afebrile and Febrile Community-Onset Bacteremia (13) and

Wen-Chien Ko

Comparing the Prognostic Impacts of Delayed Administration of Appropriate Antimicrobials in Older Patients with Afebrile and Febrile Community-Onset Bacteremia (14)Wen-Chien Ko

2,3,*Comparing the Prognostic Impacts of Delayed Administration of Appropriate Antimicrobials in Older Patients with Afebrile and Febrile Community-Onset Bacteremia (15)

1

Department of Nursing, Meiho University, Pingtung 912009, Taiwan

2

Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 70403, Taiwan

3

Department of Medicine, College of Medicine, National Cheng Kung University, Tainan 70403, Taiwan

4

Department of Adult Critical Care Medicine, Tainan Sin-Lau Hospital, Tainan 70142, Taiwan

5

Department of Nursing, National Tainan Junior College of Nursing, Tainan 700007, Taiwan

6

Department of Emergency Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 70403, Taiwan

7

Clinical Medicine Research Center, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 70403, Taiwan

*

Authors to whom correspondence should be addressed.

Antibiotics 2024, 13(5), 465; https://doi.org/10.3390/antibiotics13050465 (registeringDOI)

Submission received: 23 April 2024/Revised: 13 May 2024/Accepted: 16 May 2024/Published: 19 May 2024

(This article belongs to the Special Issue Successful Antimicrobial Stewardship Approaches to Address Nosocomial Infections)

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Abstract

Although prompt administration of an appropriate antimicrobial therapy (AAT) is crucial for reducing mortality in the general population with community-onset bacteremia, the prognostic effects of delayed AAT in older individuals with febrile and afebrile bacteremia remain unclear. A stepwise and backward logistic regression analysis was used to identify independent predictors of 30-day mortality. In a 7-year multicenter cohort study involving 3424 older patients (≥65 years) with community-onset bacteremia, febrile bacteremia accounted for 27.1% (912 patients). A crucial association of afebrile bacteremia and 30-day mortality (adjusted hazard ratio [AHR], 1.69; p < 0.001) was revealed using Cox regression and Kaplan–Meier curves after adjusting for the independent predictors of mortality. Moreover, each hour of delayed AAT was associated with an average increase of 0.3% (adjusted odds ratio [AOR], 1.003; p < 0.001) and 0.2% (AOR, 1.002; p < 0.001) in the 30-day crude mortality rates among patients with afebrile and febrile bacteremia, respectively, after adjusting for the independent predictors of mortality. Similarly, further analysis based on Cox regression and Kaplan–Meier curves revealed that inappropriate empirical therapy (i.e., delayed AAT administration > 24 h) had a significant prognostic impact, with AHRs of 1.83 (p < 0.001) and 1.76 (p < 0.001) in afebrile and febrile patients, respectively, after adjusting for the independent predictors of mortality. In conclusion, among older individuals with community-onset bacteremia, the dissimilarity of the prognostic impacts of delayed AAT between afebrile and febrile presentation was evident.

Keywords: bacteremia; afebrile; appropriate antimicrobial therapy; outcome; afebrile bacteremia; community-onset; empirical therapy

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MDPI and ACS Style

Hsueh, S.-C.; Chen, P.-L.; Ho, C.-Y.; Hong, M.-Y.; Lee, C.-C.; Ko, W.-C.Comparing the Prognostic Impacts of Delayed Administration of Appropriate Antimicrobials in Older Patients with Afebrile and Febrile Community-Onset Bacteremia. Antibiotics 2024, 13, 465.https://doi.org/10.3390/antibiotics13050465

AMA Style

Hsueh S-C, Chen P-L, Ho C-Y, Hong M-Y, Lee C-C, Ko W-C.Comparing the Prognostic Impacts of Delayed Administration of Appropriate Antimicrobials in Older Patients with Afebrile and Febrile Community-Onset Bacteremia. Antibiotics. 2024; 13(5):465.https://doi.org/10.3390/antibiotics13050465

Chicago/Turabian Style

Hsueh, Shu-Chun, Po-Lin Chen, Ching-Yu Ho, Ming-Yuan Hong, Ching-Chi Lee, and Wen-Chien Ko.2024. "Comparing the Prognostic Impacts of Delayed Administration of Appropriate Antimicrobials in Older Patients with Afebrile and Febrile Community-Onset Bacteremia" Antibiotics 13, no. 5: 465.https://doi.org/10.3390/antibiotics13050465

Note that from the first issue of 2016, this journal uses article numbers instead of page numbers. See further details here.

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MDPI and ACS Style

Hsueh, S.-C.; Chen, P.-L.; Ho, C.-Y.; Hong, M.-Y.; Lee, C.-C.; Ko, W.-C.Comparing the Prognostic Impacts of Delayed Administration of Appropriate Antimicrobials in Older Patients with Afebrile and Febrile Community-Onset Bacteremia. Antibiotics 2024, 13, 465.https://doi.org/10.3390/antibiotics13050465

AMA Style

Hsueh S-C, Chen P-L, Ho C-Y, Hong M-Y, Lee C-C, Ko W-C.Comparing the Prognostic Impacts of Delayed Administration of Appropriate Antimicrobials in Older Patients with Afebrile and Febrile Community-Onset Bacteremia. Antibiotics. 2024; 13(5):465.https://doi.org/10.3390/antibiotics13050465

Chicago/Turabian Style

Hsueh, Shu-Chun, Po-Lin Chen, Ching-Yu Ho, Ming-Yuan Hong, Ching-Chi Lee, and Wen-Chien Ko.2024. "Comparing the Prognostic Impacts of Delayed Administration of Appropriate Antimicrobials in Older Patients with Afebrile and Febrile Community-Onset Bacteremia" Antibiotics 13, no. 5: 465.https://doi.org/10.3390/antibiotics13050465

Note that from the first issue of 2016, this journal uses article numbers instead of page numbers. See further details here.

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Comparing the Prognostic Impacts of Delayed Administration of Appropriate Antimicrobials in Older Patients with Afebrile and Febrile Community-Onset Bacteremia (16)

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Comparing the Prognostic Impacts of Delayed Administration of Appropriate Antimicrobials in Older Patients with Afebrile and Febrile Community-Onset Bacteremia (2024)
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