The Effect of Inadequate Initial Antimicrobial Treatment on Mortality in Critically Ill Patients With Bloodstream Infections
Bibliographic record
Abstract
Background. Hospital mortality rates are substantially higher in critically ill patients with bloodstream infections relative to their uninfected counterparts. Given that patient mortality may be higher if appropriate treatment is delayed, we sought to determine the effect of inadequate initial treatment on mortality in critically ill patients with bloodstream infections. Methods. A retrospective cohort study was conducted across 13 intensive care units (ICUs) in Canada. We recruited 100 consecutive patients with bloodstream infection from each participating ICU. Inadequate initial treatment was defined as the lack of receipt of at least 1 dose of an antimicrobial(s) to which the causative pathogen(s) was susceptible within 1 day of initial blood culture. A random effects multivariable logistic regression model was used to evaluate whether inadequate treatment was associated with hospital mortality, accounting for patient and pathogen characteristics as well as ICU clustering. Interaction terms were added to examine whether the association varied by genus of the pathogen(s). Results. Among 1197 patients, 266 (22%) received inadequate initial treatment and 478 (40%) died. The unadjusted mortality risk was higher among those that received initial inadequate versus adequate treatment (135/266 [51%] versus 341/924 [37%], p < 0.001). After adjustment, there was no association between inadequate initial treatment and mortality among bacteremic patients (odds ratio [OR]: 0.99, 95% confidence interval [CI] 0.68–1.44). Candidemic patients receiving inadequate initial treatment had more than three times the odds of mortality compared to patients receiving adequate treatment (OR: 3.44, 95% CI: 1.24–9.54). Findings were robust to exclusion of early deaths and patients who received no antibiotic treatment, and to using a 2-day window for defining initial treatment. Conclusion. Inadequate initial treatment, although common, did not explain the high mortality experienced by critically ill, bacteremic patients in our study. Conversely, inadequate initial treatment was an important risk factor for mortality in the subgroup of candidemic patients. Further exploration of opportunities to improve the receipt of prompt, effective treatment is warranted in this high risk group. Disclosures. All authors: No reported disclosures.
Fetched live from OpenAlex and de-inverted. Abstracts are not stored in this database: the inverted indexes are 8.6 GB of the frame’s 9.3 GB of text, and the host has 13 GB free.
How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.003 | 0.027 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.001 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".