Effects of Inappropriate Administration of Empirical Antibiotics on Mortality in Adults With Bacteraemia: Systematic Review and Meta-Analysis
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Introduction: Bloodstream infections are associated with high mortality rates and contribute substantially to healthcare costs, but a consensus on the prognostic benefits of appropriate empirical antimicrobial therapy (EAT) for bacteraemia is lacking. Methods: We performed a systematic search of the PubMed, Cochrane Library, and Embase databases through July 2021. Studies comparing the mortality rates of patients receiving appropriate and inappropriate EAT were considered eligible. The quality of the included studies was assessed using Joanna Briggs Institute checklists. Results: We ultimately assessed 198 studies of 89,962 total patients. The pooled odds ratio (OR) for the prognostic impacts of inappropriate EAT was 2.06 (P < 0.001), and the funnel plot was symmetrically distributed. Among subgroups without between-study heterogeneity (I2 = 0%), those of patients with severe sepsis and septic shock (OR, 2.14), Pitt bacteraemia scores of ≥4 (OR, 1.88), cirrhosis (OR, 2.56), older age (OR, 1.78), and community-onset/acquired Enterobacteriaceae bacteraemia infection (OR, 2.53) indicated a significant effect of inappropriate EAT on mortality. The pooled adjusted OR of 125 studies using multivariable analyses for the effects of inappropriate EAT on mortality was 2.02 (P < 0.001), and the subgroups with low heterogeneity (I2 < 25%) exhibiting significant effects of inappropriate EAT were those of patients with vascular catheter infections (adjusted OR, 2.40), pneumonia (adjusted OR, 2.72), or Enterobacteriaceae bacteraemia (adjusted OR, 4.35). Notably, the pooled univariable and multivariable analyses were consistent in revealing the negligible impacts of inappropriate EAT on the subgroups of patients with urinary tract infections and Enterobacter bacteraemia. Conclusion: Although the current evidence is insufficient to demonstrate the benefits of prompt EAT in specific bacteraemic populations, we indicated that inappropriate EAT is associated with unfavorable mortality outcomes overall and in numerous subgroups. Prospective studies designed to test these specific populations are needed to ensure reliable conclusions. Systematic Review Registration: https://www.crd.york.ac.uk/prospero/, identifier: CRD42021270274.
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Use of inadequate and unnecessarily broad empiric antibiotics is linked to higher mortality.
“Literature highlights that the use of inadequate and unnecessarily broad empiric antibiotics is linked to higher mortality [21, 22].”
From Lab efficiency and improvements in the management of bloodstream infections: a before and after study (2025) · cites this paper as [21]
The Results report that inappropriate empirical antibiotic therapy was associated with higher mortality in adults with bacteraemia. The Methods define appropriateness by whether the antimicrobial was active against the causative organism; the paper does not establish that unnecessarily broad therapy is linked to higher mortality. Page numbers are unavailable in our copy. (LLM, conf=0.89)
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Gasch, O., Camoez, M., Dominguez, M. A., Padilla, B., Pintado, V., Almirante, B., Lepe, J. A., Lagarde, M., Ruiz de Gopegui, E., Martinez, J. A., et al. (2013) · Journal of Antimicrobial Chemotherapy · doi:10.1093/jac/dkt016 · Cited by 52 · see citing works
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Paluch, M., Ettahar, N., Lagraulet, B., Cattoen, C., Rethore, E., Dubrulle, A., Abad, L., Canis, F., Wayenberg, L., Lambiotte, F., et al. (2025) · European Journal of Clinical Microbiology & Infectious Diseases · doi:10.1007/s10096-025-05200-x · Cited by 5 · see citing works
- Authors
- Hung, Y.-P., Lee, C.-C., & Ko, W.-C.
- Affiliations
- National Cheng Kung University Hospital (TW)
- Corresponding author
- Lee, Ching-Chi
- Ko, Wen-Chien
- Venue
- Frontiers in Medicine
- Publisher
- Frontiers Media SA
- Published
- 2022-05-30
- Volume
- 9
- Pages
- 869822-869822
- ISSN
- 2296-858X (ISSN-L)
- PMC
- PMC9197423
- OpenAlex
- W4281801386
- Cited by
- 29
- References
- 2
- Citations by year
- 2026: 6 · 2025: 7 · 2024: 6 · 2023: 10
- FWCI
- 0.91
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- Frontiers in Medicine (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Funders
- Ministry of Science and Technology, Taiwan
- Ministry of Health and Welfare
- National Cheng Kung University Hospital
- Topics
- Health Sciences › Medicine › Epidemiology › Sepsis Diagnosis and Treatment
- Life Sciences › Immunology and Microbiology › Applied Microbiology and Biotechnology › Antibiotic Use and Resistance
- Health Sciences › Medicine › Pharmacology › Antibiotics Pharmacokinetics and Efficacy
- Keywords
- bacteremia, bloodstream infection, mortality, sepsis, septic shock, pneumonia, liver cirrhosis, urinary tract infection, prognostic factors, antibiotic stewardship, adults, subgroup analysis, risk of bias
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