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Volume 38, Issue 1

Original Article

Appropriateness of Empirical Antibiotic Therapy and Factors Associated with Mortality in Third-Generation Cephalosporin-Resistant Enterobacterales Bacteremia

Sinan Çetin
Affiliations
  • Giresun Üniversitesi Tıp Fakültesi, İnfeksiyon Hastalıkları ve Klinik Mikrobiyoloji Anabilim Dalı, Giresun, Türkiye
https://orcid.org/0000-0002-0673-9354
,
Ferah Öğüt
Affiliations
  • Giresun Üniversitesi Tıp Fakültesi, İnfeksiyon Hastalıkları ve Klinik Mikrobiyoloji Anabilim Dalı, Giresun, Türkiye
https://orcid.org/0009-0008-3674-0031
  • Antibiotic
  • bacteremia
  • Enterobacterales
  • Gram-negative
  • resistance

Abstract

Objective: Bacteremia caused by third-generation cephalosporin-resistant Enterobacterales (3GCRE) is frequently encountered. This study aimed to investigate the relationship between the appropriateness of empirical antibiotic therapy and patient outcomes in these cases and to identify factors associated with 30-day mortality.

Methods: The demographic and clinical data of adult patients with positive blood cultures for Enterobacterales and identified resistance to third-generation cephalosporins were retrospectively analyzed. Patients were divided into two groups based on whether they received appropriate empirical antibiotic therapy. Demographic data, clinical characteristics, and outcomes were compared between the two groups. Results were also analyzed in subgroups of community-acquired infections, hospital-acquired infections, and urinary tract infections. Additionally, factors associated with 30-day mortality were examined using logistic regression analysis in the overall population.

Results: The study included 144 adult patients. A total of 90 (62.5%) patients received appropriate empirical antibiotic therapy. The most common causes of bacteremia were urinary tract infections (32.6%) and central catheter-associated infections (21.5%). The predominant pathogens were Escherichia coli (n=98) and Klebsiella spp. (n=31). No significant association was found between empirical antibiotic therapy appropriateness and hospital length of stay, in-hospital mortality, or 14-, 30-, and 90-day mortality, both in the overall population and the subgroups. Kaplan-Meier survival analysis for the relationship between empirical antibiotic therapy appropriateness and 30-day mortality showed no significant difference between the groups. All-cause 30-day mortality occurred in 31 (21.5%) patients. Dementia and the need for vasopressor therapy were identified as independent risk factors for 30-day mortality, while initiating pathogen-directed appropriate antibiotic therapy within 48 hours was identified as a protective factor against mortality.

Conclusion: In this study, no significant relationship was found between the appropriateness of empirical antibiotic therapy and outcomes in bacteremia caused by 3GCRE. However, initiating appropriate antibiotic therapy within 48 hours was identified as a protective factor against mortality. Even if there is a delay in initiating appropriate antibiotic therapy, promptly initiating targeted treatment is crucial for survival.

Show References

References

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  • 51-8
  • Sinan Çetin
  • docsinancetin@gmail.com
  • 10.36519/kd.2025.5179
  • December 16, 2024
  • February 18, 2025
  • March 21, 2025

  • Çetin S, Öğüt F. [Appropriateness of empirical antibiotic therapy and factors associated with mortality in third-generation cephalosporin-resistant Enterobacterales bacteremia]. Klimik Derg. 2025;37(4):51-8. Turkish.
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