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Impact of withholding early antibiotic therapy in nonseptic surgical patients with suspected nosocomial infection: a retrospective cohort analysis

Authors :
Estevão Bassi
Bruno Martins Tomazini
Bárbara Vieira Carneiro
Amanda Rodrigues de Oliveira Siqueira
Sara Rodrigues de Oliveira Siqueira
Thais Guimarães
Fernando da Costa Ferreira Novo
Edivaldo Massazo Utiyama
Paolo Pelosi
Luiz Marcelo Sá Malbouisson
Source :
Brazilian Journal of Anesthesiology, Vol 74, Iss 3, Pp 744431- (2024)
Publication Year :
2024
Publisher :
Elsevier, 2024.

Abstract

Background: Systemic inflammatory responses mimicking infectious complications are often present in surgical patients. Methods: The objective was to assess the association between withholding early antimicrobial therapy while investigating alternative diagnoses and worse outcomes in nonseptic patients with suspected nosocomial infection in a retrospective cohort of critically ill surgical patients. The initiation of antibiotic therapy within 24 h of the suspicion of infection was defined as the Early Empirical Antibiotic strategy (EEA) group and the initiation after 24 h of suspicion or not prescribed was defined as the Conservative Antibiotic strategy (CA) group. Primary outcome was composite: death, sepsis, or septic shock within 14 days. Main exclusion criteria were sepsis or an evident source of infection at inclusion. Results: Three hundred and forty patients were eligible for inclusion (74% trauma patients). Age, sex, reason for hospital admission, SAPS3 score, SOFA score, and use of vasopressors or mechanical ventilation were not different between the groups. Within 14 days of inclusion, 100% (130/130) of EEA patients received antibiotics compared to 57% (120/210) of CA patients. After adjusting for confounding variables, there was no association between primary outcome and the groups. In a post hoc subgroup analysis including only patients with a posteriori confirmed infection (by microbiological cultures), delay in initiation of adequate antimicrobial therapy was independently associated with the primary outcome (Odds Ratio = 1.19 per day of delay; 95% CI 1.05–1.37). Conclusions: Withholding early empiric antibiotic therapy was not associated with progression of organ dysfunction within 14 days in nonseptic surgical patients with suspected nosocomial infection without an obvious source.

Details

Language :
English
ISSN :
01040014
Volume :
74
Issue :
3
Database :
Directory of Open Access Journals
Journal :
Brazilian Journal of Anesthesiology
Publication Type :
Academic Journal
Accession number :
edsdoj.b2332c82e89a4aa39d283f2ff7702134
Document Type :
article
Full Text :
https://doi.org/10.1016/j.bjane.2023.03.003