262. A Systematic Review and Meta-Analysis of the Impact of Delayed Appropriate Antibiotic Therapy on Mortality in Patients with Gram-Positive Bacteremia
Bibliographic record
Abstract
Abstract Background Antibiotic resistance is common and frequently leads to unintentional delays in appropriate antibiotic therapy. The detrimental impact of delayed therapy is well-accepted, but the majority of evidence focuses on gram-negative infections. A review and synthesis of the evidence evaluating the impact of delayed appropriate antibiotic therapy in serious gram-positive infections does not exist. Such data would define the scope of the problem in this important patient population where antibiotic resistance is common. The objective of this systematic review and meta-analysis was to assess the impact of delayed appropriate antibiotic therapy on mortality in patients with gram-positive bacteremia. Methods Pubmed and Embase were searched from inception to March 30, 2020 to identify clinical studies of patients with bacteremia due to staphylococci, enterococci, or streptococci that reported the association between delayed appropriate antibiotic therapy and mortality. Three independent reviewers screened search results. Study quality was assessed via Newcastle-Ottawa Assessment Scale. Meta-analyses evaluating association between delayed therapy and mortality were conducted via random effects models in Review Manager 5.3. The primary analysis included unadjusted effect estimates from studies reporting unadjusted data. Secondary analysis included adjusted effect estimates from studies adjusting for confounding. Results Of 3684 search results, 16 cohort studies encompassing 4173 bacteremias were included. Ten studies involved S. aureus, 5 enterococci, and 2 S. pneumoniae. One-third (33.7%) of the 3659 patients in the primary analysis received delayed appropriate antibiotic therapy. The primary meta-analysis of 15 studies reporting unadjusted data showed a statistically significant association between delayed therapy and mortality (figure 1). Results from secondary analysis using adjusted point estimates from 9 studies were similar (figure 2). Figure 1. Forrest plot of meta-analysis of unadjusted association between delayed therapy and mortality Figure 2. Forrest plot of meta-analysis of covariate adjusted association between delayed therapy and mortality Conclusion Delayed appropriate therapy was common and associated with increased mortality in patients with gram-positive bacteremia. These findings underscore the need for continued antimicrobial stewardship efforts to ensure expeditious appropriate antibiotic therapy for patients with gram-positive bacteremia. Disclosures All Authors: No reported disclosures
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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 | 0.017 | 0.047 |
| Meta-epidemiology (narrow) | 0.003 | 0.002 |
| Meta-epidemiology (broad) | 0.021 | 0.041 |
| Bibliometrics | 0.008 | 0.008 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.004 | 0.003 |
| Open science | 0.002 | 0.001 |
| Research integrity | 0.003 | 0.002 |
| Insufficient payload (model declined to judge) | 0.005 | 0.001 |
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".