Background
Patients and methods
Results
Disposition of patients
Baseline demographic and clinical characteristics
Intervention | Non intervention | ||||
---|---|---|---|---|---|
Complete | Partial | Non adherence | Total | ||
N | 199 | 141 | 231 | 571 | 602 |
Age (years; mean ± SD) | 64.9 ± 17.6 | 64.7 ± 15.8 | 64.8 ± 17.8 | 64.8 ± 17.2 | 65.0 ± 17.2 |
≤65 | 90 (45.2) | 69 (48.9) | 99 (42.8) | 258 (45.2) | 272 (45.2) |
66-75 | 38 (19.1) | 33 (23.4) | 60 (26.0) | 131 (22.9) | 128 (21.3) |
>75 | 71 (35.7) | 39 (27.7) | 72 (31.2) | 182 (31.9) | 202 (33.5) |
Males | 127 (63.8) | 91 (64.5) | 142 (61.5) | 360 (63.0) | 375 (62.3) |
Coming from healthcare facilities | 47 (23.6) | 26 (18.4) | 63 (27.3) | 136 (23.8) | 103 (17.1) |
Prior hospitalization (previous 30 days) | 56 (28.1) | 41 (29.1) | 76 (32.9) | 173 (30.3) | 150 (24.9) |
Prior hospitalization (previous 90 days) | 81 (40.7) | 53 (37.6) | 89 (38.5) | 223 (39.1) | 184 (30.6) |
Ward of admission (Surgical) | 102 (51.3) | 89 (63.1) | 158 (68.4) a
| 349 (61.1) | 423 (70.3) |
Charlson (mean ± SD) | 2.26 ± 2.04 | 2.74 ± 2.38 | 2.38 ± 2.15 | 2.43 ± 2.18 | 2. 09 ± 2.10 |
≤1 | 82 (41.2) | 53 (37.6) | 90 (39.0) | 225 (39.4) | 293 (48.7) |
2 | 44 (22.1) | 23 (16.3) | 42 (18.2) | 109 (19.1) | 111 (18.4) |
3 | 34 (17.1) | 20 (14.2) | 36 (15.6) | 90 (15.8) | 69 (11.5) |
≥4 | 39 (19.6) | 45 (31.9) | 63 (27.3) | 147 (25.7) | 129 (21.4) |
Mc Cabe (Fatal) | 64 (32.2) | 55 (39.0) | 72 (31.2) | 191 (33.4) | 201 (33.4) |
Reason for admission (infectious disease) | 102 (51.3) | 68 (48.2) | 111 (48.1) | 281 (49.2) | 299 (49.7) |
Baseline microbiological data
Intervention | Non intervention | ||||
---|---|---|---|---|---|
Complete | Partial | Non adherence | Total | ||
N | 199 | 141 | 231 | 571 | 602 |
Patients with no microbiological tests | 42 (21.1) | 35 (24.8) | 86 (37.2) a
| 163 (28.5) | 212 (35.2) |
Patients with serology | 17 (8.5) | 3 (2.1) | 9 (3.9) | 29 (5.1) | 22 (3.7) |
Patients with culture | 140 (70.4) | 103 (73.1) | 136 (58.8) | 379 (66.4) | 368 (61.1) |
Positive cultures | 80 (57.1) | 65 (63.1) | 80 (58.8) | 225 (59.3) | 177 (48.1) |
E. coli
| 16 (20.0) | 17 (26.2) | 16 (20.0) | 49 (21.8) | 43 (24.3) |
S. pneumoniae
| 13 (16.3) | 6 (9.2) | 9 (11.3) | 28 (12.4) | 21 (11.9) |
P. aeruginosa
| 11 (13.8) | 7 (10.8) | 10 (12.5) | 28 (12.4) | 13 (7.3) |
Characteristics of antibiotic treatments prior to ID recommendations
Intervention | Non intervention | ||||
---|---|---|---|---|---|
Complete | Partial | Non adherence | Total | ||
N | 199 | 141 | 231 | 571 | 602 |
Type of treatment | |||||
Empirical | 186 (93.5) | 130 (92.2) | 183 (79.2) | 499 (87.4) | 458 (76.1) |
Prolonged Prophylaxis | 13 (6.5) | 10 (7.1) | 45 (19.5) a
| 68 (11.9) | 141 (23.4) b
|
Microbiologically-based | 0 (0.0) | 1 (0.7) | 3 (1.3) | 4 (0.7) | 3 (0.5) |
