Treatment effectiveness of antibiotic therapy in Veterans with multidrug-resistant bacteremia.

Vivo A, Fitzpatrick MA, Suda KJ, Wilson GM, Jones MM, Evans ME, Evans CT. Treatment effectiveness of antibiotic therapy in Veterans with multidrug-resistant bacteremia. Antimicrobial stewardship & healthcare epidemiology : ASHE. 2023 Dec 12; 3(1):e230.

Related HSR&D Project(s)

• RCS 20-192 – Research Career Scientist Award
• IIR 16-028 – Effectiveness of Treatment and Outcomes for Veterans Infected with Resistant Gram-negative Organisms.

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Abstract:

OBJECTIVE: To describe antimicrobial therapy used for multidrug-resistant (MDR) bacteremia in Veterans and impacts on mortality. METHODS: This was a retrospective cohort study of hospitalized Veterans Affairs patients from 2012 to 2018 with a positive MDR blood culture who received antimicrobial treatment 2 days prior to through 5 days after the culture date. Only the first culture per patient was used. The association between treatment and patient characteristics was assessed using bivariate analyses. Multivariable logistic regression models examined the relationship between antibiotic regimen and in-hospital, 30-day, and 1-year mortality. Generalized linear models were used to assess cost outcomes. RESULTS: MDR was identified in 184 patients. Most cultures identified were , 3% were and 7% were other Penicillins- -lactamase inhibitor combinations (51.1%) and carbapenems (51.6%)-were the most prescribed antibiotics. In unadjusted analysis, extended spectrum cephalosporins and penicillins- -lactamase inhibitor combinations-were associated with a decreased odds of 30-day mortality but were insignificant after adjustment (adjusted odds ratio (aOR) = 0.47, 95% CI, 0.21-1.05, aOR = 0.75, 95% CI, 0.37-1.53). There was no association between combination therapy vs monotherapy and 30-day mortality (aOR = 1.55, 95% CI, 0.72-3.32). CONCLUSION: In hospitalized Veterans with MDR ., none of the treatments were shown to be associated with in-hospital, 30-day, and 1-year mortality. Combination therapy was not associated with decreased mortality for MDR bacteremia.