{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,30]],"date-time":"2026-04-30T10:33:30Z","timestamp":1777545210690,"version":"3.51.4"},"reference-count":27,"publisher":"Public Library of Science (PLoS)","issue":"3","license":[{"start":{"date-parts":[[2021,3,18]],"date-time":"2021-03-18T00:00:00Z","timestamp":1616025600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:sec id=\"sec001\">\n<jats:title>Background<\/jats:title>\n<jats:p>It is unclear if a local audit would be useful in providing guidance on how to improve local practice of empiric antibiotic therapy. We performed an audit of antibiotic therapy in bacteremia to evaluate the proportion and risk factors for inadequate empiric antibiotic coverage.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec002\">\n<jats:title>Methods<\/jats:title>\n<jats:p>This retrospective cohort study included patients with positive blood cultures across 3 hospitals in Hamilton, Ontario, Canada during October of 2019. Antibiotic therapy was considered empiric if it was administered within 24 hours after blood culture collection. Adequate coverage was defined as when the isolate from blood culture was tested to be susceptible to the empiric antibiotic. A multivariable logistic regression model was used to predict inadequate empiric coverage. Diagnostic accuracy of a clinical pathway based on patient risk factors was compared to clinician\u2019s decision in predicting which bacteria to empirically cover.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec003\">\n<jats:title>Results<\/jats:title>\n<jats:p>Of 201 bacteremia cases, empiric coverage was inadequate in 56 (27.9%) cases. Risk factors for inadequate empiric coverage included unknown source at initiation of antibiotic therapy (adjusted odds ratio (aOR) of 2.76 95% CI 1.27\u20136.01, P = 0.010) and prior antibiotic therapy within 90 days (aOR of 2.46 95% CI 1.30\u20134.74, P = 0.006). A clinical pathway that considered community-associated infection as low risk for <jats:italic>Pseudomonas<\/jats:italic> was better at ruling out <jats:italic>Pseudomonas<\/jats:italic> bacteremia with a negative likelihood ratio of 0.17 (95% CI 0.03\u20131.10) compared to clinician\u2019s decision with negative likelihood ratio of 0.34 (95% CI 0.10\u20131.22).<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec004\">\n<jats:title>Conclusions<\/jats:title>\n<jats:p>An audit of antibiotic therapy in bacteremia is feasible and may provide useful feedback on how to locally improve empiric antibiotic therapy.<\/jats:p>\n<\/jats:sec>","DOI":"10.1371\/journal.pone.0248817","type":"journal-article","created":{"date-parts":[[2021,3,18]],"date-time":"2021-03-18T17:56:12Z","timestamp":1616090172000},"page":"e0248817","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":2,"title":["Local audit of empiric antibiotic therapy in bacteremia: A retrospective cohort study"],"prefix":"10.1371","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0448-9934","authenticated-orcid":true,"given":"Anthony D.","family":"Bai","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Neal","family":"Irfan","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Cheryl","family":"Main","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Philippe","family":"El-Helou","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4337-1613","authenticated-orcid":true,"given":"Dominik","family":"Mertz","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"340","published-online":{"date-parts":[[2021,3,18]]},"reference":[{"key":"pone.0248817.ref001","doi-asserted-by":"crossref","first-page":"501","DOI":"10.1111\/1469-0691.12195","article-title":"Overall burden of bloodstream infection and nosocomial bloodstream infection in North America and Europe","volume":"19","author":"M Goto","year":"2013","journal-title":"Clin Microbiol Infect"},{"key":"pone.0248817.ref002","doi-asserted-by":"crossref","first-page":"1589","DOI":"10.1097\/01.CCM.0000217961.75225.E9","article-title":"Duration of hypotension before initiation of effective antimicrobial therapy is the critical determinant of survival in human septic shock","volume":"34","author":"A Kumar","year":"2006","journal-title":"Crit Care Med"},{"key":"pone.0248817.ref003","doi-asserted-by":"crossref","first-page":"472","DOI":"10.1128\/AAC.00462-11","article-title":"Impact of inadequate