Open AccessPrevalence of Antibiotic-Resistant Pathogens in Culture-Proven Sepsis and Outcomes Associated With Inadequate and Broad-Spectrum Empiric Antibiotic Use
Author(s) -
Chanu Rhee,
Sameer S. Kadri,
John P. Dekker,
Robert L. Danner,
Huai-Chun Chen,
David Fram,
Fang Zhang,
Rui Wang,
Michael Klompas
Publication year - 2020
Publication title -
jama network open
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 3.278
H-Index - 39
ISSN - 2574-3805
DOI - 10.1001/jamanetworkopen.2020.2899
Subject(s) - medicine , empiric therapy , sepsis , antibiotics , empiric treatment , interquartile range , vancomycin , cohort , antibiotic resistance , intensive care medicine , staphylococcus aureus , microbiology and biotechnology , biology , genetics , bacteria
Key Points Question What is the prevalence of antibiotic resistance in community-onset sepsis, and is there risk associated with the receipt of empiric broad-spectrum antibiotics? Findings In this cohort study of 17 430 adults with culture-positive sepsis admitted to 104 US hospitals, 67.0% received empiric broad-spectrum antibiotics, but resistant gram-positive organisms were isolated in only 13.6% of patients and resistant gram-negative organisms in 13.2%. Both undertreatment (failure to cover organisms) and overtreatment (resistant organisms targeted but not isolated) were associated with higher mortality after detailed risk adjustment. Meaning In this study, broad-spectrum antibiotics were frequently administered to patients with community-onset sepsis without resistant organisms, and these therapies were associated with worse outcomes.
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