A systematic review of the association between delayed appropriate therapy and mortality among patients hospitalized with infections due to Klebsiella pneumoniae or Escherichia coli: how long is too long?

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dc.contributor.authorLodise, Thomas P
dc.contributor.authorZhao, Qi
dc.contributor.authorFahrbach, Kyle
dc.contributor.authorGillard, Patrick
dc.contributor.authorMartin, Amber
dc.contributor.orcidhttps://orcid.org/0000-0002-4730-0655
dc.date.accessioned2025-02-07T19:34:55Z
dc.date.available2025-02-07T19:34:55Z
dc.date.issued12/5/2018
dc.description.abstractBACKGROUND: Temporal relationships between the time to appropriate antibiotic therapy and outcomes are not well described. METHODS: A systematic literature review and meta-analysis was performed to examine this relationship in patients hospitalized with Klebsiella pneumoniae or Escherichia coli infections. RESULTS: Twenty identified studies contained data for patients who received delayed appropriate therapy (DAT) versus appropriate antibiotic therapy for these pathogens. Of the 20 included studies, the majority (19/20) focused on patients with bloodstream infections, and only 1 study evaluated patients with pneumonia. When all DAT results were combined (any delay > 24 h from culture collection or any delay after culture and susceptibility reporting [C& SR]), there was an increased risk of mortality (odds ratio [OR], 1.60 [95% CI, 1.25-2.50]). The risk of mortality was greater when DAT > 48 h from culture collection or DAT > C&SR results were combined (OR, 1.76 [95% CI, 1.27-2.44]). CONCLUSIONS: Our findings suggest there is a need to shift current treatment practices away from antibiotic escalation strategies that contribute to delayed appropriate therapy and toward early, relatively aggressive and comprehensive, antibiotic therapy, especially among patients with bloodstream infections due to K. pneumoniae or E. coli.
dc.description.urihttps://doi.org/10.1186/s12879-018-3524-8
dc.description.urihttp://www.ncbi.nlm.nih.gov/pmc/articles/pmc6280436
dc.identifier.citationLodise TP, Zhao Q, Fahrbach K, Gillard PJ, Martin A. A systematic review of the association between delayed appropriate therapy and mortality among patients hospitalized with infections due to Klebsiella pneumoniae or Escherichia coli: how long is too long? BMC Infect Dis. 2018 Dec 5;18(1):625. doi: 10.1186/s12879-018-3524-8. PMID: 30518337; PMCID: PMC6280436.
dc.identifier.issn1471-2334
dc.identifier.other30518337
dc.identifier.urihttps://hdl.handle.net/20.500.14303/710
dc.language.isoen
dc.publisherBioMed Central
dc.relation.ispartofBMC Infectious Diseases
dc.rightsThis Item is protected by copyright and/or related rights. You are free to use this Item in any way that is permitted by the copyright and related rights legislation that applies to your use. For other uses you need to obtain permission from the rights-holder(s). http://rightsstatements.org/vocab/InC/1.0/
dc.subjectAnti-Infective Agents/therapeutic use
dc.subjectBacteremia/drug therapy/mortality
dc.subjectEscherichia coli/isolation & purification
dc.subjectEscherichia coli Infections/drug therapy/mortality
dc.subjectHospital Mortality
dc.subjectHospitalization/statistics & numerical data
dc.subjectKlebsiella Infections/drug therapy/mortality
dc.subjectKlebsiella pneumoniae/isolation & purification
dc.subjectRetrospective Studies
dc.subjectTime Factors
dc.subjectTime-to-Treatment/statistics & numerical data
dc.titleA systematic review of the association between delayed appropriate therapy and mortality among patients hospitalized with infections due to Klebsiella pneumoniae or Escherichia coli: how long is too long?
dc.typeArticle
local.departmentprogramDepartment of Pharmacy Practice
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