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Cited by 724

The DOI matches its Crossref record; 5 of the 5 references it cites were found in a registry or an index.

Systematic Review and Meta-Analysis of the Efficacy of Appropriate Empiric Antibiotic Therapy for Sepsis

Open access
Paul, Mical, Shani, Vered, Muchtar, Eli, Kariv, Galia, Robenshtok, Eyal, Leibovici, Leonard·2010·Antimicrobial Agents and Chemotherapy
DOI 10.1128/aac.00627-10
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Abstract

Quantifying the benefit of early antibiotic treatment is crucial for decision making and can be assessed only in observational studies. We performed a systematic review of prospective studies reporting the effect of appropriate empirical antibiotic treatment on all-cause mortality among adult inpatients with sepsis. Two reviewers independently extracted data. Risk of bias was assessed using the Newcastle-Ottawa score. We calculated unadjusted odds ratios (ORs) with 95% confidence intervals for each study and extracted adjusted ORs, with variance, methods, and covariates being used for adjustment. ORs were pooled using random-effects meta-analysis. We examined the effects of methodological and clinical confounders on results through subgroup analysis or mixed-effect meta-regression. Seventy studies were included, of which 48 provided an adjusted OR for inappropriate empirical antibiotic treatment. Inappropriate empirical antibiotic treatment was associated with significantly higher mortality in the unadjusted and adjusted comparisons, with considerable heterogeneity occurring in both analyses ( I 2 > 70%). Study design, time of mortality assessment, the reporting methods of the multivariable models, and the covariates used for adjustment were significantly associated with effect size. Septic shock was the only clinical variable significantly affecting results (it was associated with higher ORs). Studies adjusting for background conditions and sepsis severity reported a pooled adjusted OR of 1.60 (95% confidence interval = 1.37 to 1.86; 26 studies; number needed to treat to prevent one fatal outcome, 10 patients [95% confidence interval = 8 to 15]; I 2 = 46.3%) given 34% mortality with inappropriate empirical treatment. Appropriate empirical antibiotic treatment is associated with a significant reduction in all-cause mortality. However, the methods used in the observational studies significantly affect the effect size reported. Methods of observational studies assessing the effects of antibiotic treatment should be improved and standardized.

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Metadata

Authors
Paul, M., Shani, V., Muchtar, E., Kariv, G., Robenshtok, E., & Leibovici, L.
Venue
Antimicrobial Agents and Chemotherapy
Publisher
American Society for Microbiology
Published
2010-11
Volume
54
Issue
11
Pages
4851-4863
ISSN
  • 0066-4804 (ISSN-L)
  • 1098-6596
DOI
10.1128/aac.00627-10
OpenAlex
W2019349925
Cited by
724
References
5
FWCI
2.41
Type
journal article
Language
en
Open access
green

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