Receipt of early phenotype-desirable antimicrobial therapy (PDAT) was associated with favorable 30-day clinical outcomes in patients hospitalized with Enterobacterales bloodstream infections, researchers reported today JAMA Network Open.
In a retrospective cohort study that analyzed data on adult patients with at least one blood culture isolate positive for Escherichia coli, Klebsiella oxytoca, Klebsiella pneumoniae, or Proteus mirabilis, researchers from PINC AI Applied Sciences, bioMerieux, and the University of Maryland compared clinical outcomes in patients who received early versus delayed PDAT, which is defined as the receipt of a beta-lactam antibiotic with the narrowest spectrum of activity to effectively treat the patient’s phenotype. While PDAT is considered crucial for antimicrobial stewardship, the impact of timing of clinical outcomes is not well understood.
A total of 8,193 patients (mean age, 69; 58.1% female) from 252 hospitals were included in the study, and 5,033 (61.4%) received early PDAT (within 0 to 2 days of blood culture collection). The main outcome was desirability of outcome ranking (DOOR), with 1 being the most desirable outcome and 5 the least.
More desirable outcomes with early PDAT
After adjusting for comorbidities and severity of illness, patients receiving early PDAT were 20% less likely to be readmitted within 30 days compared with those receiving delayed PDAT (odds ratio, 0.80; 95% confidence interval [CI], 0.69 to 0.92; ). A higher percentage of patients receiving early PDAT had a DOOR of 1 compared with patients receiving delayed PDAT (56.3% vs 52.2%). Those receiving early PDAT had a 52.5% probability (95% CI, 51.3% to 53.7%) of a more desirable outcome than those receiving delayed PDAT, a finding that persisted in the adjusted analysis (probability, 52.0%; 95% CI, 50.9% to 53.2%).
The study also found that patients who received delayed PDAT were more likely to be still hospitalized or discharged someplace other than home and have longer hospital stays and higher healthcare costs compared with those who received early PDAT.
“Starting early PDAT may be important not only for antimicrobial stewardship but also for improving the clinical outcome of affected patients,” the study authors concluded.
