Early PDAT Shows Promise for Bacteremia

TOPLINE:

Early receipt of a phenotype-desirable antimicrobial therapy (PDAT), defined as beta-lactam antibiotic with the narrowest spectrum of activity that effectively targets the pathogen’s phenotype, improves 30-day clinical outcomes in patients hospitalized with Enterobacterales bacteremia.

METHODOLOGY:

• Researchers conducted a retrospective cohort study to compare the clinical outcomes in patients hospitalized with Enterobacterales bloodstream infections caused by Escherichia coli, Klebsiella oxytoca, K pneumoniae, or Proteus mirabilis who received either early or delayed PDAT.
• They analyzed 8193 patients (mean age, 69 years; 58.1% women) with inpatient admissions between January 1, 2017 and June 30, 2022.
• Early PDAT was defined as receipt of PDAT within 0-2 days of blood culture collection, while delayed PDAT was defined as initiation on days 3-4.
• The main outcome was adjusted desirability of outcome ranking (DOOR) proportions, wherein patients were ranked from 1 (most desirable outcome, alive with no events) to 5 (least desirable outcome, death) within 30 days of blood culture collection or discharge.

TAKEAWAY:

• Compared with patients receiving delayed PDAT, those receiving early PDAT were 20% less likely (odds ratio, 0.80; 95% CI, 0.69-0.92) to be readmitted to the hospital within 30 days and had significantly fewer hospitalization days (P = .001).
• The percentage of patients achieving a DOOR of 1 was higher with early PDAT (56.3%) than with delayed PDAT (50.8%; P = .001).
• Moreover, patients receiving early PDAT had a 52% probability of achieving a desirable clinical outcome than those receiving delayed PDAT.

IN PRACTICE:

“Starting early PDAT may be important not only for antimicrobial stewardship but also for improving the clinical outcome of affected patients,” the authors wrote.

SOURCE:

This study was led by Rena C. Moon, MD, MPH, PINC AI Applied Sciences, Premier Inc., Charlotte, North Carolina. It was published online on December 23, 2024, in the JAMA Network Open. 

LIMITATIONS:

This study relied on administrative secondary data, which may have potential coding errors. Microbiological data may be prone to measurement error. The timing of antibiotic administration was not recorded. Patients with polymicrobial and intra-abdominal infections were excluded, limiting the generalizability of the findings.

DISCLOSURES:

This study was funded by bioMérieux, Inc, which also contributed to the study’s design, funded the data use fee, and manuscript preparation. Authors involved in the study served as employees of bioMérieux, Inc., and Premier Inc. during the conduct of the study and outside of the submitted work.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.