Antibiotic regimens including | |||||
One compound | 119 (59.8) | 93 (66.0) | 170 (73.6) | 382 (66.9) | 451 (74.9) |
Two or more compounds | 80 (40.2) | 48 (34.0) | 61 (26.4) | 189 (33.1) | 151 (25.1) |
Treatment initiation in Emergency room | 56 (28.1) | 40 (28.4) | 65 (28.1) | 161 (28.2) | 97 (16.1) b
|
Treatment evaluation (initial) | 199 | 141 | 231 | 571 | 602 |
Adequate | 70 (35.2) | 22 (15.6) a
| 4 (1.7) a,c
| 96 (16.8) | 60 (10.0) |
Inadequate | 129 (64.8) | 115 (81.6) a
| 222 (96.1) a,c
| 466 (81.6) | 531 (88.2) |
Unnecessary | 0 (0.0) | 4 (2.8) | 5 (2.2) | 9 (1.6) | 11 (1.8) |
Modification of initial treatment | 129 (64.8) | 52 (36.9) a
| 33 (14.3) a,c
| 214 (37.5) | 105 (17.4) b
|
Outcome
Intervention | Non intervention | ||||
---|---|---|---|---|---|
Complete | Partial | Non adherence | Total | ||
N | 199 | 141 | 231 | 571 | 602 |
Length of hospitalization (days; mean ±SD) | 24.1 ± 29.3 | 26.5 ± 24.3 | 20.2 ± 18.8 | 23.1 ± 24.3 | 20.3 ± 33.8 |
Clinical outcome
| |||||
Cure + improvement | 184 (92.5) | 121 (85.8) | 185 (80.1) a
| 490 (85.8) | 493 (81.9) a
|
Death | 4 (2.0) | 5 (3.5) | 12 (5.2) | 21 (3.7) | 30 (5.0) |
Microbiological outcome
| |||||
No. patients microbiologically evaluableb
| 36 (18.1) | 29 (20.6) | 40 (17.3) | 105 (18.4) | 85 (14.1) |
Eradication | 25 (69.4) | 11 (37.9) | 8 (20.0) a
| 44 (41.9) | 18 (21.2) a,c
|
Factors associated with adherence and clinical outcome
Success | Failure | P | OR | |
---|---|---|---|---|
N | 983 | 190 | Bivariate | Multivariate |
Age (mean ± SD) | 64.1 ± 17.6 | 68.9 ± 14.7 | <0.001 | p= 0.100 |
Coming from healthcare facilities | 183 (18.6) | 56 (29.5) | 0.001 | p= 0.215 |
Prior hospitalization (previous 30 days) | 255 (25.9) | 68 (35.8) | 0.005 | p= 0.625 |
Charlson index | 2.07 ± 2.07 | 3.17 ± 2.16 | <0.001 |
1.19 (1.10-1.28) p<0.001
|
Heart failure | 358 (36.4) | 94 (49.5) | 0.001 | p= 0.123 |
Renal insufficiency | 281 (28.6) | 86 (45.3) | <0.001 | p= 0.155 |
Diabetes | 408 (41.5) | 93 (48.9) | 0.058 | p= 0.744 |
Malignancies | 384 (39.0) | 104 (54.7) | <0.001 | p= 0.775 |
Immunosuppressive therapy | 178 (18.1) | 47 (24.7) | 0.034 | p= 0.262 |
Malnutrition | 74 (7.5) | 34 (17.9) | <0.001 |
2.00 (1.22-3.26) p=0.006
|
Nosocomial infection | 187 (25.3) | 88 (51.8) | <0.001 |
4.12 (2.27-7.48) p<0.001
|
Microbiological tests | 652 (66.3) | 160 (84.2) | <0.001 | p= 0.020 |
Complete adherence | 184 (18.7) | 15 (7.9) | 0.001 |
0.35 (0.19-0.64) p=0.001
|
Treatment initiated in Emergency room | 777 (79.0) | 138 (72.6) | 0.051 | p= 0.023 |
Adequate initial treatment | 147 (15.0) | 9 (4.7) | <0.001 |
0.39 (0.19-0.80) p=0.010
|
Modification of initial treatment | 306 (31.1) | 43 (22.6) | 0.019 | p= 0.140 |
Length of hospitalization | 18.9 (27.0) | 36.3 (37.4) | <0.001 |
1.01 (1.01-1.02) p<0.001
|