Impact of inappropriate antibiotic therapy on mortality in patients with ventilator-associated pneumonia and blood stream infection: A meta-analysis☆

Abstract 

Objectives

Studies have found that initial treatment of ventilator-associated pneumonia (VAP) and blood stream infections (BSI) with inappropriate antimicrobial therapy is associated with higher rates of mortality, but additional studies have failed to confirm this.

Methods

Databases were searched to identify studies that met the following criteria: observational trials, patients with VAP or BSI receiving appropriate and inappropriate antimicrobial therapy, and mortality data. We conducted random-effects model meta-analyses, both with and without adjustment.

Results

Meta-analyses of VAP studies using unadjusted and adjusted data indicated that inappropriate therapy significantly increased patients' odds of mortality (odds ratio [OR], 2.34; 95% confidence interval [CI], 1.51-3.63; P = .0001, I² = 28.5% and OR, 3.03; 95% CI, 1.12-8.19; P = .0292, I² = 89.2%, respectively). Meta-analyses of BSI studies using unadjusted and adjusted data showed that inappropriate therapy significantly increased patients' odds of mortality (OR, 2.33; 95% CI, 1.96-2.76; P < .0001, I² = 48.7% and OR, 2.28; 95% CI, 1.43-3.65; P = .0006, I² = 88.2%, respectively).

Conclusions

There appears to be an association between initial inappropriate antimicrobial therapy and increased mortality in patients with VAP and BSI.

Keywords: Ventilators, Pneumonia, Bacteremia, Antibiotic, Mortality, Meta-analysis