Observational studyAntimicrobial resistance and infection control2022
Use of broad-spectrum antimicrobials for more than 72 h and the detection of multidrug-resistant bacteria in Japanese intensive care units: a multicenter retrospective cohort study.
Observational study in Antimicrobial resistance and infection control, 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT02920463 (DetermInants of Antimicrobial Use aNd De-escalAtion in Critical Care), which is not on this map. Cited by 12 papers.
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The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
DetermInants of Antimicrobial Use aNd De-escalAtion in Critical Care (DIANA Study)
Who cites it
12 citing papers in PubMed.
- Regional Adherence to Early Sepsis Management Bundle and Associated Mortality in Hong Kong Between 2009-2018.Open forum infectious diseases · 2026Article
- Risk-benefit balance of blood cultures among patients with stage IV cancer in unplanned admission: a nationwide propensity score-weighted study in Japan.The Journal of antimicrobial chemotherapy · 2025Article
- Application of metagenomic next-generation sequencing technology in hematologic malignancy patients with sepsis following antibiotic use.BMC infectious diseases · 2025Article
- Impact of COVID-19 isolation measures on ICU microbial resistance dynamics: simulation-based statistical modeling analysis.Antimicrobial resistance and infection control · 2025Article
- Disease spectrum of patients with hospital-acquired multidrug-resistant organism infections in the intensive care unit: a retrospective study.Frontiers in microbiology · 2025Article
- Article
- Canadian Antibiotic Prescribing for Sepsis (CAPS) Study: AJournal of the Association of Medical Microbiology and Infectious Disease Canada = Journal officiel de l'Association pour la microbiologie medicale et l'infectiologie Canada · 2024Article
- An investigation of broad-spectrum antibiotic-induced liver injury based on the FDA Adverse Event Reporting System and retrospective observational study.Scientific reports · 2024Observational
- No improvement in mortality among critically ill patients with carbapenems as initial empirical therapy and more detection of multi-drug resistant pathogens associated with longer use: a post hoc analysis of a prospective cohort study.Microbiology spectrum · 2024Observational
- Exploring Prior Antibiotic Exposure Characteristics for COVID-19 Hospital Admission Patients: OpenSAFELY.Antibiotics (Basel, Switzerland) · 2024Article
- Empiric antimicrobial therapy in the intensive care unit based on the risk of multidrug-resistant bacterial infection: a single-centre case‒control study of blood culture results in Japan.Antimicrobial resistance and infection control · 2023Article
- Effect of Broad-Spectrum Antibiotic De-escalation on Critically Ill Patient Outcomes: A Retrospective Cohort Study.Journal of epidemiology and global health · 2023Article
Corrections and comments
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Authors and funding
28 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundLarge multicenter studies reporting on the association between the duration of broad-spectrum antimicrobial administration and the detection of multidrug-resistant (MDR) bacteria in the intensive care unit (ICU) are scarce. We evaluated the impact of broad-spectrum antimicrobial therapy for more than 72 h on the detection of MDR bacteria using the data from Japanese patients enrolled in the DIANA study.
methodsWe analyzed the data of ICU patients in the DIANA study (a multicenter international observational cohort study from Japan). Patients who received empirical antimicrobials were divided into a broad-spectrum antimicrobial group and a narrow-spectrum antimicrobial group, based on whether they received broad-spectrum antimicrobials for more or less than 72 h, respectively. Differences in patient characteristics, background of infectious diseases and empirical antimicrobial administration, and outcomes between the two groups were compared using the chi-square tests (Monte Carlo method) for categorical variables and the Mann-Whitney U-test for continuous variables. We also conducted a logistic regression analysis to investigate the factors associated with the detection of new MDR bacteria.
resultsA total of 254 patients from 31 Japanese ICUs were included in the analysis, of whom 159 (62.6%) were included in the broad-spectrum antimicrobial group and 95 (37.4%) were included in the narrow-spectrum antimicrobial group. The detection of new MDR bacteria was significantly higher in the broad-spectrum antimicrobial group (11.9% vs. 4.2%, p = 0.042). Logistic regression showed that broad-spectrum antimicrobial continuation for more than 72 h (OR [odds ratio] 3.09, p = 0.047) and cerebrovascular comorbidity on ICU admission (OR 2.91, p = 0.041) were associated with the detection of new MDR bacteria.
conclusionsAmong Japanese ICU patients treated with empirical antimicrobials, broad-spectrum antimicrobial usage for more than 72 h was associated with the increased detection of new MDR bacteria. Antimicrobial stewardship programs in ICUs should discourage the prolonged use of empirical broad-spectrum antimicrobial therapy. Trial registration ClinicalTrials.gov, NCT02920463, Registered 30 September 2016, https://clinicaltrials.gov/ct2/show/NCT02920463.
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