Time to Effective Antibiotic Therapy and Clinical Outcomes in Bloodstream Infections With ESBL-Producing Enterobacterales: A Retrospective Multicenter Cohort Study.

Authors

Thomas Sahlström Månsson, Alice Askemyr, Lisa Mellhammar

Published in

Open forum infectious diseases. Volume 13. Issue 10. Pages ofag604. Epub Sep 22, 2026.

Abstract

Patients with bloodstream infections (BSIs) with antimicrobial resistant bacteria often receive ineffective empirical therapy (IET). The implications are still uncertain.
We performed a retrospective, multicenter, study of patients with BSIs caused by extended-spectrum β-lactamase (ESBL)-producing gram-negative bacteria in southern Sweden from 2013 to 2022. Patients were categorized based on time to effective therapy: ≤24 hours (EET) and >24 hours (IET). Therapy was considered effective if the agent was active in susceptibility testing and administered intravenously at an appropriate dose. The primary outcome was 30-day mortality. Secondary outcomes were ICU admission and hospital length of stay.
A total of 289/644 (44.9%) patients received IET within the first 24 hours after the index blood culture collection. No significant impact of IET on 30-day mortality was found in univariable (Hazard ratio 0.66; P = .15) or multivariable Cox regression analysis (Hazard ratio 0.64; P = .13). Patients receiving EET were more likely to receive intensive care (Odds ratio 0.38; P = .008), but the association was nonsignificant after adjusting for severity of illness and comorbidities. IET was not associated with a longer hospital stay in Fine-Gray competing risks regression analysis (univariable: sHR 1.15; P = .082; multivariable: sHR 1.11; P = .20).
IET was not associated with 30-day mortality, in patients with BSIs with ESBL-producing Enterobacterales. If confirmed in prospective studies, our findings could support antimicrobial stewardship efforts by reducing unnecessary empirical carbapenem use without compromising short-term clinical outcomes, particularly in low-prevalence settings.

PMID:
42845807
Bibliographic data and abstract were imported from PubMed on 08 Oct 2026.

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