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- Title
Trends in Empiric Broad-Spectrum Antibiotic Use for Suspected Community-Onset Sepsis in US Hospitals.
- Authors
Rhee, Chanu; Chen, Tom; Kadri, Sameer S.; Lawandi, Alexander; Yek, Christina; Walker, Morgan; Warner, Sarah; Fram, David; Chen, Huai-Chun; Shappell, Claire N.; DelloStritto, Laura; Klompas, Michael
- Abstract
Key Points: Question: Is broad-spectrum antibiotic use for suspected community-onset sepsis changing over time? Findings: In this cross-sectional study of 6.3 million adults admitted to 241 US hospitals between 2017 and 2021, half of all anti–methicillin-resistant Staphylococcus aureus and antipseudomonal β-lactam antibiotics were prescribed for suspected community-onset sepsis but only 9.5% of suspected community-onset sepsis cases treated with broad-spectrum antibiotics had resistant organisms identified. Meaning: These results suggest that more attention is needed toward balancing early broad-spectrum antibiotic prescribing for patients with sepsis with limiting overuse for the majority who do not have antibiotic-resistant infections. This cross-sectional study of US adults hospitalized with suspected community-onset sepsis examines trends in empirical broad-spectrum antibiotic use from 2017 to 2021. Importance: Little is known about the degree to which suspected sepsis drives broad-spectrum antibiotic use in hospitals, what proportion of antibiotic courses are unnecessarily broad in retrospect, and whether these patterns are changing over time. Objective: To describe trends in empiric broad-spectrum antibiotic use for suspected community-onset sepsis. Design, Setting, and Participants: This cross-sectional study used clinical data from adults admitted to 241 US hospitals in the PINC AI Healthcare Database. Eligible participants were aged 18 years or more and were admitted between 2017 and 2021 with suspected community-onset sepsis, defined by a blood culture draw, lactate measurement, and intravenous antibiotic administration on admission. Exposures: Empiric anti–methicillin-resistant Staphylococcus aureus (MRSA) and/or antipseudomonal β-lactam agent use. Main Outcomes and Measures: Annual rates of empiric anti-MRSA and/or antipseudomonal β-lactam agent use and the proportion that were likely unnecessary in retrospect based on the absence of β-lactam resistant gram-positive or ceftriaxone-resistant gram-negative pathogens from clinical cultures obtained through hospital day 4. Annual trends were calculated using mixed-effects logistic regression models, adjusting for patient and hospital characteristics. Results: Among 6 272 538 hospitalizations (median [IQR] age, 66 [53-78] years; 443 465 male [49.6%]; 106 095 Black [11.9%], 65 763 Hispanic [7.4%], 653 907 White [73.1%]), 894 724 (14.3%) had suspected community-onset sepsis, of whom 582 585 (65.1%) received either empiric anti-MRSA (379 987 [42.5%]) or antipseudomonal β-lactam therapy (513 811 [57.4%]); 311 213 (34.8%) received both. Patients with suspected community-onset sepsis accounted for 1 573 673 of 3 141 300 (50.1%) of total inpatient anti-MRSA antibiotic days and 2 569 518 of 5 211 745 (49.3%) of total antipseudomonal β-lactam days. Between 2017 and 2021, the proportion of patients with suspected sepsis administered anti-MRSA or antipseudomonal therapy increased from 63.0% (82 731 of 131 275 patients) to 66.7% (101 003 of 151 435 patients) (adjusted OR [aOR] per year, 1.03; 95% CI, 1.03-1.04). However, resistant organisms were isolated in only 65 434 cases (7.3%) (30 617 gram-positive [3.4%], 38 844 gram-negative [4.3%]) and the proportion of patients who had any resistant organism decreased from 9.6% to 7.3% (aOR per year, 0.87; 95% CI, 0.87-0.88). Most patients with suspected sepsis treated with empiric anti-MRSA and/or antipseudomonal therapy had no resistant organisms (527 356 of 582 585 patients [90.5%]); this proportion increased from 88.0% in 2017 to 91.6% in 2021 (aOR per year, 1.12; 95% CI, 1.11-1.13). Conclusions and Relevance: In this cross-sectional study of adults admitted to 241 US hospitals, empiric broad-spectrum antibiotic use for suspected community-onset sepsis accounted for half of all anti-MRSA or antipseudomonal therapy; the use of these types of antibiotics increased between 2017 and 2021 despite resistant organisms being isolated in less than 10% of patients treated with broad-spectrum agents.
- Subjects
UNITED States; ANTIBIOTICS; CROSS-sectional method; STATISTICAL models; MEDICAL care use; INAPPROPRIATE prescribing (Medicine); STAPHYLOCOCCAL diseases; MICROBIAL sensitivity tests; RESEARCH funding; BETA lactam antibiotics; DRUG resistance in microorganisms; LOGISTIC regression analysis; QUESTIONNAIRES; HOSPITAL care; HOSPITALS; METHICILLIN-resistant staphylococcus aureus; DESCRIPTIVE statistics; RETROSPECTIVE studies; HOSPITAL mortality; DISCHARGE planning; DISEASE prevalence; PSEUDOMONAS diseases; ODDS ratio; INTRAVENOUS therapy; SEPSIS; PHYSICIAN practice patterns; LACTATES; COMMUNITY-acquired infections; DRUG prescribing; CONFIDENCE intervals; DATA analysis software; CEFTRIAXONE; GRAM-negative bacteria; COMORBIDITY; NOSOLOGY; HOSPICE care
- Publication
JAMA Network Open, 2024, Vol 7, Issue 6, pe2418923
- ISSN
2574-3805
- Publication type
Article
- DOI
10.1001/jamanetworkopen.2024.18923