Journal article
Frequency of Antibiotic Overtreatment and Associated Harms in Patients Presenting With Suspected Sepsis to the Emergency Department: A Retrospective Cohort Study
Clinical infectious diseases, Vol.80(6), pp.1197-1207
07/18/2025
DOI: 10.1093/cid/ciaf118
PMID: 40231968
Abstract
Treatment guidelines recommend rapidly treating all patients with suspected sepsis with broad-spectrum antibiotics. This may contribute to antibiotic overuse. We quantified the incidence of antibiotic overtreatment and possible antibiotic-associated harms among patients with suspected sepsis.
We reviewed the medical records of 600 adults treated for suspected sepsis with anti-methicillin-resistant Staphylococcus aureus and/or antipseudomonal β-lactam antibiotics in the emergency departments of 7 hospitals, 2019-2022, to assess their post hoc likelihood of infection, whether narrower antibiotics would have sufficed in retrospect, and possible antibiotic-associated complications. We used generalized estimating equations to assess associations between likelihood of infection and hospital mortality.
Of 600 patients, 411 (68.5%) had definite (48.0%) or probable (20.5%) bacterial infection and 189 (31.5%) had possible but less likely (18.3%) or definitely no (13.2%) bacterial infection. Among patients with definite/probable bacterial infection, 325 of 411 (79.1%) received antibiotics that were overly broad in retrospect. Potential antibiotic-associated complications developed in 104 of 600 (17.3%) patients within 90 days, most commonly new infection or colonization with organisms resistant to first-line agents (48/600 [8.0%]). Mortality was higher for patients with less likely/definitely no bacterial infection versus definite/probable bacterial infections (9.0% vs 4.9%; adjusted odds ratio [aOR], 2.25 [95% confidence interval{CI}, 1.70-2.98]), but antibiotic-associated complication rates were similar (14.8% vs 18.5%; aOR, 0.79 [95% CI, .60-1.05]).
Among 600 patients treated with broad-spectrum antibiotics for possible sepsis, 1 in 3 most likely did not have a bacterial infection, 4 in 5 of those with bacterial infections were treated with regimens that were broader than necessary in retrospect, and 1 in 6 developed antibiotic-associated complications.
Details
- Title: Subtitle
- Frequency of Antibiotic Overtreatment and Associated Harms in Patients Presenting With Suspected Sepsis to the Emergency Department: A Retrospective Cohort Study
- Creators
- Claire N Shappell - Brigham and Women's HospitalTingting Yu - Harvard Pilgrim Health CareMichael Klompas - Brigham and Women's HospitalAnna A Agan - Harvard Pilgrim Health CareLaura DelloStritto - Harvard Pilgrim Health CareBrett A Faine - Department of Emergency Medicine, University of Iowa Health Care, Iowa City, Iowa, USAMichael R Filbin - Massachusetts General HospitalNicholas M Mohr - Department of Emergency Medicine, University of Iowa Health Care, Iowa City, Iowa, USASteven T Park - University of California, IrvineKamryn Plechot - University of California, IrvineEmily Porter - Massachusetts General HospitalDavid Roach - Brigham and Women's HospitalSarah E Train - University of Wisconsin School of Medicine and Public HealthAnne Zepeski - University of IowaChanu Rhee - Brigham and Women's Hospital
- Resource Type
- Journal article
- Publication Details
- Clinical infectious diseases, Vol.80(6), pp.1197-1207
- DOI
- 10.1093/cid/ciaf118
- PMID
- 40231968
- NLM abbreviation
- Clin Infect Dis
- ISSN
- 1058-4838
- eISSN
- 1537-6591
- Publisher
- OXFORD UNIV PRESS INC
- Grant note
- K08HS029518 / Agency for Healthcare Research and Quality U54CK000611 / CDC HHS
- Language
- English
- Electronic publication date
- 04/15/2025
- Date published
- 07/18/2025
- Academic Unit
- Epidemiology; Emergency Medicine; Pharmacy Practice and Science; Anesthesia; Injury Prevention Research Center
- Record Identifier
- 9984810949302771
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