XXXX ; a multi-centre prospective evaluation of empiric antibiotic therapy and outcome in English acute hospitals.

@entity1 @entity7120 @entity281 @entity6281 @entity581 @entity4005 @entity3400 @entity582 @entity526
UNASSIGNED: Increasing antibiotic resistance makes choosing antibiotics for suspected Gram-negative @entity281 challenging. This study set out to identify key determinants of mortality among @entity1 with @entity6281 , focusing particularly on the importance of appropriate empiric antibiotic treatment. We conducted a prospective observational study of 679 unselected adults with @entity6281 at ten acute english hospitals between October 2013 and March 2014. Appropriate empiric antibiotic treatment was defined as intravenous treatment on the day of blood culture collection with an antibiotic to which the cultured organism was sensitive in  vitro. Mortality analyses were adjusted for @entity1 demographics, co-morbidities and illness severity. The majority of @entity582 were community-onset (70%); most were caused by @entity526 (65%), @entity4005 spp. (15%) or Pseudomonas spp. (7%). Main foci of @entity281 were urinary tract (51%), abdomen/biliary tract (20%) and lower respiratory tract (14%). The main antibiotics used were co-amoxiclav (32%) and @entity3400 - @entity7120 (30%) with 34% receiving combination therapy (predominantly @entity581 ). Empiric treatment was inappropriate in 34%. All-cause mortality was 8% at 7 days and 15% at 30 days. Independent predictors of mortality (p <0.05) included older age, greater burden of co-morbid disease, severity of illness at presentation and inflammatory response. Inappropriate empiric antibiotic therapy was not associated with mortality at either time-point (adjusted OR 0.82; 95% CI 0.35-1.94 and adjusted OR 0.92; 95% CI 0.50-1.66, respectively). Although our study does not exclude an impact of empiric antibiotic choice on survival in @entity6281 , outcome is determined primarily by @entity1 and disease factors.
