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Empirical antibiotics do not reduce mortality in patients with CAUTI
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Empirical antibiotic treatment did not improve survival of patients with catheter-associated urinary tract infection at an Israeli hospital, according to researchers.
Foregoing empirical antibiotics to treat the infection (CAUTI) could be a worthy option for clinicians, they wrote in Clinical Infectious Diseases.
“The knowledge that appropriate empirical treatment is not associated with improved survival among patients with CAUTIs allows deferral of antibiotic treatment until better understanding of the fever cause,” researcher Tanya Babich of the Beilinson Hospital Rabin Medical Center’s department of medicine in Petah-Tikva, and colleagues wrote. “This might be an important aid to antibiotic stewardship in hospitals and long-term care facilities.”
From August 2010 to February 2015, the researchers reviewed data from 315 patients with CAUTI sepsis at the Rabin Medical Center. Of those patients, 166 (52%) received antimicrobials in the month before infection. In addition, 200 of the patients (63.5%) had an indwelling urinary catheter for more than 30 days. The mean patient age was 79.16 years.
In all, 155 patients (49%) received appropriate empirical antibiotic treatment, the researchers said. The crude 30-day all-cause mortality rate was 30.8% (97 patients), and the median survival time was 82 days.
Early appropriate empirical antibiotic treatment did not have a statistically significant association with 30-day mortality, the researchers said (OR = 1.35; 95% CI, 0.78-2.32). That changed little after propensity score matching — accounting for predictors of appropriate antibiotic treatment — that included 238 patients (OR = 1.39; 95% CI, 0.76-2.55).
The researchers suggested that, under certain circumstances, clinicians could pursue options other than early empirical treatment.
“Caregivers might consider supportive treatment until the cause of sepsis is elucidated and susceptibility patterns of the causative pathogen are known,” they wrote. “Future studies should try and define subgroups of patients who benefit from early, empirical antibiotic treatment vs. those who do not.” – by Joe Green
Disclosure: The researchers report no relevant financial disclosures.
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