Influence of Appropriate Empirical Antibiotic Treatment on the Prognosis of ICU Patients with HAP Caused by Carbapenem-Resistant Gram-Negative Bacteria

Xiaoling Zhang; Xuting Jin; Jiajia Ren; Jueheng Liu; Haichang Ma; Xiaoming Fang; Huifan Zhang; Yujie Zhao; Yanli Hou; Yanni Luo; Lei Guo; Qi Ma; Ya Gao; Jingjing Zhang; Jiamei Li; Xiaochuang Wang; Gang Wang

doi:10.2147/IDR.S407383

Influence of Appropriate Empirical Antibiotic Treatment on the Prognosis of ICU Patients with HAP Caused by Carbapenem-Resistant Gram-Negative Bacteria

Infect Drug Resist. 2023 May 30:16:3389-3398. doi: 10.2147/IDR.S407383. eCollection 2023.

Authors

Xiaoling Zhang¹, Xuting Jin¹, Jiajia Ren¹, Jueheng Liu¹, Haichang Ma¹, Xiaoming Fang¹, Huifan Zhang¹, Yujie Zhao¹, Yanli Hou¹, Yanni Luo¹, Lei Guo¹, Qi Ma¹, Ya Gao¹, Jingjing Zhang¹, Jiamei Li¹, Xiaochuang Wang¹, Gang Wang¹

Affiliation

¹ Department of Critical Care Medicine, the Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi Province, People's Republic of China.

Abstract

Purpose: In patients with carbapenem-resistant Gram-negative bacteria (CRGNB) infection, the impact of appropriate empirical antibiotic treatment (AEAT) initialized before culture results were available remains controversial. We aimed to investigate the effect of AEAT on the prognosis of critically ill patients with hospital-acquired pneumonia (HAP) caused by CRGNB.

Patients and methods: Patients with CRGNB-infected HAP and received empirical antibiotic treatment (EAT) for at least 3 days in the intensive care unit (ICU) of a tertiary teaching hospital in China from February 2017 to September 2021 were included in the retrospective cohort study. Patients were categorized into AEAT and inappropriate empirical antibiotic treatment (IEAT) groups based on whether they received EAT covering CRGNB. The associations of AEAT with ICU and 28-day mortality were assessed using multivariable logistic regression model.

Results: A total of 94 patients were enrolled, including 29 patients in AEAT group and 65 patients in IEAT group. Patients in AEAT group had a higher Sequential Organ Failure Assessment (SOFA) score (P = 0.003), levels of procalcitonin (PCT) (P = 0.001), and lactic acid (LAC) (P = 0.026); while patients in the IEAT group had a higher platelet count (PLT) (P = 0.001). There was no significant difference in the length of ICU stay between the two groups (P = 0.051). Compared with IEAT, AEAT was associated with an increased risk of 28-day mortality in the univariable logistic regression model (OR: 2.618, 95% CI: 1.063-6.448). However, after adjusted for SOFA score, PLT, PCT, and LAC level, the association between AEAT and 28-day mortality diminished (OR: 1.028, 95% CI: 0.353-2.996). AEAT showed no significant association with ICU mortality in neither univariable (OR: 1.167, 95% CI: 0.433-3.142) nor multivariable (OR: 0.357, 95% CI: 0.097-1.320) models.

Conclusion: AEAT showed no significant influence on ICU or 28-day mortality in critically ill patients with HAP caused by CRGNB infection.

Keywords: ICU mortality; appropriate empirical antibiotics; carbapenem-resistant; gram-negative bacteria; hospital-acquired pneumonia.

Grants and funding

This study was supported by the National Key Research and Development Program of China (2018YFC1705905) and the Young Talent Support Program of Shaanxi Province University.