{"id":26394,"date":"2024-09-10T04:56:00","date_gmt":"2024-09-09T20:56:00","guid":{"rendered":"http:\/\/csccm.org.cn\/?p=26394"},"modified":"2024-09-10T05:43:10","modified_gmt":"2024-09-09T21:43:10","slug":"jama-netw-open%e5%8f%91%e8%a1%a8%e8%ae%ba%e6%96%87%ef%bc%9a%e7%be%8e%e5%9b%bd%e5%8c%bb%e9%99%a2%e4%b8%ad%e7%96%91%e4%bc%bc%e7%a4%be%e5%8c%ba%e8%b5%b7%e7%97%85%e8%84%93%e6%af%92%e7%97%87%e6%82%a3","status":"publish","type":"post","link":"https:\/\/csccm.org.cn\/?p=26394","title":{"rendered":"[JAMA Netw Open\u53d1\u8868\u8bba\u6587]\uff1a\u7f8e\u56fd\u533b\u9662\u4e2d\u7591\u4f3c\u793e\u533a\u8d77\u75c5\u8113\u6bd2\u75c7\u60a3\u8005\u5e7f\u8c31\u6297\u751f\u7d20\u4f7f\u7528\u7684\u8d8b\u52bf"},"content":{"rendered":"\n

Original Investigation <\/p>\n\n\n\n

Critical Care Medicine<\/p>\n\n\n\n

June 27, 2024<\/p>\n\n\n\n

Trends in Empiric Broad-Spectrum Antibiotic Use for Suspected Community-Onset Sepsis in US Hospitals<\/h1>\n\n\n\n

Chanu Rhee, Tom Chen, Sameer S. Kadri, et al<\/h3>\n\n\n\n

JAMA Netw Open. <\/em>2024;7(6):e2418923. doi:10.1001\/jamanetworkopen.2024.18923<\/h3>\n\n\n\n

<\/a>Key Points<\/p>\n\n\n\n

Question<\/strong>  Is broad-spectrum antibiotic use for suspected community-onset sepsis changing over time?<\/p>\n\n\n\n

Findings<\/strong>  In this cross-sectional study of 6.3 million adults admitted to 241 US hospitals between 2017 and 2021, half of all anti\u2013methicillin-resistant Staphylococcus aureus<\/em> and antipseudomonal \u03b2-lactam antibiotics were prescribed for suspected community-onset sepsis but only 9.5% of suspected community-onset sepsis cases treated with broad-spectrum antibiotics had resistant organisms identified.<\/p>\n\n\n\n

Meaning<\/strong>  These results suggest that more attention is needed toward balancing early broad-spectrum antibiotic prescribing for patients with sepsis with limiting overuse for the majority who do not have antibiotic-resistant infections.<\/a><\/p>\n\n\n\n

Abstract<\/p>\n\n\n\n

Importance<\/strong>  Little is known about the degree to which suspected sepsis drives broad-spectrum antibiotic use in hospitals, what proportion of antibiotic courses are unnecessarily broad in retrospect, and whether these patterns are changing over time.<\/p>\n\n\n\n

Objective<\/strong>  To describe trends in empiric broad-spectrum antibiotic use for suspected community-onset sepsis.<\/p>\n\n\n\n

Design, Setting, and Participants<\/strong>  This cross-sectional study used clinical data from adults admitted to 241 US hospitals in the PINC AI Healthcare Database. Eligible participants were aged 18 years or more and were admitted between 2017 and 2021 with suspected community-onset sepsis, defined by a blood culture draw, lactate measurement, and intravenous antibiotic administration on admission.<\/p>\n\n\n\n

Exposures<\/strong>  Empiric anti\u2013methicillin-resistant Staphylococcus aureus<\/em> (MRSA) and\/or antipseudomonal \u03b2-lactam agent use.<\/p>\n\n\n\n

Main Outcomes and Measures<\/strong>  Annual rates of empiric anti-MRSA and\/or antipseudomonal \u03b2-lactam agent use and the proportion that were likely unnecessary in retrospect based on the absence of \u03b2-lactam resistant gram-positive or ceftriaxone-resistant gram-negative pathogens from clinical cultures obtained through hospital day 4. Annual trends were calculated using mixed-effects logistic regression models, adjusting for patient and hospital characteristics.<\/p>\n\n\n\n

Results<\/strong>\u00a0\u00a0Among 6\u202f272\u202f538 hospitalizations (median [IQR] age, 66 [53-78] years; 443\u202f465 male [49.6%]; 106\u202f095 Black [11.9%], 65\u202f763 Hispanic [7.4%], 653\u202f907 White [73.1%]), 894\u202f724 (14.3%) had suspected community-onset sepsis, of whom 582\u202f585 (65.1%) received either empiric anti-MRSA (379\u202f987 [42.5%]) or antipseudomonal \u03b2-lactam therapy (513\u202f811 [57.4%]); 311\u202f213 (34.8%) received both. Patients with suspected community-onset sepsis accounted for 1\u202f573\u202f673 of 3\u202f141\u202f300 (50.1%) of total inpatient anti-MRSA antibiotic days and 2\u202f569\u202f518 of 5\u202f211\u202f745 (49.3%) of total antipseudomonal \u03b2-lactam days. Between 2017 and 2021, the proportion of patients with suspected sepsis administered anti-MRSA or antipseudomonal therapy increased from 63.0% (82\u202f731 of 131\u202f275 patients) to 66.7% (101\u202f003 of 151\u202f435 patients) (adjusted OR [aOR] per year, 1.03; 95% CI, 1.03-1.04). However, resistant organisms were isolated in only 65\u202f434 cases (7.3%) (30\u202f617 gram-positive [3.4%], 38\u202f844 gram-negative [4.3%]) and the proportion of patients who had any resistant organism decreased from 9.6% to 7.3% (aOR per year, 0.87; 95% CI, 0.87-0.88). Most patients with suspected sepsis treated with empiric anti-MRSA and\/or antipseudomonal therapy had no resistant organisms (527\u202f356 of 582\u202f585 patients [90.5%]); this proportion increased from 88.0% in 2017 to 91.6% in 2021 (aOR per year, 1.12; 95% CI, 1.11-1.13).<\/p>\n\n\n\n

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Conclusions and Relevance<\/strong>  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.<\/p>\n","protected":false},"excerpt":{"rendered":"

Original Investigation  Critical Care Medicine Jun […]<\/p>\n","protected":false},"author":3,"featured_media":0,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":[],"categories":[32,23],"tags":[],"_links":{"self":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts\/26394"}],"collection":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/users\/3"}],"replies":[{"embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=26394"}],"version-history":[{"count":2,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts\/26394\/revisions"}],"predecessor-version":[{"id":26719,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts\/26394\/revisions\/26719"}],"wp:attachment":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=26394"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=26394"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=26394"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}