empirical therapy on the mortality of patients with bloodstream infections: a propensity score-based analysis","volume":"56","author":"P Retamar","year":"2012","journal-title":"Antimicrob Agents Chemother"},{"key":"pone.0248817.ref004","doi-asserted-by":"crossref","first-page":"307","DOI":"10.1016\/j.diagmicrobio.2010.10.026","article-title":"Prevalence of antimicrobial resistant pathogens from blood cultures from Canadian hospitals: results of the CANWARD 2007\u20132009 study","volume":"69","author":", Canadian Antimicrobial Resistance Alliance (CARA)","year":"2011","journal-title":"Diagn Microbiol Infect Dis"},{"key":"pone.0248817.ref005","doi-asserted-by":"crossref","first-page":"1384","DOI":"10.1093\/jac\/dkn113","article-title":"Design of a \u2018day 3 bundle\u2019to improve the reassessment of inpatient empirical antibiotic prescriptions","volume":"61","author":"C Pulcini","year":"2008","journal-title":"J Antimicrob Chemother"},{"key":"pone.0248817.ref006","doi-asserted-by":"crossref","first-page":"789","DOI":"10.1093\/jac\/dkq018","article-title":"Reassessment of intravenous antibiotic therapy using a reminder or direct counselling","volume":"65","author":"P Lesprit","year":"2010","journal-title":"J Antimicrob Chemother"},{"key":"pone.0248817.ref007","doi-asserted-by":"crossref","first-page":"548","DOI":"10.1016\/j.ijantimicag.2017.12.013","article-title":"Determinants of inappropriate empirical antibiotic treatment: systematic review and meta-analysis","volume":"51","author":"E Carrara","year":"2018","journal-title":"Int J Antimicrob Agents"},{"key":"pone.0248817.ref008","doi-asserted-by":"crossref","first-page":"788","DOI":"10.1128\/CMR.00062-05","article-title":"Updated review of blood culture contamination","volume":"19","author":"KK Hall","year":"2006","journal-title":"Clin Microbiol Rev"},{"key":"pone.0248817.ref009","doi-asserted-by":"crossref","first-page":"373","DOI":"10.1016\/0021-9681(87)90171-8","article-title":"A new method of classifying prognostic comorbidity in longitudinal studies: development and validation","volume":"40","author":"ME Charlson","year":"1987","journal-title":"J Chronic Dis"},{"key":"pone.0248817.ref010","doi-asserted-by":"crossref","first-page":"948","DOI":"10.1111\/1469-0691.12085","article-title":"Predictive scoring model of mortality in Gram-negative bloodstream infection","volume":"19","author":"MN Al-Hasan","year":"2013","journal-title":"Clin Microbiol Infect"},{"key":"pone.0248817.ref011","doi-asserted-by":"crossref","first-page":"791","DOI":"10.7326\/0003-4819-137-10-200211190-00007","article-title":"Health care\u2013associated bloodstream infections in adults: a reason to change the accepted definition of community-acquired infections","volume":"137","author":"ND Friedman","year":"2002","journal-title":"Ann Intern Med"},{"key":"pone.0248817.ref012","doi-asserted-by":"crossref","first-page":"e0208819","DOI":"10.1371\/journal.pone.0208819","article-title":"Time to positivity of blood cultures supports early re-evaluation of empiric broad-spectrum antimicrobial therapy","volume":"14","author":"MM Lambregts","year":"2019","journal-title":"PLoS One"},{"key":"pone.0248817.ref013","doi-asserted-by":"crossref","first-page":"e0154944","DOI":"10.1371\/journal.pone.0154944","article-title":"The effect of inadequate initial empiric antimicrobial treatment on mortality in critically ill patients with bloodstream infections: a multi-centre retrospective cohort study","volume":"11","author":"RD Savage","year":"2016","journal-title":"PLoS One"},{"key":"pone.0248817.ref014","volume-title":"The Sanford guide to antimicrobial therapy 2019","author":"DN Gilbert","year":"2019"},{"key":"pone.0248817.ref015","doi-asserted-by":"crossref","first-page":"984","DOI":"10.1001\/jama.2018.12163","article-title":"Effect of piperacillin-tazobactam vs meropenem on 30-day mortality for patients with E coli or Klebsiella pneumoniae bloodstream infection and ceftriaxone resistance: a randomized clinical trial","volume":"320","author":"PN Harris","year":"2018","journal-title":"JAMA"},{"key":"pone.0248817.ref016","doi-asserted-by":"crossref","first-page":"142","DOI":"10.1111\/hdi.12061","article-title":"Methicillin\u2010resistant Staphylococcus aureus carriage in hospitalized chronic hemodialysis patients and its predisposing factors","volume":"18","author":"LY