Early Discontinuation of Antibiotics in Patients Admitted With Clinically Suspected Serious Infection but Negative Cultures: Retrospective Cohort Study of Practice Patterns and Outcomes at 111 US Hospitals.
Early Discontinuation of Antibiotics in Patients Admitted With Clinically Suspected Serious Infection but Negative Cultures: Retrospective Cohort Study of Practice Patterns and Outcomes at 111 US Hospitals.
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入院临床疑似严重感染但培养阴性的患者早期停用抗生素：美国 111 家医院实践模式和结果的回顾性队列研究。
DOI：
10.1093/ofid/ofad286
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发表时间：
2023
影响因子：
4.2
通讯作者：
NIH–AntimicrobialResistanceOutcomesResearchInitiative
中科院分区：
文献类型：
--
作者：
Kadri,SameerS;Warner,Sarah;Rhee,Chanu;Klompas,Michael;Follmann,Dean;Swihart,BruceJ;Laxminarayan,Ramanan;Klein,Eili;NIH–AntimicrobialResistanceOutcomesResearchInitiative
背景 对于培养阴性的严重感染 (CNSI) 住院患者，抗生素的最佳持续时间尚不清楚。我们比较了接受 3 或 4 天抗生素治疗与≥5 天抗生素治疗的 CNSI 患者的结局。方法通过电子健康记录数据，在 2009 年至 2014 年间美国 111 医院收治的成人中发现 CNSI，定义为疑似严重感染（抽取血培养并使用抗生素 ≥3 天）以及基于培养和非培养的感染检测阴性。在住院最后一天接受抗生素治疗的患者以及具有脓毒症模拟病症诊断代码的患者被排除在外。在第 3 天没有发烧/体温过低或血管加压药的患者中，我们计算了与使用 3 或 4 天与≥5 天抗生素相关的院内死亡率或出院至临终关怀机构的比值比，并调整了混杂因素。结果在 20 714 名 CNSI 患者中，有 1862 名 (9%) 在 3 或 4 天内停用了抗生素。早期停药与总体死亡率较高（调整后比值比 [aOR]，1.27；95% CI，0.98–1.65）、患有脓毒症（1.39；0.88–2.22）和无脓毒症（1.17；0.81–1.69）的患者以及患有肺部（1.23；0.65–2.34）和非肺部 CNSI 的患者（1.30；.99–1.72）。早期停药对倾向评分权重（aOR，1.36；95% CI，1.03–1.80）和保留脓毒症类似患者（1.38；1.16–1.65）似乎是有害的，但在保留在最后一天住院时接受抗生素治疗的患者时，早期停药具有保护作用（0.48；.37–.64]）。结论在我们的初步分析中，CNSI 与重大危害无关，但基于替代分析决策的不同结论以及残留混杂的风险表明需要进行随机对照试验。
BackgroundThe optimal duration for antibiotics in patients hospitalized with culture-negative serious infection (CNSI) is unknown. We compared outcomes in patients with CNSI treated with 3 or 4 vs ≥5 days of antibiotics.MethodsCNSI was identified among adults admitted to 111 US hospitals between 2009 and 2014 via electronic health record data, defined as suspected serious infection (blood cultures drawn and ≥3 days of antibiotics) and negative culture- and nonculture-based tests for infection. Patients treated with antibiotics on their last hospital day and patients with diagnosis codes for sepsis-mimicking conditions were excluded. Among patients without fevers/hypothermia or vasopressors by day 3, we calculated odds ratios for in-hospital mortality or discharge to hospice associated with 3 or 4 vs ≥5 days of antibiotics, adjusting for confounders.ResultsAntibiotics were discontinued in 3 or 4 days in 1862 (9%) of 20 714 patients with CNSI. Early discontinuation was not associated with higher mortality odds overall (adjusted odds ratio [aOR], 1.27; 95% CI, .98–1.65), in patients presenting with (1.39; .88–2.22) and without sepsis (1.17; .81–1.69), and in those with pulmonary (1.23; .65–2.34) and nonpulmonary CNSI (1.30; .99–1.72). Early discontinuation appeared detrimental with propensity score weighting (aOR, 1.36; 95% CI, 1.03–1.80) and when retaining patients with sepsis mimics (1.38; 1.16–1.65), but it was protective (0.48; .37–.64]) when retaining patients who received antibiotics on their last hospital day.ConclusionsEarly discontinuation of antibiotics in CNSI was not associated with significant harm in our primary analysis, but different conclusions based on alternative analytic decisions, as well as risk of residual confounding, indicate that randomized controlled trials are needed.