RT journal article
T1 Antibiotic use and outcome in patients with negative blood cultures, a new target population for antimicrobial stewardship interventions: A prospective multicentre cohort (NO-BACT)
A1 Girón Ortega, José Antonio
A1 Fernández Guerrero, Raquel
A1 Montes de Oca Arjona, Montserrat
A1 Galán Sanchez, Fátima
A1 Pellejero Sagastizábal, Galadriel
A1 Morte Romea, Elena
A1 De Cueto, Marina
A1 Beltrán Garcia, Margarita
A1 Palacio Baena, Zaira
A1 Jiménez Jorge, Silvia
A1 Rodríguez Baño, Jesús
A1 Retamar Gentil, Pilar
A2 BiomedicinaBiotecnología y Salud Pública
K1 Blood cultures
K1 Antimicrobial treatment
K1 Mortality
K1 Risk factors
K1 Antimicrobial stewardship
AB Objectives: To evaluate the appropriateness of antimicrobial treatment and the risk factors for mortality in patients with negative blood cultures (BC), in order to evaluate whether this population would be a suitable target for antimicrobial stewardship (AMS) interventions. Methods: A multicentre prospective cohort study of patients with negative BC in three Spanish hospitals between October 2018 and July 2019 was performed. The main endpoints were the appropriateness of antimicrobial treatment (evaluated by two investigators according to local guidelines) and 30-day mortality. Cox-regression was performed to estimate the association between variables and 30-day mortality. Results: Of 1011 patients in whom BC was obtained, these were negative in 803 (79%) and were included; 30-day mortality was 9% (70 patients); antibiotic treatment was considered inappropriate in 299 (40%) of 747 patients evaluated at day 2, and in 266 (46%) of 573 at day 5–7. The variables independently associated with increased risk of 30-day mortality were higher age (HR 1.05; 95% CI 1.03–1.07), neoplasia (HR 2.73; 95% CI 1.64–4.56), antibiotic treatment in the 48 h prior to BC extraction (HR 2.06; 95% CI 1.23–3.43) and insufficient antibiotic coverage at day 2 after BC obtainment (HR 2.35; 95% CI 1.39–4.00). Urinary, catheter and biliary sources of infection were associated with lower risk (HR 0.40; 95% CI 0.20–0.81). Conclusions: Antimicrobial treatment is frequently inappropriate among patients with negative BC; insufficient antibiotic coverage at day 2 was associated with mortality. These results suggest that patients with negative BC are a suitable population for AS interventions. Antimicrobial treatment in patients with negative blood culture was frequently inappropriate, and inappropriate coverage at day 2 was associated with increased risk of death. These data support the consideration of this population as a potential target for antimicrobial stewardship interventions.
PB Elsevier
SN 1532-2742
YR 2024
FD 2024
LK http://hdl.handle.net/10498/32409
UL http://hdl.handle.net/10498/32409
LA eng
DS Repositorio Institucional de la Universidad de Cádiz
RD 10-nov-2026