Table 1 Demographic and clinical characteristics of patients
Variables | Overall (N = 457) | Before EUCAST update (n = 148) | After EUCAST update, without selective reporting (n = 202) | After EUCAST update, with selective reporting (n = 107) | P-value (all periods) | P- value (period 2 vs period 3) |
|---|---|---|---|---|---|---|
Female | 176 (38.5) | 58 (39.2) | 73 (36.1) | 45 (42.1) | 0.5 | 0.3 |
Age | 68.7 (54.4; 78.2) | 68.7 (51.5; 77.4) | 69.8 (57.1; 78.9) | 65.6 (53.3; 77.9) | 0.8 | 0.4 |
Immunosuppression* | 78 (17.1) | 26 (17.6) | 39 (19.3) | 13 (12.15) | 0.2 | 0.1 |
Immunosuppressive treatment | 17 (3.7) | 7 (4.7) | 9 (4.5) | 1 (0.9) | 0.2 | 0.09 |
Myeloablative chemotherapy (< 1 month) | 9 (1.9) | 4 (2.7) | 5 (2.5) | 0 (0.0) | 0.2 | 0.1 |
Neutropenia | 17 (3.7) | 3 (2.0) | 12 (5.9) | 2 (1.9) | 0.08 | 0.1 |
Solid organ transplant recipient | 21 (4.6) | 8 (5.4) | 11 (5.5) | 2 (1.9) | 0.3 | 0.1 |
Other Immunosuppression | 29 (6.4) | 10 (6.8) | 13 (6.4) | 6 (5.6) | 0.8 | 0.7 |
History of ESBL producing Enterobacteriaceae (infection/colonisation during the six previous months)** | 10 (2.2) | 4 (2.7) | 3 (1.5) | 3 (2.8) | 0.6 | 0.4 |
Severity of current infection | 0.2 | 0.1 | ||||
None | 364 (80.0) | 115 (77.7) | 160 (79.2) | 91 (85.1) | ||
Sepsis | 63 (13.9) | 25 (16.9) | 25 (12.4) | 13 (12.2) | ||
Sepsis shock | 28 (6.2) | 8 (5.4) | 17 (8.4) | 3 (2.8) | ||
McCabe score for current infection | 0.003 | 0.04 | ||||
Rapidly fatal disease (< 1 year) | 69 (15.1) | 32 (21.6) | 30 (14.9) | 7 (6.5) | ||
Ultimately fatal disease (1–4 years) | 164 (35.9) | 41 (27.7) | 74 (36.1) | 51 (46.7) | ||
Non-fatal disease (> 5 years) | 224 (49.1) | 75 (50.7) | 99 (49.1) | 50 (46.7) | ||
Patients’ location | 0.1 | 0.2 | ||||
Emergency Room | 5 (1.1) | 2 (1.4) | 3 (1.5) | 0 (0.0) | ||
Intensive care | 56 (12.3) | 14 (9.5) | 28 (13.9) | 14 (13.1) | ||
Medical ward | 178 (38.9) | 52 (35.1) | 89 (43.8) | 37 (34.6) | ||
Rehabilitation ward | 9 (1.9) | 2 (1.4) | 3 (1.5) | 4 (3.7) | ||
Surgical ward | 154 (33.7) | 53 (35.8) | 60 (28.7) | 41 (38.3) | ||
Outpatient | 55 (12.1) | 25 (16.9) | 19 (9.4) | 11 (10.3) | ||
Infection’s setting | 0.05 | 0.9 | ||||
Community acquired | 201 (43.9) | 77 (52.1) | 81 (40.1) | 43 (40.2) | ||
Healthcare-associated*** | 256 (56.1) | 71 (47.9) | 121 (59.9) | 107 (59.8) | ||
Site of infection | 0.2 | 0.4 | ||||
Bacteraemia without focus | 8 (1.7) | 0 (0.0) | 7 (3.5) | 1 (0.9) | ||
Bone/joints | 30 (6.5) | 11 (7.4) | 11 (5.5) | 8 (7.5) | ||
Catheter-related bacteraemia | 9 (1.9) | 1 (0.7) | 5 (2.5) | 3 (2.8) | ||
Central nervous system | 2 (0.4) | 0 (0.0) | 0 (0.0) | 2 (1.9) | ||
Digestive | 30 (6.6) | 9 (6.1) | 17 (7.9) | 5 (4.7) | ||
Endovascular | 6 (1.3) | 4 (2.7) | 2 (0.9) | 0 (0.0) | ||
ENT | 23 (5.1) | 8 (5.4) | 9 (4.5) | 6 (5.6) | ||
Gynaecological/obstetrical | 1 (0.2) | 1 (0.7) | 0 (0.0) | 0 (0.0) | ||
