Does appropriate empiric antibiotic therapy modify intensive care unit-acquired Enterobacteriaceae bacteraemia mortality and discharge?

K B Pouwels, Esther van Kleef, S Vansteelandt, R Batra, J D Edgeworth, T Smieszek, J V Robotham

    Research output: Contribution to journalA1: Web of Science-articlepeer-review


    Background: Conflicting results have been found regarding outcomes of intensive care unit (ICU)-acquired Enterobacteriaceae bacteraemia and the potentially modifying effect of appropriate empiric antibiotic therapy.

    Aim: To evaluate these associations while adjusting for potential time-varying confounding using methods from the causal inference literature.

    Methods: Patients who stayed more than two days in two general ICUs in England between 2002 and 2006 were included in this cohort study. Marginal structural models with inverse probability weighting were used to estimate the mortality and discharge associated with Enterobacteriaceae bacteraemia and the impact of appropriate empiric antibiotic therapy on these outcomes.

    Findings: Among 3411 ICU admissions, 195 (5.7%) ICU-acquired Enterobacteriaceae bacteraemia cases occurred. Enterobacteriaceae bacteraemia was associated with an increased daily risk of ICU death [cause-specific hazard ratio (HR): 1.48; 95% confidence interval (CI): 1.10-1.99] and a reduced daily risk of ICU discharge (HR: 0.66; 95% CI: 0.54-0.80). Appropriate empiric antibiotic therapy did not significantly modify ICU mortality (HR: 1.08; 95% CI: 0.59-1.97) or discharge (HR: 0.91; 95% CI: 0.63-1.32).

    Conclusion: ICU-acquired Enterobacteriaceae bacteraemia was associated with an increased daily risk of ICU mortality. Furthermore, the daily discharge rate was also lower after acquiring infection, even when adjusting for time-varying confounding using appropriate methodology. No evidence was found for a beneficial modifying effect of appropriate empiric antibiotic therapy on ICU mortality and discharge.

    Original languageEnglish
    JournalJournal of Hospital Infection
    Issue number1
    Pages (from-to)23-28
    Number of pages6
    Publication statusPublished - 2017


    • Adult
    • Aged
    • Anti-Bacterial Agents/therapeutic use
    • Bacteremia/complications
    • Cohort Studies
    • Cross Infection/mortality
    • England/epidemiology
    • Enterobacteriaceae/isolation & purification
    • Female
    • Hospital Mortality
    • Humans
    • Intensive Care Units/statistics & numerical data
    • Male
    • Middle Aged
    • Patient Discharge/statistics & numerical data

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