Epidemiology and Outcomes of Antibiotic De-escalation in Patients with Suspected Sepsis in US Hospitals.

Autor:	Kam KQ; Department of Population Medicine, Harvard Pilgrim Health Care Institute, Boston, MA, USA.; Infectious Disease Service, Department of Pediatrics, KK Women's & Children's Hospital, Singapore, Singapore.; SingHealth Duke-NUS Pediatrics Academic Clinical Program (ACP), Duke-NUS Medical School, Singapore, Singapore., Chen T; Department of Population Medicine, Harvard Pilgrim Health Care Institute, Boston, MA, USA., Kadri SS; Critical Care Medicine Department, National Institutes of Health Clinical Center, Bethesda, MD.; Critical Care Medicine Branch, National Heart Lung and Blood Institute, Bethesda, MD., Lawandi A; Critical Care Medicine Department, National Institutes of Health Clinical Center, Bethesda, MD.; Division of Infectious Diseases, Department of Medicine, McGill University Health Centre, Quebec, Canada., Yek C; Critical Care Medicine Department, National Institutes of Health Clinical Center, Bethesda, MD.; Critical Care Medicine Branch, National Heart Lung and Blood Institute, Bethesda, MD., Walker M; Critical Care Medicine Department, National Institutes of Health Clinical Center, Bethesda, MD.; Critical Care Medicine Branch, National Heart Lung and Blood Institute, Bethesda, MD., Warner S; Critical Care Medicine Department, National Institutes of Health Clinical Center, Bethesda, MD.; Critical Care Medicine Branch, National Heart Lung and Blood Institute, Bethesda, MD., Fram D; Commonwealth Informatics, Waltham, MA, USA., Chen HC; Commonwealth Informatics, Waltham, MA, USA., Shappell CN; Division of Pulmonary and Critical Care Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA., DelloStritto L; Department of Population Medicine, Harvard Pilgrim Health Care Institute, Boston, MA, USA., Jin R; Department of Population Medicine, Harvard Pilgrim Health Care Institute, Boston, MA, USA., Klompas M; Department of Population Medicine, Harvard Pilgrim Health Care Institute, Boston, MA, USA.; Division of Infectious Diseases, Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA., Rhee C; Department of Population Medicine, Harvard Pilgrim Health Care Institute, Boston, MA, USA.; Division of Infectious Diseases, Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA.
Jazyk:	angličtina
Zdroj:	Clinical infectious diseases : an official publication of the Infectious Diseases Society of America [Clin Infect Dis] 2024 Dec 06. Date of Electronic Publication: 2024 Dec 06.
DOI:	10.1093/cid/ciae591
Abstrakt:	Background: Little is known about the frequency, hospital-level variation, predictors, and clinical outcomes of antibiotic de-escalation in suspected sepsis. Methods: We retrospectively analyzed all adults admitted to 236 US hospitals between 2017-2021 with suspected sepsis (defined by a blood culture draw, lactate measurement, and intravenous antibiotic administration) who were initially treated with ≥2 days of anti-MRSA and anti-pseudomonal antibiotics but had no resistant organisms requiring these agents identified through hospital day 4. De-escalation was defined as stopping anti-MRSA and anti-pseudomonal antibiotics or switching to narrower antibiotics by day 4. We created a propensity score for de-escalation using 82 hospital, demographic, and clinical variables, matched de-escalated to non-de-escalated patients, and then assessed associations between de-escalation and outcomes. Results: Among 124,577 eligible patients, antibiotics were de-escalated in 36,806 (29.5%) including narrowing in 27,177 (21.8%) and cessation in 9,629 (7.7%). De-escalation rates varied widely between hospitals (median 29.4%, IQR 21.3-38.0%). Predictors of de-escalation included less severe disease on day 3-4, positive cultures for non-resistant organisms, and negative/absent MRSA nasal swabs. De-escalation was more common in medium, large, or teaching hospitals in the Northeast or Midwest. De-escalation was associated with lower adjusted risks for acute kidney injury (OR 0.80, 95% CI: 0.76-0.84), ICU admission after day 4 (OR 0.59, 95% CI: 0.52-0.66), and in-hospital mortality (OR 0.92, 95% CI: 0.86-0.996). Conclusions: Antibiotic de-escalation in patients with suspected sepsis is infrequent, variable across hospitals, linked with clinical and microbiologic factors, and associated with lower risk for acute kidney injury, ICU admission, and in-hospital mortality. (© The Author(s) 2024. Published by Oxford University Press on behalf of Infectious Diseases Society of America. All rights reserved. For commercial re-use, please contact reprints@oup.com for reprints and translation rights for reprints. All other permissions can be obtained through our RightsLink service via the Permissions link on the article page on our site—for further information please contact journals.permissions@oup.com.)
Databáze:	MEDLINE
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