The effect of empiric antibiotic therapy on mortality in debilitated patients with dementia |
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Authors: | S Reisfeld M Paul B S Gottesman P Shitrit L Leibovici and M Chowers |
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Institution: | (1) Infectious Diseases Unit, Meir Medical Center, 59 Tsharnichovski St., Kfar Saba, 44281, Israel;(2) Infectious Diseases Unit, Beilinson Campus, Rabin Medical Center, Petah Tikva, Israel;(3) Sackler Faculty of Medicine, Tel Aviv University, Ramat Aviv, Israel;(4) Internal Medicine E, Beilinson Campus, Rabin Medical Center, Peth Tikva, Israel; |
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Abstract: | The purpose of this investigation was to assess the effect of empirical antibiotic treatment on 30-day mortality among debilitated
inpatients with dementia and Gram-negative bacteremia. A retrospective cohort study in the years 2005–2007 was undertaken.
Data were collected through patient chart review. The association between individual variables and 30-day mortality was assessed
through univariate analysis. Variables significantly associated with mortality (p < 0.05) were entered into a logistic regression analysis. Adjusted odds ratios (ORs) for mortality with 95% confidence intervals
(CIs) are shown. Subgroup analysis of patients with and without decubitus ulcers was performed. In our cohort of 378 patients
with dementia and Gram-negative bacteremia, the 30-day mortality was 39% overall and 61% in the subgroup of patients with
decubitus ulcers. Inappropriate empirical therapy was associated with higher mortality, although this effect was not statistically
significant (OR 1.41, 95% CI 0.86–2.29). Inappropriate empirical therapy did not affect mortality in the subgroup of patients
with decubitus ulcers (OR 0.37, 95% CI 0.11–1.28). Other factors found to independently affect mortality included age, co-morbidities,
source of infection, sepsis severity, and hospital-acquired infection. Appropriate empirical antibiotic therapy for patients
with dementia and severe bacterial infection did not have a clear advantage, especially in the sickest group of patients with
decubitus ulcers. |
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