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Characteristics of surgical patients receiving inappropriate empiric antimicrobial therapy

Davies, Stephen W. MD, MPH; Efird, Jimmy T. PhD, MSc; Guidry, Christopher A. MD, MSc; Hranjec, Tjasa MD, MSc; Metzger, Rosemarie MD, MPH; Swenson, Brian R. MD, MSc; Sawyer, Robert G. MD

Journal of Trauma and Acute Care Surgery: October 2014 - Volume 77 - Issue 4 - p 546–554
doi: 10.1097/TA.0000000000000309
Original Articles
Editor's Choice

BACKGROUND: Inappropriate antibiotics have been observed to result in an increased duration of antibiotic treatment and hospital length of stay, development of multidrug-resistant organisms, and mortality rate compared with appropriate antibiotic treatment. Few studies have evaluated independent risk factors associated with inappropriateness. The purpose of this study was to identify independent predictors of inappropriate, empiric antimicrobial therapy for the treatment of severe sepsis.

METHODS: This was a retrospective analysis of a prospectively maintained database of all surgical/trauma patients admitted to a tertiary care center from 1996 to 2007 and treated for sepsis. “Appropriate” empiric antibiotic treatment was determined by sensitivity testing. Demographics and comorbidities, infection sites, infection organisms, and outcomes between strata were compared. Differences in outcome were estimated using relative risk and 95% confidence intervals for correlated data.

RESULTS: A total of 2,855 patients (7,158 infections) were identified. Independent predictors of inappropriate, empiric antimicrobial therapy for the treatment of severe sepsis included site of infection and organism type. Severity of illness, age, medical conditions, and community versus health care–associated infections were not associated with inappropriate therapy. Although inappropriate empiric therapy was associated with a longer length of stay and duration of antimicrobial use, it did not result in higher mortality.

CONCLUSION: Our study observed that inappropriate empiric antibiotic selection is related to site of infection and pathogen. Other clinical variables do not appear to predict inappropriateness of antibiotic treatment. Efforts should be focused on early broad-spectrum therapy and more rapid microbiologic methods.

LEVEL OF EVIDENCE: Therapeutic/care management study, level II.

From the Department of General Surgery (S.W.D., C.A.G., R.G.S.), School of Medicine, University of Virginia, Charlottesville, Virginia; Biostatistics Unit (J.T.E.), Center for Health Disparities, Brody School of Medicine, East Carolina University, Greenville, North Carolina; Department of Surgery (T.H.), Division of Burn/Trauma/Critical Care, University of Texas Southwestern, Dallas, Texas; Department of Endocrine Surgery (R.M.), Cleveland Clinic, Cleveland, Ohio; and (B.R.S.), Mercy Clinic General and Specialty Surgery, Springfield, Missouri.

Submitted: February 12, 2014, Revised: March 20, 2014, Accepted: March 31, 2014.

Address for reprints: Stephen W. Davies, MD, MPH, Department of General Surgery, School of Medicine, University of Virginia, 1215 Lee Street, PO Box 800679, Charlottesville, VA 22908-0679; email:

© 2014 Lippincott Williams & Wilkins, Inc.