Canadian Antibiotic Prescribing for Sepsis (CAPS) Study: A Post Hoc Analysis of the FABLED Cohort Study
Abstract
Background: Understanding the microbiology and optimal pharmacotherapy of patients with community-onset sepsis is key to improving outcomes. Yet, empiric therapies prescribed in Canadian emergency departments as they relate to microbial etiology and focus of infection are inadequately described.
Methods: We performed a post hoc analysis of the FABLED cohort study, which quantified the effect of antimicrobials on blood culture yield in septic patients. Patients presenting with sepsis were enrolled in six Canadian emergency departments between 2013 and 2018. We characterized the appropriateness of empiric therapies relative to the pathogens isolated and focus of infection identified.
Results: The data of 315 patients with sepsis was analyzed. Broad-spectrum antibiotics were used in 68.6% of the cohort. Despite this, Pseudomonas was never isolated in any blood cultures, and drug-resistant organisms were only encountered in 4.8% of the cohort. Among patients with bacteremia (n = 100), 28% of patients received appropriate antibiotic therapy whereas the remainder received therapies that were either overly narrow (16%) or unnecessarily broad (56%) in spectrum. Among patients with an identified focus of infection (n = 266), 30.5% received appropriate empiric antibiotics. Prescribing patterns that were overly broad, overly narrow, or a combination of the two were observed in 39.8%, 7.5%, and 22.2% of patients, respectively. Thirty-day mortality was lowest among patients receiving…
How strong is the evidence?
Evidence Hub reads this as a cohort study, done in people. Its evidence level is 3 of 5 (Moderate · trial / cohort / secondary analysis). Trials without a large randomized design, cohorts and secondary analyses give moderate evidence. Reported size: 315 participants or records.
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