Yeoh","year":"2014","journal-title":"Hemodial Int"},{"key":"pone.0248817.ref017","doi-asserted-by":"crossref","first-page":"477","DOI":"10.1128\/JCM.01596-07","article-title":"Methicillin-resistant Staphylococcus aureus nasal carriage among injection drug users: six years later","volume":"46","author":"GN Al-Rawahi","year":"2008","journal-title":"J Clin Microbiol"},{"key":"pone.0248817.ref018","doi-asserted-by":"crossref","first-page":"E725","DOI":"10.1503\/cmaj.130364","article-title":"Utility of prior screening for methicillin-resistant Staphylococcus aureus in predicting resistance of S. aureus infections","volume":"185","author":"DR MacFadden","year":"2013","journal-title":"CMAJ"},{"key":"pone.0248817.ref019","doi-asserted-by":"crossref","first-page":"S7","DOI":"10.1086\/383042","article-title":"Microbiological data for patients with febrile neutropenia","volume":"39","author":"A Kanamaru","year":"2004","journal-title":"Clin Infect Dis"},{"key":"pone.0248817.ref020","doi-asserted-by":"crossref","first-page":"580","DOI":"10.1086\/596709","article-title":"Gram-negative bacteremia upon hospital admission: when should Pseudomonas aeruginosa be suspected?","volume":"48","author":"V Schechner","year":"2009","journal-title":"Clin Infect Dis"},{"key":"pone.0248817.ref021","doi-asserted-by":"crossref","first-page":"1228","DOI":"10.1016\/j.burns.2010.05.009","article-title":"Pseudomonas aeruginosa bacteraemia in burns patients: risk factors and outcomes","volume":"36","author":"P Mahar","year":"2010","journal-title":"Burns"},{"key":"pone.0248817.ref022","doi-asserted-by":"crossref","first-page":"702","DOI":"10.1016\/j.amjmed.2008.03.029","article-title":"Incidence of Pseudomonas aeruginosa bacteremia: a population-based study","volume":"121","author":"MN Al-Hasan","year":"2008","journal-title":"Am J Med"},{"key":"pone.0248817.ref023","doi-asserted-by":"crossref","first-page":"329","DOI":"10.1086\/519283","article-title":"A systematic review of the methods used to assess the association between appropriate antibiotic therapy and mortality in bacteremic patients","volume":"45","author":"JC McGregor","year":"2007","journal-title":"Clin Infect Dis"},{"key":"pone.0248817.ref024","doi-asserted-by":"crossref","first-page":"e-1780","DOI":"10.1128\/JCM.01780-18","article-title":"Comparing patient risk factor-, sequence type-, and resistance locus identification-based approaches for predicting antibiotic resistance in Escherichia coli bloodstream infections","volume":"57","author":"DR MacFadden","year":"2019","journal-title":"J Clin Microbiol"},{"key":"pone.0248817.ref025","doi-asserted-by":"crossref","first-page":"453","DOI":"10.1007\/s10096-007-0304-6","article-title":"Epidemiology and outcome of primary community-acquired bacteremia in adult patients","volume":"26","author":"M Ortega","year":"2007","journal-title":"Eur J Clin Microbiol Infect Dis"},{"key":"pone.0248817.ref026","doi-asserted-by":"crossref","first-page":"108","DOI":"10.1016\/j.cmi.2018.03.029","article-title":"Decision-support models for empiric antibiotic selection in Gram-negative bloodstream infections","volume":"25","author":"DR MacFadden","year":"2019","journal-title":"Clin Microbiol Infect"},{"key":"pone.0248817.ref027","first-page":"30477","article-title":"Inappropriate empirical antibiotic therapy for bloodstream infections based on discordant in-vitro susceptibilities: a retrospective cohort analysis of prevalence, predictors, and mortality risk in US hospitals","volume":"S1473-3099","author":"SS Kadri","year":"2020","journal-title":"Lancet Infect Dis"}],"container-title":["PLOS ONE"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0248817","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,3,18]],"date-time":"2021-03-18T17:56:33Z","timestamp":1616090193000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0248817"}},"subtitle":[],"editor":[{"given":"Dafna","family":"Yahav","sequence":"first","affiliation":[],"role":[{"role":"editor","vocabulary":"crossref"}]}],"short-title":[],"issued":{"date-parts":[[2021,3,18]]},"references-count":27,"journal-issue":{"issue":"3","published-online":{"date-parts":[[2021,3,18]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pone.0248817","relation":{},"ISSN":["1932-6203"],"issn-type":[{"value":"1932-6203","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,3,18]]}}}