Study: Antibiotic de-escalation reduces adverse outcomes in patients with sepsis

Editor's Note

A study analyzing data from 124,577 suspected sepsis cases across 236 US hospitals found that antibiotic de-escalation—switching to narrower-spectrum antibiotics or stopping broad-spectrum antibiotics—occurred in less than 30% of cases but was associated with improved patient outcomes, according to December 6 report from the Center for Infectious Disease Research & Policy Research and Innovation Office (CIDRAP), University of Minnesota. Published in Clinical Infectious Diseases, the research underscores the variability in de-escalation practices and its potential benefits.

De-escalation was defined as discontinuing or narrowing anti-MRSA and anti-pseudomonal antibiotics by day 4 of hospitalization in patients with no resistant organisms, CIDRAP reports. Of the patients analyzed, 29.6% underwent de-escalation, with rates higher in large, urban teaching hospitals, particularly in the Northeast. Predictors of de-escalation included less severe illness, non-resistant cultures, infections present at admission, and negative MRSA nasal swabs.

According to the outlet, patients who underwent de-escalation experienced lower risks of acute kidney injury (OR 0.80), ICU admission after day 4 (OR 0.59), and in-hospital mortality (OR 0.92). A trend toward reduced Clostridioides difficile infections was also observed. Researchers attributed these benefits to reduced antibiotic toxicities, minimized resistance, and less disruption to the gut microbiome.

Authors emphasized the need for randomized controlled trials to confirm these results and refine clinical guidelines.