The following is a summary of “Outcomes of inadequate empiric therapy and timing of newer antibacterial therapy in hospitalized adults with culture-positive Enterobacterales and Pseudomonas aeruginosa: a multicenter analysis,” published in the August 2024 issue of Infectious Disease by Riccobene et al.

Researchers conducted a retrospective study evaluating hospital outcomes related to the effectiveness of overall and newer antibiotic treatments for individuals with Enterobacterales (ENT) and Pseudomonas aeruginosa (PsA) infections in the US.

They identified hospitalized adults ≥ 18 years old with facility-reported antibiotic susceptibility (2018–2022) across 161 BD Insights Research Database facilities as ENT- or PsA-positive. To assess the impact of inadequate empiric therapy (IET) and the timing of initiating newer antibacterials (ceftazidime-avibactam; ceftolozane-tazobactam; cefiderocol; meropenem-vaborbactam; eravacycline; and imipenem-cilcastatin-relebactam) on hospital mortality and post-culture length of stay (LOS), generalized linear mixed models were employed.

The results showed 229,320 susceptibility results for ENT and 36,027 for PsA, 1.7% of ENT and 16.8% of PsA cases were carbapenem non-susceptible (carb-NS). Median time to first susceptibility result was longer for carb-NS compared to carb-susceptible strains, 64 hours vs. 48 hours for ENT and 67 hours vs. 60 hours for PsA. For ENT, IET was linked to higher mortality (OR, 1.29 [95% CI, 1.16–1.43, P<0.0001]) and longer hospital length of stay (14.8 days vs. 13.3 days, P<0.0001). Delayed initiation of newer antibacterial therapy significantly increased hospital mortality for ENT (P=0.0182) and PsA (P=0.0249) and extended post-culture length of stay for both ENT (P<0.0001) and PsA (P<0.0001).

Investigators concluded that inadequate empiric therapy and delayed use of newer antibiotics were linked to significantly poorer hospital outcomes, highlighting the need to identify patients at high risk to optimize treatment.

Source: bmcinfectdis.biomedcentral.com/articles/10.1186/s12879-024-09700-7