Retrospective Study
Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Mar 28, 2015; 21(12): 3587-3592
Published online Mar 28, 2015. doi: 10.3748/wjg.v21.i12.3587
Appropriate empirical antibiotic use and 30-d mortality in cirrhotic patients with bacteremia
Hyun Park, Ki Jun Jang, Won Jang, Sang Hoon Park, Ji Young Park, Tae Joo Jeon, Tae Hoon Oh, Won Chang Shin, Won-Choong Choi, Dong Hyun Sinn
Hyun Park, Ki Jun Jang, Won Jang, Sang Hoon Park, Ji Young Park, Tae Joo Jeon, Tae Hoon Oh, Won Chang Shin, Won-Choong Choi, Department of Internal Medicine, Sanggye Paik Hospital, Inje University, Seoul 135-710, South Korea
Dong Hyun Sinn, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 135-710, South Korea
Author contributions: Park H provided the data collection, statistical analysis, and writing of the draft manuscript; Jang KJ, Jang W and Park SH performed data collection; Park JY, Oh TH, Shin WC and Choi WC performed critical revision of the manuscript; Sinn DH designed this study, statistical analysis, critical revision of the manuscript; all authors approved the final submission.
Ethics approval: All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation and with the Helsinki Declaration of 1975, as revised in 2008, and was reviewed and approved by the Institutional Review Board at Sanggye Paik Hospital.
Informed consent: Waived by the Institutional Review Board.
Conflict-of-interest: The authors (Park H, Jang KJ, Jang W, Park SH, Park JY, Jeon TJ, Oh TH, Shin WC, Choi WC and Sinn DH) declare no conflict of interest relevant to this study.
Data sharing: No additional data are available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Dong Hyun Sinn, MD, PhD, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-Gu, Seoul 135-710, South Korea. sinndhn@hanmail.net
Telephone: +82-2-34103409 Fax: +82-2-34106983
Received: September 27, 2014
Peer-review started: September 29, 2014
First decision: November 26, 2014
Revised: December 1, 2014
Accepted: January 8, 2015
Article in press: January 8, 2015
Published online: March 28, 2015
Processing time: 184 Days and 4.4 Hours
Abstract

AIM: To analyze whether prompt and appropriate empirical antibiotic (AEA) use is associated with mortality in cirrhotic patients with bacteremia.

METHODS: A total of 102 episodes of bacteremia in 72 patients with cirrhosis were analyzed. AEA was defined as a using or starting an antibiotic appropriate to the isolated pathogen at the time of bacteremia. The primary endpoint was 30-d mortality.

RESULTS: The mortality rate at 30 d was 30.4% (31/102 episodes). Use of AEA was associated with better survival at 30 d (76.5% vs 46.9%, P = 0.05), and inappropriate empirical antibiotic (IEA) use was an independent factor associated with increased mortality (OR = 3.24; 95%CI: 1.50-7.00; P = 0.003, adjusted for age, sex, Child-Pugh Class, gastrointestinal bleeding, presence of septic shock). IEA use was more frequent when the isolated pathogen was a multiresistant pathogen, and when infection was healthcare-related or hospital-acquired.

CONCLUSION: AEA use was associated with increased survival of cirrhotic patients who developed bacteremia. Strategies for AEA use, tailored according to the local epidemiological patterns, are needed to improve survival of cirrhotic patients with bacteremia.

Keywords: Liver cirrhosis; Bacteremia; Appropriate antibiotics; Survival; Multiresistant pathogen

Core tip: Appropriate empirical antibiotic use was associated with improved survival in cirrhotic patients with bacteremia, indicating the importance of initial antibiotic selection.