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1 August 2007

Volume 45, Number 3
Clinical Infectious Diseases 2007;45:329–337
© 2007 by the Infectious Diseases Society of America. All rights reserved.
1058-4838/2007/4503-0009$15.00
DOI: 10.1086/519283
REVIEW ARTICLE

A Systematic Review of the Methods Used to Assess the Association between Appropriate Antibiotic Therapy and Mortality in Bacteremic Patients

Jessina C. McGregor,1

Shayna E. Rich,2

Anthony D. Harris,2,4

Eli N. Perencevich,2,4

Regina Osih,3

Thomas P. Lodise, Jr.,5

Ram R. Miller,2 and

Jon P. Furuno2

1Oregon State University College of Pharmacy, Portland; Departments of 2Epidemiology and Preventive Medicine and 3Medicine, University of Maryland School of Medicine, and 4Veterans Affairs Maryland Health Care System, Baltimore; and 5Albany College of Pharmacy, Albany, New York

Studies of the association between inappropriate antibiotic therapy and mortality among bacteremic patients have generated conflicting findings. We systematically reviewed these studies to identify methodological heterogeneity that may explain the lack of agreement. We identified 51 articles that met the inclusion criteria, and we extracted the following data: study design, definition and measurement of variables, and statistical methods. Only 8 studies (16%) defined inappropriate antibiotic therapy as that which was inactive in vitro against the isolated organism(s) and not consistent with current clinical practice recommendations and distinguished between empiric and definitive treatment. Thirty‐four studies (67%) measured the severity of illness, but only 6 (12%) specified the time at which it was measured. The methodological recommendations suggested in this article are intended to improve the validity and generalizability of future research. In brief, future studies should define “inappropriate” therapy on the basis of in vitro susceptibility data, should separately evaluate empiric and definitive therapy, and should control for the baseline severity of illness.

Received 29 November 2006; accepted 4 April 2007; electronically published 19 June 2007.

Reprints or correspondence: Dr. Jessina C. McGregor, Oregon State University College of Pharmacy, 3303 SW Bond Ave., Mail Code CH12C, Portland, OR 97239 ().

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