Background
Methods
Search strategy
Inclusion and exclusion criteria
Data extraction and statistical analysis
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All DAT (includes studies with DAT > 24, > 48, or > 72 h from the time of culture collection and results from studies with DAT > C& SR)
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DAT > 24 h and DAT > C& SR, combined
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DAT > 48 h and DAT > C& SR, combinedo This approximates the typical 48- to 72-h time frame for reporting of culture and susceptibility data
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Additional DAT categorieso DAT > 24 ho DAT > 48 ho DAT > 72 ho DAT > C& SR
Results
Systematic literature search
Author, Year | Time Point for DAT, h | Pathogen | Resistance Status | Therapy Type | Infection Type | n/N | Mortality Rate, % |
---|---|---|---|---|---|---|---|
Abhilash et al., 2010 [12] | 48 | K. pneumoniae or E. coli | 73.3% ESBL producing | Appropriate | Bacteremia; primary sources: UTI, intra-abdominal, pneumonia | 17/74 | 23.0 |
DAT | 16/57 | 28.1 | |||||
Anderson et al., 2006 [13] | 72 |
K. pneumoniae
| 7.7% CAZ-R (of which 85% ESBL producers) | Appropriate | Bacteremia | 12/38 | 31.6 |
DAT | 14/22 | 63.6 | |||||
Daikos et al., 2009 [11] | NR |
K. pneumoniae
| 41.4% VPKP (of which 20.9% CRE) | Appropriate | Bacteremia | 23/137 | 16.8 |
DAT | 8/25 | 32.0 | |||||
Du et al., 2002 [14] | NR | K. pneumoniae or E. coli | 27% ESBL producers | Appropriate | Bacteremia | 14/71 | 19.7 |
DAT | 7/14 | 50.0 | |||||
Gransden et al., 1990 [15] | 48 |
E. coli
| NR | Appropriate | Bacteremia; primary source: UTI, othera | 109/659 | 16.5 |
DAT | 36/132 | 27.3 | |||||
Jung et al., 2012 [16] | NR |
K. pneumoniae
| 3.3% ESBL producers | Appropriate | Bacteremia; primary source: UTI, otherb | 82/500 | 16.4 |
DAT | 15/54 | 27.8 | |||||
Kang et al., 2004 [17] | 24 |
K. pneumoniae
| 100% ESBL producers (study-selected) | Appropriate | Bacteremia; primary source: pancreatobiliary tract, liver, pneumonia, UTI, peritonitis | 7/33 | 21.2 |
DAT | 3/14 | 21.4 | |||||
24 |
E. coli
| Appropriate | 2/25 | 8.0 | |||
DAT | 4/23 | 17.4 | |||||
Kang et al., 2013 [18] | 72 |
E. coli
| 100% ESBL producers (study-selected) | Appropriate | Bacteremia; primary source: bacteremia, UTI, biliary tract, intra-abdominal, pneumonia | 3/28 | 10.7 |
DAT | 7/64 | 10.9 | |||||
Kim et al., 2002 [19] | 72 |
K. pneumoniae
| 27.2% ESBL producers | Appropriate | Bacteremia; primary source: bacteremia, biliary, pneumonia, UTI, liver, peritonitis | 5/19 | 26.3 |
DAT | 5/24 | 20.8 | |||||
Lee et al., 2012 [30] | NR | K. pneumoniae or E. coli | 100% ESBL producers (study-selected) | Appropriate | Bacteremia; primary source: pneumonia, urosepsis, otherc | 25/230 | 10.9 |
DAT | 8/21 | 38.1 | |||||
Metan et al., 2005 [20] | NR |
E. coli
| 100% ESBL producers (study-selected) | Appropriate | Bacteremia; primary source: pneumonia, UTI, pancreaticobiliary tract, post-surgical wound, cellulitis, abdominal abscess | 12/45 | 26.7 |
DAT | 2/8 | 25.0 | |||||
