{"id":29890,"date":"2026-03-03T04:32:00","date_gmt":"2026-03-02T20:32:00","guid":{"rendered":"https:\/\/csccm.org.cn\/?p=29890"},"modified":"2026-03-03T05:45:32","modified_gmt":"2026-03-02T21:45:32","slug":"jama-intern-med%e5%8f%91%e8%a1%a8%e8%ae%ba%e6%96%87%ef%bc%9a%e7%a4%be%e5%8c%ba%e8%b5%b7%e7%97%85%e6%88%90%e5%b9%b4%e8%84%93%e6%af%92%e7%97%87%e6%82%a3%e8%80%85%e7%9a%84%e6%8a%97%e7%94%9f%e7%b4%a0","status":"publish","type":"post","link":"https:\/\/csccm.org.cn\/?p=29890","title":{"rendered":"[JAMA Intern Med\u53d1\u8868\u8bba\u6587]\uff1a\u793e\u533a\u8d77\u75c5\u6210\u5e74\u8113\u6bd2\u75c7\u60a3\u8005\u7684\u6297\u751f\u7d20\u964d\u9636\u68af\u6cbb\u7597"},"content":{"rendered":"\n

Original Investigation <\/p>\n\n\n\n

Less Is More<\/p>\n\n\n\n

Antibiotic De-Escalation in Adults Hospitalized for Community-Onset Sepsis<\/h1>\n\n\n\n

Ashwin B. Gupta, Megan Heath, Emily Walzl, et al<\/h3>\n\n\n\n

JAMA Intern Med Published Online: December 22, 2025<\/h3>\n\n\n\n

doi: 10.1001\/jamainternmed.2025.6919<\/h3>\n\n\n\n

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

Question<\/strong>  Is broad-spectrum antibiotic de-escalation on encounter day 4 safe among patients hospitalized with community-onset sepsis who have no positive test result for multidrug-resistant organisms (MDROs)?<\/p>\n\n\n\n

Findings<\/strong>  In this target trial emulation study including 36\u202f924 patients with community-onset sepsis, de-escalation from methicillin-resistant Staphylococcus aureus<\/em> (MRSA) or Pseudomonas aeruginosa<\/em> coverage were associated with similar 90-day all-cause mortality, fewer days of antibiotic therapy, and shorter length of hospitalizations compared with continued broad-spectrum coverage.<\/p>\n\n\n\n

Meaning<\/strong>  These results suggest that de-escalation of broad-spectrum antibiotics among patients with community-onset sepsis and no positive MDRO test results is associated with similar safety outcomes and may reduce antibiotic exposure and length of hospitalization.<\/a><\/p>\n\n\n\n

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

Importance<\/strong>  Prolonged exposure to broad-spectrum antibiotics (BSA) may be associated with patient harm.<\/p>\n\n\n\n

Objective<\/strong>  To assess outcomes of BSA de-escalation compared with continuation on encounter day 4 in patients hospitalized for community-onset sepsis.<\/p>\n\n\n\n

Design, Setting, and Participants<\/strong>  This target trial emulation study was conducted at 67 hospitals participating in the Michigan Hospital Medicine Safety Consortium. Patients 18 years and older hospitalized for community-onset sepsis from June 2020 through September 2024 who initiated empiric BSA therapy without evidence of multidrug-resistant organism infection were included. Data were analyzed from September 2024 to November 2025.<\/p>\n\n\n\n

Exposure<\/strong>  Inverse probability of treatment\u2013weighted cohort exposed to de-escalation of BSA vs continuation at day 4.<\/p>\n\n\n\n

Main Outcomes and Measures<\/strong>  The primary outcome was 90-day all-cause mortality. Secondary outcomes included in-hospital mortality, 30-day mortality, length of hospitalization, and days of antibiotic therapy.<\/p>\n\n\n\n

Results<\/strong>\u00a0\u00a0Among 36\u202f924 patients with community-onset sepsis, 18\u202f559 (50.3%) were female, 18\u202f365 (49.7%) were male, and the median (IQR) age was 71 (61-80) years. A total of 6926 (18.8%) and 11\u202f149 (30.2%) were eligible for target trial emulations evaluating de-escalation of anti\u2013methicillin-resistant\u00a0Staphylococcus aureus<\/em>\u00a0(MRSA) and anti\u2013Pseudomonas aeruginosa<\/em>(PSA; or other resistant gram-negative bacteria) antibiotics, respectively. Of these, 2993 (43.2%) and 2493 (22.4%) were de-escalated from anti-MRSA and anti-PSA coverage. After weighting, patients who were de-escalated vs continued on BSA were well balanced on baseline characteristics. In weighted analyses, anti-MRSA and anti-PSA de-escalation were associated with similar 90-day mortality as continued BSA therapy (anti-MRSA: odds ratio, 1.00; 95% CI, 0.88-1.14; anti-PSA: odds ratio, 0.98; 95% CI, 0.86-1.13). Additionally, anti-MRSA and anti-PSA de-escalation were associated with fewer days of antibiotics to day 14 (anti-MRSA de-escalation: risk ratio [RR], 0.91; 95% CI, 0.89-0.93; anti-PSA de-escalation: RR, 0.91; 95% CI, 0.88-0.93) and shorter length of hospitalization (anti-MRSA de-escalation: RR, 0.88; 95% CI, 0.85-0.92; anti-PSA de-escalation: RR, 0.91; 0.88-0.93). All other secondary outcomes were similar. Across 67 hospitals, the proportion of eligible patients de-escalated from BSA varied more than 2-fold (anti-MRSA de-escalation, 27.3% to 61.7%; anti-PSA de-escalation, 6.9% to 37.7%).<\/p>\n\n\n\n

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Conclusions and Relevance<\/strong>  In this study, de-escalation of empiric BSA therapy at day 4 was associated with similar safety outcomes, fewer antibiotic days, and shorter length of hospitalization among patients with community-onset sepsis compared with those who continued BSA therapy but varied widely in practice.<\/p>\n","protected":false},"excerpt":{"rendered":"

Original Investigation  Less Is More Antibiotic De […]<\/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\/29890"}],"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=29890"}],"version-history":[{"count":2,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts\/29890\/revisions"}],"predecessor-version":[{"id":30148,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts\/29890\/revisions\/30148"}],"wp:attachment":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=29890"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=29890"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=29890"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}