Prompt therapy a must to reduce mortality in severe bacterial infection patients
Timing of appropriate therapy is important in the management of patients with severe bacterial infections, that is any delay should be avoided to reduce mortality in this population, according to a study.
Researchers performed a systematic review of available literature and searched multiple online databases for studies examining the impact of delayed appropriate therapy on clinical outcomes for hospitalized adult patients with bacterial infections. They pooled and analysed data by modelling delayed therapy three ways: delay vs no delay in receiving appropriate therapy; duration of delay; and inappropriate vs appropriate initial therapy.
Thirty-seven studies were included in the analysis: three prospective, 32 retrospective, and two case-control studies. Two studies were performed internationally, and 35 in single countries across Europe, Asia, and the US. Sample sizes ranged between 31 and 40,137 patients, with 26 studies analysing data from ≥100 patients.
Patient age range was 15–102 years, and average age ranged from 47 to 71 years. Most studies (85 percent) involved infections due to various organisms, and 14 examined infections caused by a single pathogen such as Staphylococcus aureus (five studies) and Streptococcus pneumoniae (three studies). Six studies assessed only infections caused by pathogens resistant to at least one class of antibiotic, or infections with those producing extended-spectrum beta-lactamases or carbapenemases.
Compared with delayed treatment, receipt of prompt appropriate therapy was associated with significantly lower mortality (odds ratio [OR], 0.57, 95 percent confidence interval [CI], 0.45–0.72). This was true in studies reporting mortality at 20–30 days (OR, 0.57, 95 percent CI, 0.43–0.76), mortality during intensive care unit stay (OR, 0.47, 95 percent CI, 0.27–0.80), and involving patients with bacteraemia (OR, 0.54, 95 percent CI, 0.40–0.75).
There was no difference seen in time to appropriate therapy between patients who died and those who survived (p=0.09), although heterogeneity between studies was high.
The present data highlight the importance of administering appropriate therapy early in the course of infection to improve meaningful outcomes such as mortality, the researchers said. It supports the recommended approach of early broad-spectrum empiric therapy, followed by de-escalation to targeted treatment, rather than use of antibiotic escalation strategies.