The impact of improper empiric usage of "anti-Pseudomonals" upon admission to an acute care hospital.

Abstract Background Many septic patients are receiving empiric anti-Pseudomonal (or Gram-negative non-glucose fermenting, i.e., GNNGF) coverage, upon admission to acute care hospitals, despite the fact that the indications are not scientifically established. Overuse of anti-Pseudomonals might contribute to the burden of resistance. Materials/methods Retrospective observational analyses, pertaining to the characteristics of septic adult patients who received empiric anti-Pseudomonals, along with its impact on outcomes, were executed (08-12/2016) at Shamir Medical Center, Israel. “Proper” empiric anti-Pseudomonal usage was defined if 1) the patient received the agents as per IDSA guidelines, or 2) had positive MDRO upon admission score ( https://assafharofe.azurewebsites.net ), or 3) if a GNNGF was the eventual causative pathogen. Risk factors and outcomes were queried by logistic and Cox regression. Results Only in 57 (3.7%) of 1,536 patients with acute sepsis, GNNGF was the causative pathogen. There were 192 (13%) who received empiric anti-Pseudomonals, of which 161 (84%) were defined as “proper”. Patients who received empiric anti-Pseudomonals were significantly older (p  Conclusions Improper empiric usage of anti-Pseudomonals in acute care hospitals is common. Instituting empiric anti-Pseudomonals solely due to IDSA guidelines, was independently associated with later acquisition of CRAB. Empiric anti-Pseudomonals usage should be based on scientifically established prediction tools and not on IDSA guidelines.