ArticleClinical infectious diseases : an official publication of the Infectious Diseases Society of America2023
Patterns, Predictors, and Intercenter Variability in Empiric Gram-Negative Antibiotic Use Across 928 United States Hospitals.
Article in Clinical infectious diseases : an official publication of the Infectious Diseases Society of America, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 19 papers.
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Who cites it
19 citing papers in PubMed.
- Identifying hospital-level predictors for antibiotic use: a Global Point Prevalence Survey study among Belgian, Philippine and South African hospitals.JAC-antimicrobial resistance · 2026Article
- Clinical impact of broad- versus narrow-spectrum empiric therapy in acute cholangitis: A Japanese claims database study.PloS one · 2026Article
- Are there racial/ethnic differences in antibiotic treatment of community acquired pneumonia in the inpatient setting?PloS one · 2026Article
- Perspectives in Brain Abscess Diagnosis and Management: A National Survey of Infectious Disease Specialists.Open forum infectious diseases · 2025Article
- Association Between Delayed Broad-Spectrum Gram-negative Antibiotics and Clinical Outcomes: How Much Does Getting It Right With Empiric Antibiotics Matter?Clinical infectious diseases : an official publication of the Infectious Diseases Society of America · 2025Article
- Epidemiology and Outcomes of Antibiotic De-escalation in Patients With Suspected Sepsis in US Hospitals.Clinical infectious diseases : an official publication of the Infectious Diseases Society of America · 2025Article
- New Kids on the Block: Estimating Use of Next-generation Gram-negative Antibiotics Across Greater Than 700 Hospitals in the United States.Open forum infectious diseases · 2025Article
- Characterization of Bacterial Spectrum and Antimicrobial Resistance Patterns in Wound Infections from a Chinese Hospital.Infection and drug resistance · 2025Article
- Fatigue and Vitamin D Status in Frail Elderly with and without Cancer, and Healthy Controls of Different Ages: Results from the IMAGE Study.Gerontology · 2025Observational
- The role of rapid multiplex molecular syndromic panels in the clinical management of infections in critically ill patients: an experts-opinion document.Critical care (London, England) · 2024Review
- Piperacillin/Tazobactam Susceptibility Test Interpretive Criteria for Enterobacterales: Recommendations From the United States Committee on Antimicrobial Susceptibility Testing.Clinical infectious diseases : an official publication of the Infectious Diseases Society of America · 2024Article
- Carbapenem use in extended-spectrum cephalosporin-resistant Enterobacterales infections in US hospitals and influence of IDSA guidance: a retrospective cohort study.The Lancet. Infectious diseases · 2024Article
- Clinicians' interpretation of thresholds in hospital antibiograms for gram-negative rod infections: A survey and contingent valuation study of hospitalists.Journal of hospital medicine · 2024Article
- Advancing health equity through action in antimicrobial stewardship and healthcare epidemiology.Infection control and hospital epidemiology · 2024Article
- Hospital antimicrobial stewardship funding and resourcing impact on broad-spectrum antibiotic use: a cross-sectional study.Antimicrobial stewardship & healthcare epidemiology : ASHE · 2024Article
- Health Equity and Antibiotic Prescribing in the United States: A Systematic Scoping Review.Open forum infectious diseases · 2023Article
- Physician antimicrobial prescribing and patient outcomes on general medical wards: a multicentre retrospective cohort study.CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne · 2023Article
- Clinical, contextual and hospital-level factors associated with escalation and de-escalation of empiric Gram-negative antibiotics among US inpatients.JAC-antimicrobial resistance · 2023Article
- Clinical Characteristics and the Effect of Timing for Metagenomic Next-Generation Sequencing in Critically Ill Patients with Sepsis.Infection and drug resistance · 2022Article
Corrections and comments
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Authors and funding
9 authors.
Funding
Abstract
backgroundEmpiric antibiotic use among hospitalized adults in the United States (US) is largely undescribed. Identifying factors associated with broad-spectrum empiric therapy may inform antibiotic stewardship interventions and facilitate benchmarking.
methodsWe performed a retrospective cohort study of adults discharged in 2019 from 928 hospitals in the Premier Healthcare Database. "Empiric" gram-negative antibiotics were defined by administration before day 3 of hospitalization. Multivariable logistic regression models with random effects by hospital were used to evaluate associations between patient and hospital characteristics and empiric receipt of broad-spectrum, compared to narrow-spectrum, gram-negative antibiotics.
resultsOf 8 017 740 hospitalized adults, 2 928 657 (37%) received empiric gram-negative antibiotics. Among 1 781 306 who received broad-spectrum therapy, 30% did not have a common infectious syndrome present on admission (pneumonia, urinary tract infection, sepsis, or bacteremia), surgery, or an intensive care unit stay in the empiric window. Holding other factors constant, males were 22% more likely (adjusted odds ratio [aOR], 1.22 [95% confidence interval, 1.22-1.23]), and all non-White racial groups 6%-13% less likely (aOR range, 0.87-0.94), to receive broad-spectrum therapy. There were significant prescribing differences by region, with the highest adjusted odds of broad-spectrum therapy in the US West South Central division. Even after model adjustment, there remained substantial interhospital variability: Among patients receiving empiric therapy, the probability of receiving broad-spectrum antibiotics varied as much as 34+ percentage points due solely to the admitting hospital (95% interval of probabilities: 43%-77%).
conclusionsEmpiric gram-negative antibiotic use is highly variable across US regions, and there is high, unexplained interhospital variability. Sex and racial disparities in the receipt of broad-spectrum therapy warrant further investigation.
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