Micek et al., 2010 [21] | 24 |
E. coli
| 3% ESBL producers | Appropriate | Bacteremia; primary source: lungs, UTI, central venous catheter, intra-abdominal | 60/188 | 31.9 |
DAT | 11/37 | 29.7 | |||||
24 |
K. pneumoniae
| 8.5% ESBL producers | Appropriate | 47/129 | 36.4 | ||
DAT | 15/30 | 50.0 | |||||
Ortega et al., 2011 [22] | NR |
K. pneumoniae
| 12% CTX-R | Appropriate | Bacteremia; primary source: UTI, biliary, catheter-related, pneumonia, abdomen, skin and soft tissue | 82/824 | 10.0 |
DAT | 14/86 | 16.3 | |||||
Park et al., 2011 [23] | 24 |
E. coli
| 100% ESBL producers (study-selected) | Appropriate | Bacteremia; primary source: UTI, intra-abdominal; hepatobiliary; skin and soft tissue | 10/108 | 9.3 |
DAT | 7/42 | 16.7 | |||||
Rodriguez-Bano et al., 2010 [24] | 24 |
E. coli
| 100% ESBL producers (study-selected) | Appropriate | Bacteremia; primary source: UTI, intra-abdominal, respiratory tract | 16/53 | 30.2 |
DAT | 13/43 | 30.2 | |||||
Schiappa et al., 1996 [25] | 72 | K. pneumoniae or E. coli | 100% CAZ-R (study-selected) | Appropriate | Bacteremia | 1/19 | 5.3 |
DAT | 5/12 | 41.7 | |||||
Tuon et al., 2011 [26] | 48 |
K. pneumoniae
| 60% ESBL producers | Appropriate | Bacteremia | 28/55 | 50.9 |
DAT | 20/49 | 40.8 | |||||
Wang et al., 2011 [27] | NR | K. pneumoniae or E. coli | 100% ESBL producers (study-selected) | Appropriate | Bacteremia; primary source: pneumonia, urosepsis, intra-abdominal, bacteremia, vascular catheter-related, skin and soft tissue | 12/50 | 24.0 |
DAT | 15/63 | 23.8 | |||||
Wu et al., 2012 [28] | 48 |
E. coli
| 100% ESBL producers (study-selected) | Appropriate | Bacteremia; primary source: urinary tract, intra-abdominal, bacteremia | 4/24 | 16.7 |
DAT | 9/38 | 23.4 | |||||
Zarkotou et al., 2011 [29] | 24 |
K. pneumonia
| 100% KPC producers (study-selected) | Appropriate | Bacteremia; primary source: central venous catheter, respiratory tract, UTI, skin or soft tissue, central nervous system | 5/14 | 35.7 |
DAT | 13/39 | 33.3 |
Patient mortality by delayed appropriate therapy time frame
Overall delayed appropriate therapy
Delayed appropriate therapy > 48 hours or delayed appropriate therapy > C& SR, combined
Delayed appropriate therapy > 24 hours
Definition | K. pneumoniae or E. coli Infections | K. pneumoniae Infections Alone | E. coli Infections Alone | |||
---|---|---|---|---|---|---|
Studies, n [Ref] | OR (95% CI) | Studies, n [Ref] | OR (95% CI) | Studies, n [Ref] | OR (95% CI) | |
DAT > 24 h | 5 [17, 21, 23, 24, 29] | 1.24 (0.85–1.80) | 3 [17, 21, 29] | 1.37 (0.73–2.54) | 4 [17, 21, 23, 24] | 1.19 (0.73–1.93) |
DAT > 48 h | 4 [12, 15, 26, 28] | 1.33 (0.84–2.12) | 1 [26] | a | 2 [15, 28] | 1.86 (1.23–2.80) |
DAT > 72 h | 4 [13, 18, 19, 25] | 2.12 (0.66–6.79) | 2 [13, 19] | 1.93 (0.25–12.48) | 1 [25] | a |
DAT > C& SR | 7 [11, 14, 16, 20, 22, 27, 30] | 2.06 (1.36–3.12) | 3 [11, 16, 22] | 1.93 (1.29–2.89) | 1 [20] | a |
All (Any DAT > 24 or DAT > C& SR) | 20 [11–30] | 1.60 (1.25–2.05) | 9 [11, 13, 16, 17, 19, 21, 22, 26, 29] | 1.53 (1.07–2.17) | 8 [15, 17, 18, 20, 21, 23, 24, 28] | 1.49 (1.10–2.01) |