Antibiotic De-Escalation in Adults Hospitalized for Community-Onset Sepsis

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)?In this target trial emulation study including 36 924 patients with community-onset sepsis, de-escalation from methicillin-resistant (MRSA) or 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.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.

Corresponding Author: Ashwin B. Gupta, MD, Medicine Service, VA Ann Arbor Healthcare System, 2215 Fuller Rd, B742, Ann Arbor, MI 48105 (ashwing@med.umich.edu).

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