Meiho University Institutional Repository:Item 987654321/4234
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    题名: Comparing the Prognostic Impacts of Delayed Administration of Appropriate Antimicrobials in Older Patients with Afebrile and Febrile Community-Onset Bacteremia
    作者: 薛夙君
    贡献者: 健康暨護理學院
    关键词: bacteremia
    afebrile
    appropriate antimicrobial therapy
    outcome
    afebrile bacteremia
    community-onset
    empirical therapy
    日期: 2024-08-29
    上传时间: 2024-08-30T06:33:32Z (UTC)
    摘要: Although prompt administration of an appropriate antimicrobial therapy (AAT) is crucial
    for reducing mortality in the general population with community-onset bacteremia, the prognostic
    effects of delayed AAT in older individuals with febrile and afebrile bacteremia remain unclear. A
    stepwise and backward logistic regression analysis was used to identify independent predictors of
    30-day mortality. In a 7-year multicenter cohort study involving 3424 older patients (≥65 years) with
    community-onset bacteremia, febrile bacteremia accounted for 27.1% (912 patients). A crucial association
    of afebrile bacteremia and 30-day mortality (adjusted hazard ratio [AHR], 1.69; p < 0.001)
    was revealed using Cox regression and Kaplan–Meier curves after adjusting for the independent
    predictors of mortality. Moreover, each hour of delayed AAT was associated with an average increase
    of 0.3% (adjusted odds ratio [AOR], 1.003; p < 0.001) and 0.2% (AOR, 1.002; p < 0.001) in the
    30-day crude mortality rates among patients with afebrile and febrile bacteremia, respectively, after
    adjusting for the independent predictors of mortality. Similarly, further analysis based on Cox regression
    and Kaplan–Meier curves revealed that inappropriate empirical therapy (i.e., delayed AAT
    administration > 24 h) had a significant prognostic impact, with AHRs of 1.83 (p < 0.001) and 1.76 (p
    < 0.001) in afebrile and febrile patients, respectively, after adjusting for the independent predictors
    of mortality. In conclusion, among older individuals with community-onset bacteremia, the dissimilarity
    of the prognostic impacts of delayed AAT between afebrile and febrile presentation was evident.
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