Low respiratory tract | 176 (38.5) | 62 (41.9) | 71 (35.2) | 43 (40.2) | ||
Mucocutaneous | 52 (11.4) | 13 (8.8) | 24 (11.9) | 15 (14.2) | ||
Urinary tract | 110 (24.1) | 37 (25.0) | 51 (25.3) | 22 (20.6) | ||
Other soft tissue infection | 10 (2.2) | 2 (1.4) | 6 (2.9) | 2 (1.9) | ||
Gram negative rod coinfection | 117 (25.6) | 39 (26.4) | 56 (27.7) | 22 (20.6) | 0.3 | 0.1 |
Antibiotic prescription before susceptibility testing‡ | 334 (73.1) | 102 (68.9) | 160 (79.2) | 72 (67.3) | 0.03 | 0.02 |
Type of antibiotic prescribed before susceptibility testing | 0.8 | 0.9 | ||||
Cefepime | 36 (10.8) | 9 (8.8) | 21 (13.1) | 6 (8.3) | ||
Ceftazidime | 10 (2.9) | 1 (1.0) | 6 (3.8) | 3 (4.2) | ||
Ciprofloxacin | 36 (10.8) | 12 (11.8) | 17 (10.6) | 7 (9.7) | ||
Imipenem | 6 (1.8) | 2 (2.0) | 2 (1.3) | 2 (2.8) | ||
Levofloxacin | 6 (1.8) | 3 (2.9) | 2 (1.3) | 1 (1.4) | ||
Meropenem | 34 (10.2) | 7 (6.9) | 18 (11.3) | 9 (12.5) | ||
Piperacillin/tazobactam | 182 (39.8) | 58 (56.9) | 83 (51.9) | 41 (56.9) | ||
Non antipseudomonal antibiotic | 21 (6.27) | 8 (7.8) | 10 (6.3) | 3 (4.2) | ||
Other | 3 (1.1) | 2 (2.0) | 1 (0.6) | 0 (0.) | ||
Microbiologically documented coinfection | 179 (39.2) | 59 (39.9) | 81 (40.1) | 39 (36.5) | 0.8 | 0.5 |
Type of antibiotic prescribed after susceptibility testing | < 0.001 | < 0.001 | ||||
Cefepime | 49 (10.7) | 19 (12.8) | 17 (8.4) | 13 (12.2) | ||
Ceftazidime | 31 (6.8) | 8 (5.4) | 13 (6.4) | 10 (9.4) | ||
Ciprofloxacin | 86 (18.8) | 30 (20.3) | 36 (17.8) | 20 (18.7) | ||
Imipenem | 3 (0.7) | 1 (0.7) | 1 (0.5) | 1 (0.9) | ||
Levofloxacin | 11 (2.4) | 4 (2.7) | 3 (1.5) | 4 (3.7) | ||
Meropenem | 65 (14.2) | 5 (3.4) | 51 (25.3) | 9 (8.4) | ||
Piperacillin-tazobactam | 206 (45.1) | 77 (52.0) | 80 (39.6) | 49 (45.8) | ||
Other | 6 (1.3) | 4 (2.7) | 1 (0.5) | 1 (0.9) | ||
IDs counselling after susceptibility testing | < 0.001 | 0.04 | ||||
None | 217 (47.6) | 88 (59.5) | 78 (38.6) | 52 (48.6) | ||
Continuation of empiric therapy | 77 (16.8) | 4 (2.7) | 54 (26.7) | 19 (17.8) | ||
Continuation of targeted therapy | 49 (10.7) | 23 (15.5) | 16 (7.9) | 10 (9.4) | ||
Start of antibiotic therapy | 43 (9.4) | 17 (11.5) | 12 (5.9) | 14 (13.1) | ||
Stop of antibiotic therapy | 4 (0.9) | 2 (1.4) | 2 (0.9) | 0 (0.0) | ||
Modification of empiric therapy | 42 (9.2) | 12 (8.1) | 22 (10.9) | 8 (7.5) | ||
Modification of targeted therapy | 24 (5.3) | 2 (1.4) | 18 (8.9) | 4 (3.7) | ||
Dosing adjustment after susceptibility testing | 25 (10.4) | 2 (2.7) | 16 (14.4) | 7 (12.7) | 0.03 | |
Outcomes | ||||||
Targeted antibiotic therapy | 0.1 | |||||
Continuation of empiric therapy | 242 (52.9) | 76 (51.4) | 111 (54.2) | 55 (51.4) | ||
Modification of empiric therapy | 91 (19.8) | 26 (17.6) | 48 (23.7) | 17 (15.9) | ||
Start of antibiotic therapy | 125 (27.2) | 46 (31.1) | 43 (21.2) | 36 (33.3) | ||
Adequate targeted antibiotic dosing | 364 (80.4) | 84 (57.9) | 183 (91.1) | 97 (90.7) | < 0.001 | |