Trends in Empiric Broad-Spectrum Antibiotic Use for Suspected Community-Onset Sepsis in US Hospitals
Authors' conclusion
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.
Study context
- Population
- Adults admitted to 241 US hospitals (PINC AI Healthcare Database) 2017–2021 with suspected community-onset sepsis (blood culture, lactate and IV antibiotics on admission)
- Participants
- 6,272,538 hospitalizations
- Exposure
- Annual trends 2017 to 2021
- Outcome
- Annual rates of empiric anti-MRSA and/or antipseudomonal β-lactam use and proportion likely unnecessary (no resistant pathogen in cultures through hospital day 4)
Methodological detailsmulticentre, mixed-effects logistic regression adjusted for patient and hospital characteristics
- Multicentre
- Mixed-effects logistic regression adjusted for patient and hospital characteristics
Main finding
As reported in the abstract
Empiric anti-MRSA or antipseudomonal therapy in suspected sepsis
- Received empiric anti-MRSA or antipseudomonal β-lactam therapy, overall
- 582 585 (65.1%)
- Proportion treated, 2017
- 63.0% (82 731 of 131 275 patients)
- Proportion treated, 2021
- 66.7% (101 003 of 151 435 patients)
- Trend in treatment, aOR per year
- 1.03 (95% CI 1.03-1.04)
- Treated patients with no resistant organisms
- 527 356 of 582 585 patients [90.5%]
- No resistant organisms among treated, 2017 vs 2021
- 88.0% vs 91.6%
- Trend in unnecessary treatment, aOR per year
- 1.12 (95% CI 1.11-1.13)
Observational data: associations, not effects.
Further findings
Type of empiric therapy
- Anti-MRSA
- 379 987 [42.5%]
- Antipseudomonal β-lactam
- 513 811 [57.4%]
- Both
- 311 213 (34.8%)
Share of total inpatient antibiotic days due to suspected sepsis
- Anti-MRSA days
- 1 573 673 of 3 141 300 (50.1%)
- Antipseudomonal β-lactam days
- 2 569 518 of 5 211 745 (49.3%)
Resistant organisms isolated
- Any resistant organism
- 65 434 cases (7.3%)
- Gram-positive
- 30 617 [3.4%]
- Gram-negative
- 38 844 [4.3%]
- Any resistant organism, 2017 vs 2021
- 9.6% to 7.3%
- Trend, aOR per year
- 0.87 (95% CI 0.87-0.88)
Original publication
Trends in Empiric Broad-Spectrum Antibiotic Use for Suspected Community-Onset Sepsis in US Hospitals. JAMA Netw Open. Published 3 June 2024. doi:10.
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