ArticleClinical infectious diseases : an official publication of the Infectious Diseases Society of America2025
Epidemiology and Outcomes of Antibiotic De-escalation in Patients With Suspected Sepsis in US Hospitals.
Article in Clinical infectious diseases : an official publication of the Infectious Diseases Society of America, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 15 papers.
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15 citing papers in PubMed.
- Time to Antibiotics and Mortality in Immunocompromised Versus Non-immunocompromised Patients With Suspected Sepsis.Clinical infectious diseases : an official publication of the Infectious Diseases Society of America · 2026Article
- Significant Publications on Infectious Diseases Pharmacotherapy in 2024.Journal of pharmacy practice · 2026Review
- Evaluation of Q-linea ASTar rapid phenotypic antimicrobial susceptibility testing and potential impact in patients with gram-negative bloodstream infections.Microbiology spectrum · 2026Article
- Performance of the LIAISON PLEX gram-positive blood culture assay for identifying bacterial pathogens and resistance genes in blood cultures.Journal of clinical microbiology · 2026Article
- Correlation analysis of serum FGF9, Sestrin2 and HBDH with the severity of sepsis.Journal of medical biochemistry · 2026Article
- Sepsis in Frail Older Adults: Tailored Antimicrobial Stewardship and Individualized Care Approach.Antibiotics (Basel, Switzerland) · 2026Review
- Clinical characteristics and 28-day outcomes of sepsis associated with klebsiella pneumoniae carbapenemase-producing Enterobacterales: a single-center retrospective cohort study.BMC infectious diseases · 2026Article
- Article
- Optimizing species identification after antimicrobial pretreatment in Enterobacterales: a prospective cohort study.BMC microbiology · 2026Article
- Day-4 antipseudomonal and anti-MRSA de-escalation was not associated with higher mortality in critically ill patients with sepsis.Frontiers in medicine · 2026Article
- Optimal antibiotic use in the intensive care unit.Critical care (London, England) · 2025Review
- Comparison of Spectrum Coverage Score-based Antimicrobial Consumption in Acute Care Hospitals Over Eight Years: A Multicentric Study.Open forum infectious diseases · 2025Article
- Article
- Decision analysis model of rapid versus deferred antibiotic initiation in patients with suspected sepsis in the emergency department.Intensive care medicine · 2025Article
- Methicillin-resistantAntimicrobial stewardship & healthcare epidemiology : ASHE · 2025Article
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Abstract
backgroundLittle is known about the frequency, hospital-level variation, predictors, and outcomes of antibiotic de-escalation in suspected sepsis.
methodsWe retrospectively analyzed adults admitted to 236 US hospitals from 2017-2021 with suspected sepsis (defined by blood culture draw, lactate measurement, and intravenous antibiotic administration) who were initially treated with ≥2 days of anti-methicillin-resistant Staphylococcus aureus (MRSA) and anti-pseudomonal antibiotics but had no resistant organisms that required 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 and clinical variables; matched de-escalated to non-de-escalated patients; and assessed associations between de-escalation and outcomes.
resultsAmong 124 577 patients, antibiotics were de-escalated in 36 806 (29.5%): narrowing in 27 177 (21.8%), cessation in 9629 (7.7%). De-escalation rates varied between hospitals (median, 29.4%; interquartile range, 21.3%-38.0%). Predictors of de-escalation included less severe disease on day 3-4, positive cultures for nonresistant organisms, and negative/absent MRSA nasal swabs. De-escalation was more common in medium, large, and teaching hospitals in the Northeast and Midwest. De-escalation was associated with lower adjusted risks for acute kidney injury (AKI) (odds ratio [OR], 0.80; 95% confidence interval [CI], .76-.84), intensive-care unit (ICU) admission after day 4 (OR, 0.59; 95% CI, .52-.66), and in-hospital mortality (OR, 0.92; 95% CI, .86-.996).
conclusionsAntibiotic de-escalation in suspected sepsis is infrequent, variable across hospitals, linked with clinical and microbiologic factors, and associated with lower risk for AKI, ICU admission, and in-hospital mortality.
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