Empiric antibiotic therapy resistance and mortality in emergency department patients with bloodstream infection: a retrospective cohort study
Abstract Background Timely management of sepsis in the emergency department, including the use of appropriate antimicrobials, is crucial for improving patient outcomes. Inadequate empiric antimicrobial treatment is associated with potential changes in patient outcomes. We aimed to pinpoint risk fact...
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BMC
2025-01-01
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| Series: | BMC Emergency Medicine |
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| Online Access: | https://doi.org/10.1186/s12873-025-01177-0 |
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| author | Leonhard M. von Beck Gabriella Anna Rapszky Veronika E. Kiss Szilard Sandor Szabolcs Gaal-Marschal Tamas Berenyi Csaba Varga Bank G. Fenyves |
| author_facet | Leonhard M. von Beck Gabriella Anna Rapszky Veronika E. Kiss Szilard Sandor Szabolcs Gaal-Marschal Tamas Berenyi Csaba Varga Bank G. Fenyves |
| author_sort | Leonhard M. von Beck |
| collection | DOAJ |
| description | Abstract Background Timely management of sepsis in the emergency department, including the use of appropriate antimicrobials, is crucial for improving patient outcomes. Inadequate empiric antimicrobial treatment is associated with potential changes in patient outcomes. We aimed to pinpoint risk factors, characterize antibiotic resistance trends, and investigate the association between antibiotic resistance and mortality among patients with bacteremia admitted to the emergency department. Methods We conducted a retrospective analysis of emergency department patients admitted between 15/06/2016 and 30/09/2022. Patients with a positive blood culture receiving emergency department-initiated antibiotic therapy were included. Antibiotic administration, resistance, and survival data were collected. Descriptive statistics, survival analysis, and Cox proportional hazards models were performed. Results Of 157,884 emergency department visits, 1,136 patients had a positive blood culture and received antibiotic therapy initiated in the emergency department. Resistance against empiric antibiotics was 14.5%. The overall 30-day and one-year mortality was 38.6% and 61.8%, respectively. In adjusted Cox models, patients with Escherichia coli or Staphylococcus aureus infection had 36% lower and 44% higher risk of death, respectively. Although resistance to emergency department-administered antibiotic therapy was not associated with overall mortality, one-year mortality of patients with Escherichia coli bacteremia was higher in those with antibiotic resistance (69.0% vs. 49.4%, p = 0.011); these patients had a 1.5-fold increased risk of death in an adjusted Cox model. Conclusion The mortality of patients with bloodstream infection is high. The association of mortality with empiric emergency department-initiated antibiotic adequacy is pathogen-dependent. |
| format | Article |
| id | doaj-art-0a515f32af6442d88edc648e15fee11c |
| institution | Kabale University |
| issn | 1471-227X |
| language | English |
| publishDate | 2025-01-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Emergency Medicine |
| spelling | doaj-art-0a515f32af6442d88edc648e15fee11c2025-02-02T12:11:44ZengBMCBMC Emergency Medicine1471-227X2025-01-0125111010.1186/s12873-025-01177-0Empiric antibiotic therapy resistance and mortality in emergency department patients with bloodstream infection: a retrospective cohort studyLeonhard M. von Beck0Gabriella Anna Rapszky1Veronika E. Kiss2Szilard Sandor3Szabolcs Gaal-Marschal4Tamas Berenyi5Csaba Varga6Bank G. Fenyves7Department of Emergency Medicine, Semmelweis UniversityDepartment of Emergency Medicine, Semmelweis UniversityDepartment of Emergency Medicine, Semmelweis UniversityDepartment of Emergency Medicine, Semmelweis UniversityDepartment of Emergency Medicine, Semmelweis UniversityDepartment of Emergency Medicine, Semmelweis UniversityDepartment of Emergency Medicine, Semmelweis UniversityDepartment of Emergency Medicine, Semmelweis UniversityAbstract Background Timely management of sepsis in the emergency department, including the use of appropriate antimicrobials, is crucial for improving patient outcomes. Inadequate empiric antimicrobial treatment is associated with potential changes in patient outcomes. We aimed to pinpoint risk factors, characterize antibiotic resistance trends, and investigate the association between antibiotic resistance and mortality among patients with bacteremia admitted to the emergency department. Methods We conducted a retrospective analysis of emergency department patients admitted between 15/06/2016 and 30/09/2022. Patients with a positive blood culture receiving emergency department-initiated antibiotic therapy were included. Antibiotic administration, resistance, and survival data were collected. Descriptive statistics, survival analysis, and Cox proportional hazards models were performed. Results Of 157,884 emergency department visits, 1,136 patients had a positive blood culture and received antibiotic therapy initiated in the emergency department. Resistance against empiric antibiotics was 14.5%. The overall 30-day and one-year mortality was 38.6% and 61.8%, respectively. In adjusted Cox models, patients with Escherichia coli or Staphylococcus aureus infection had 36% lower and 44% higher risk of death, respectively. Although resistance to emergency department-administered antibiotic therapy was not associated with overall mortality, one-year mortality of patients with Escherichia coli bacteremia was higher in those with antibiotic resistance (69.0% vs. 49.4%, p = 0.011); these patients had a 1.5-fold increased risk of death in an adjusted Cox model. Conclusion The mortality of patients with bloodstream infection is high. The association of mortality with empiric emergency department-initiated antibiotic adequacy is pathogen-dependent.https://doi.org/10.1186/s12873-025-01177-0SepsisE. ColiS. AureusEast-Central EuropeHungary |
| spellingShingle | Leonhard M. von Beck Gabriella Anna Rapszky Veronika E. Kiss Szilard Sandor Szabolcs Gaal-Marschal Tamas Berenyi Csaba Varga Bank G. Fenyves Empiric antibiotic therapy resistance and mortality in emergency department patients with bloodstream infection: a retrospective cohort study BMC Emergency Medicine Sepsis E. Coli S. Aureus East-Central Europe Hungary |
| title | Empiric antibiotic therapy resistance and mortality in emergency department patients with bloodstream infection: a retrospective cohort study |
| title_full | Empiric antibiotic therapy resistance and mortality in emergency department patients with bloodstream infection: a retrospective cohort study |
| title_fullStr | Empiric antibiotic therapy resistance and mortality in emergency department patients with bloodstream infection: a retrospective cohort study |
| title_full_unstemmed | Empiric antibiotic therapy resistance and mortality in emergency department patients with bloodstream infection: a retrospective cohort study |
| title_short | Empiric antibiotic therapy resistance and mortality in emergency department patients with bloodstream infection: a retrospective cohort study |
| title_sort | empiric antibiotic therapy resistance and mortality in emergency department patients with bloodstream infection a retrospective cohort study |
| topic | Sepsis E. Coli S. Aureus East-Central Europe Hungary |
| url | https://doi.org/10.1186/s12873-025-01177-0 |
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